Lesser metatarsophalangeal joints: intra-articular distension, volumetric measurements, and changes of position

Pearls and pitfalls of fluoroscopic-guided foot and ankle injections: what the radiologist needs to know

OBJECTIVE

This article provides a comprehensive, joint-by-joint review of fluoroscopic-guided foot and ankle injections and emphasizes pre-procedural planning, relevant anatomy, appropriate technique, troubleshooting the difficult procedure, and the importance of communicating unexpected findings with the referring clinician. The interrogation of pain generators including variant ossicles, fractures, and post-surgical/traumatic findings is also described.

CONCLUSIONS

Even the most challenging foot and ankle injections may be successfully completed with a solid anatomical understanding and thoughtful approach.

Aspiration and Injection Techniques of the Lower Extremity

Orthopaedic surgeons frequently use aspirations and injections to both diagnose and treat disorders of the lower extremity. Comprehensive knowledge of regional anatomy, procedural indications, and appropriate techniques are essential. Clinicians must be well versed in a range of musculoskeletal aspiration and injection techniques, including patient positioning, equipment needs, injectable solutions, aspirate analysis, and potential complications. Safe and effective aspiration and injection techniques for the lower extremity, including the hip, knee, foot, and ankle, are reviewed. Image guidance modalities include fluoroscopy, ultrasonography, CT, and MRI.

Second metatarsophalangeal joint arthrography: a cadaveric correlation study

Arthrography of the second metatarsophalangeal joint is an important diagnostic tool to evaluate the integrity of the plantar plate and to aid in the decision process for surgical intervention. A variety of filling patterns have been identified with lesser metatarsophalangeal joint arthrography and their significance with soft-tissue pathology remains to be completely understood. The purpose of this cadaveric study was to evaluate dye patterns in a series of arthrograms of the second metatarsophalangeal joint and to correlate them with identifiable anatomic lesions or structural variants. Thirty-nine cadaveric specimens (including 28 matched pairs) underwent second metatarsophalangeal joint arthrography with a colored radiopaque dye. Arthrographic findings were observed and recorded. Specimens exhibiting dye extravasation outside of the capsular constraints of the joint were dissected to discover any soft-tissue abnormalities. Twenty-one percent of specimens exhibited abnormal extravasation of dye outside of the joint capsule. A plantar plate tear was identified in 2 of these specimens. Filling of the first intermetatarsophalangeal bursa occurred in 6 specimens. However, because this finding was identified in 2 matched pairs, an anatomic variance is suggested rather than a pathologic entity. This cadaveric study shows that anatomic variances exist concerning the second metatarsophalangeal capsule and that arthrography should be correlated with the clinical scenario.