Feasibility of First Metatarsophalangeal Joint Injections for Sesamoid Disorders: A Cadaveric Investigation

Abstract

Accurate first MTPJ injections reliably deliver latex to the articular surfaces of the metatarsosesamoid articulations. Clinicians administering diagnostic or therapeutic injections for patients with sesamoid disorders should consider injecting the first MTPJ as an alternative to direct metatarsosesamoid articulation injections.

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

“…Three studies (two with level 2 evidence71 83 and one with level 3 evidence52) found 100% accuracy for USGI of the MTP joints with one of the three52 noting poor accuracy (0% accurate) with LMGI.…”

“…A small majority of these studies (5/9 (56%))31 66 71 82 83 evaluated injections into a single type of small joint (eg, metacarpophalangeal (MCP) joint), while the remainder (4/9 (44%))16 26 52 81 evaluated injections into multiple small joints. Sixty-seven per cent (6/9)16 26 31 52 81 82 of the studies assessed small joint injections in the hands and 56% (5/9)16 52 66 71 83 evaluated small foot joint injections. Of those studies assessing hand procedures, three studies (50%) included the carpometacarpal (CMC) joint,26 52 82 two (33%) the PIP joints52 81 and one (17%)26 the distal interphalangeal (IP) joints.…”

“…Of those studies assessing hand procedures, three studies (50%) included the carpometacarpal (CMC) joint,26 52 82 two (33%) the PIP joints52 81 and one (17%)26 the distal interphalangeal (IP) joints. Among the studies of foot procedures, four (60%)16 52 71 83 were directed at the metatarsophalangeal (MTP) joints and one (20%)66 the tarsometatarsal (TMT) joints.…”

“…The majority (5/8 (63%)) of small joint injection accuracy studies provided level 1 or 2 evidence 31 66 71 82 83. The remaining studies provided level 3 or 5 evidence 26 52 81.…”

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

“…Iliopsoas tendon and bursa [90] Intra-articular hip joint [91] Piriformis injection [92] Knee Intra-articular knee [93] Baker's cyst aspiration [94] Pes anserine bursa [95] Foot/ankle Subtalar/tibiotalar/sinus tarsi [96] Retrocalcaneal bursa [97] Plantar fascia [98] Metatarsophalangeal joint/sesamoid disorders [99] Interdigital neuroma [100] ongoing studies are needed to assess clinical efficacy, the role of ultrasound in the emerging field of bioregenerative medicine appears crucial.…”