Short-term Efficacy of Ultrasonographic Guidance for Intra-articular Corticosteroid Injection in Hallux Rigidus: A Single-Blind Randomized Controlled Trial

Abstract

Background: Multiple considerations should be taken before standardizing a clinical procedure such as efficacy, safety, or the cost. The aim of this study was to compare the effects of landmark-guided vs ultrasonography-guided intra-articular injection of corticosteroid into the first metatarsophalangeal joint cavity to reduce pain and dysfunction in patients with hallux rigidus. Methods: We carried out a single-blind randomized controlled trial with 2 parallel arms in an outpatient clinic affiliated with a medical university. In total, 50 participants (35 women) with the mean (SD) age of 49.8 (10.3) years were randomly allocated to landmark-guided or ultrasonography-guided groups (each n = 25). Each patient received a single intra-articular injection of 40-mg methylprednisolone plus 1 mL lidocaine into the affected first metatarsophalangeal joint. The primary outcome was joint pain and the secondary outcome was the American Orthopaedic Foot & Ankle Society score. We measured the outcomes at baseline and 2 and 6 weeks after the intervention. Results: Six weeks after the injections, there were no statistically significant differences between the study groups in pain reduction and increase in the American Orthopaedic Foot & Ankle Society scores ( P = .131 and .241, respectively). We did not find any complications for the injections in both groups. There were statistically significant changes within each group in pain and the scores for the landmark ( P < .001, and P = .007), and ultrasonography groups (both P < .001). Conclusion: Landmark guidance is as effective as ultrasonographic guidance for intra-articular injection in patients with hallux rigidus. A single intra-articular injection of 40 mg methylprednisolone plus 1 mL lidocaine is an efficient and safe therapeutic measure for decreasing joint pain and maintaining its function, at least for 6 weeks. Level of Evidence: Level I, high-quality prospective randomized study.

Case Report: Portable handheld ultrasound facilitates intra-articular injections in articular foot pathologies

“…They did not find any differences in terms of symptomatic relief in their 2-and 6weeks follow-up visits. They also did not find any complications in either group (19). In another study comparing the accuracy of palpation and US-guided intra-articular needle placement in the small joints of the hand (proximal interphalangeal and metacarpophalangeal joints), Raza et al showed that 59% of palpation-guided injections were accurate compared to 96% in the US-guided injections group (13).…”

A multi‐professional survey of UK practice in the use of intra‐articular corticosteroid injection for symptomatic first metatarsophalangeal joint osteoarthritis

“…More recently, Reilly et al (2022) [30] questioned the accuracy of this technique when injecting radio‐opaque contrast in a cadaveric study ( n = 6 feet). However, Razavi et al (2021) [31] found no clinical benefit when using ultrasound guidance in a small trial of 50 people with first MTPJ OA randomised to landmark guidance or ultrasound guidance.…”

“…Assessed & injected at 1st outpatient appointment 26 (18) 2nd appointment for injection General outpatient clinic 44 (31) Injection outpatient clinic 24 (17) In theatre 17 (12) Radiology outpatient 3…”

The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic

“… 55 US guided posterior subtalar joint injections allow easy and precise needle insertion while reducing the risk of damaging nearby vital soft-tissues structures un-noticed by other procedures such as fluoroscopy or CT. 56 However, LMB approach is as effective as US-guidance for intra-articular injection in patients with hallux rigidus. 57 …”