• 1.

    Bliddal, H . :Placement of intra-articular injections verified by mini air-arthrography. .Ann Rheum Dis 58::641. ,1999. .

  • 2.

    Pons, M, F Alvarez, J Solana, et al. :Sodium hyaluronate in the treatment of hallux rigidus: a single-blind, randomized study. .Foot Ankle Int 28::38. ,2007. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 3.

    Sarkin, TL . :Indications for intra-articular steroid in osteoarthritis of the ankle and big toe joints. .S Afr Med J 48::2067. ,1974. .

  • 4.

    Solan, MC, JD Calder, and SP Bendall. :Manipulation and injection for hallux rigidus: is it worthwhile? J Bone Joint Surg Br 83::706. ,2001. .

  • 5.

    Trepman, E and SJ Yeo. :Nonoperative treatment of metatarsophalangeal joint synovitis. .Foot Ankle Int 16::771. ,1995. .

  • 6.

    Bernau, A and P Heeg. :Intraarticular punctures and injections: indications–prevention of infection–technique–complications [in German]. .Orthopade 32::548. ,2003. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Dalinka, MK, V Stewart, JS Bomalaski, et al. :Periarticular calcifications in association with intra-articular corticosteroid injections. .Radiology 153::615. ,1984. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Gottlieb, NL and WG Riskin. :Complications of local corticosteroid injections. .JAMA 243::1547. ,1980. .

  • 9.

    Lemont, H and J Hetman. :Cutaneous foot depigmentation following an intra-articular steroid injection. .JAPMA 81::606. ,1991. .

  • 10.

    Oxlund, H . :The influence of a local injection of cortisol on the mechanical properties of tendons and ligaments and the indirect effect on skin. .Acta Orthop Scand 51::231. ,1980. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Oxlund, H . :Long term local cortisol treatment of tendons and the indirect effect on skin: an experimental study in rats. .Scand J Plast Reconstr Surg 16::61. ,1982. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Lopes, RV, RN Furtado, L Parmigiani, et al. :Accuracy of intra-articular injections in peripheral joints performed blindly in patients with rheumatoid arthritis. .Rheumatology (Oxford) 47::1792. ,2008. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Thiel, W . :The preservation of the whole corpse with natural color [in German]. .Ann Anat 174::185. ,1992. .

  • 14.

    Heidari, N, W Pichler, S Grechenig, et al. :Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle? a cadaver study. .J Bone Joint Surg Br 92::176. ,2010. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15.

    Pichler, W, AM Weinberg, S Grechenig, et al. :Intra-articular injection of the acromioclavicular joint. .J Bone Joint Surg Br 91::1638. ,2009. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 16.

    Weinberg, AM, W Pichler, S Grechenig, et al. :Frequency of successful intra-articular puncture of the sternoclavicular joint: a cadaver study. .Scand J Rheumatol 38::396. ,2009. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 17.

    Fredberg, U, G van Overeem Hansen, and L Bolvig. :Placement of intra-articular injections verified by ultrasonography and injected air as contrast medium. .Ann Rheum Dis 60::542. ,2001. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Reach, JS, ME Easley, B Chuckpaiwong, et al. :Accuracy of ultrasound guided injections in the foot and ankle. .Foot Ankle Int 30::239. ,2009. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

Do the Presence of Pathologic Changes and the Level of Operator Experience Alter the Rate of Intra-Articular Injection of the First Metatarsophalangeal Joint?

A Cadaver Study

Nima Heidari Consultant Foot & Ankle and Limb Reconstruction Surgeon, St. Bartholomew’s and Royal London Hospital, Queen Mary, University of London.

Search for other papers by Nima Heidari in
Current site
Google Scholar
PubMed
Close
 MD
,
Tanja Kraus Department of Pediatric Orthopedics, Medical University Graz, Graz, Austria.

Search for other papers by Tanja Kraus in
Current site
Google Scholar
PubMed
Close
 MD
,
Stefan Fischerauer Department of Pediatric Surgery, Medical University Graz, Graz, Austria.

Search for other papers by Stefan Fischerauer in
Current site
Google Scholar
PubMed
Close
 MD
,
Norbert Tesch Institute of Anatomy, Medical University Graz, Graz, Austria.

Search for other papers by Norbert Tesch in
Current site
Google Scholar
PubMed
Close
 MD
, and
Annelie Weinberg Department of Pediatric Surgery, Medical University Graz, Graz, Austria.

Search for other papers by Annelie Weinberg in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Background:

Injections, punctures, and aspirations of the first metatarsophalangeal joint are common interventions. Accurate intra-articular placement of the needle is a prerequisite for the achievement of desirable results and the avoidance of complications. We evaluated the rate of successful intra-articular injections and the influence of the degree of operator experience in achieving this success.

Methods:

A total of 106 cadaveric metatarsophalangeal joints were injected with a methylene blue–containing solution and subsequently dissected to distinguish intra-articular from periarticular injections. To evaluate the importance of experience, 38 injections were performed by a student, 38 by a trained resident, and 30 by an experienced surgeon. In the second part of the study, we examined the relation of pathologic findings of the metatarsophalangeal joint and the accuracy of intra-articular injection.

Results:

The overall rate of unintentional periarticular injections remained low (9.4%; 10 of 106 joints). The student achieved a successful intra-articular injection in 86.8% of joints (33 of 38), the resident in 92.1% (35 of 38), and the specialist in 93.3% (28 of 30). The number of extra-articular injections increased significantly with the presence of deformity (hallux valgus) and arthritis of the first metatarsophalangeal joint.

Conclusions:

The presence of pathologic changes reduces the rate of successful intra-articular joint puncture. However, the overall frequency of successful intra-articular injections can be improved through experience and the use of imaging. (J Am Podiatr Med Assoc 103(3): 204–207, 2013)

Corresponding author: Tanja Kraus, MD, Pediatric Orthopedics, Medical University Graz, Auenbruggerpaltz 34, Graz, 8036 Austria. (E-mail: tanja.kraus@medunigraz.at)