Conservative Treatment of Peroneal Tendon Injuries: Peroneal Tendon Sheath Ultrasound-Guided Corticosteroid Injection

2020 ◽  
pp. 173-181
Author(s):  
David I. Pedowitz ◽  
Rachel Shakked ◽  
Daniel J. Fuchs ◽  
Johannes B. Roedl
Keyword(s):  
Conservative Treatment ◽  
Corticosteroid Injection ◽  
Tendon Sheath ◽  
Tendon Injuries ◽  
Peroneal Tendon ◽  
Ultrasound Guided

scholarly journals Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0021
Author(s):  
Mauricio Drummond ◽  
Caroline Ayinon ◽  
Albert Lin ◽  
Robin Dunn
Keyword(s):  
Physical Therapy ◽  
Rotator Cuff ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Corticosteroid Injection ◽  
Calcific Tendinitis ◽  
Ultrasound Guided ◽  
Calcium Deposits

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

Clinical Outcomes and Complications of Peroneal Tendon Sheath Ultrasound-Guided Corticosteroid Injection

2019 ◽  
Vol 40 (8) ◽  
pp. 888-894 ◽  
Author(s):  
Brianna R. Fram ◽  
Ryan Rogero ◽  
Daniel Fuchs ◽  
Rachel J. Shakked ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Pain Relief ◽  
Clinical Outcomes ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Tendon Sheath ◽  
Adverse Outcomes ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Duration Of Symptoms ◽  
Peroneal Tendons

Background: The treatment of symptomatic peroneal tendinopathy and tears traditionally begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment. Ultrasound-(US)-guided peroneal tendon sheath (PTS) corticosteroid injection is an additional nonoperative modality, but limited data exist on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US-guided PTS corticosteroid injection for chronic tendinopathy or tears. Methods: We retrospectively identified patients who had undergone US-guided PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation at our institution from 2012 to 2018. Underlying diagnosis was based on clinical examination, magnetic resonance imaging (MRI) results, and/or intraoperative findings, when available. Medical record data were supplemented by e-mail or telephone follow-up. Collected information included patient age, sex, body mass index (BMI), smoking status, workers’ compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any adverse outcomes of injection. We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. Results: Twenty-four of 96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients reported 0-1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) greater than 12 weeks. Preinjection duration of symptoms was associated with postinjection duration of pain relief ( P=.036). There were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression. Conclusion: Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management. Level of Evidence: Level IV, case series.

The Accuracy of Ultrasound-Guided and Palpation-Guided Peroneal Tendon Sheath Injections

2011 ◽  
Vol 90 (7) ◽  
pp. 564-571 ◽  
Author(s):  
Jeffery J. Muir ◽  
Heather M. Curtiss ◽  
John Hollman ◽  
Jay Smith ◽  
Jonathan T. Finnoff
Keyword(s):  
Tendon Sheath ◽  
Peroneal Tendon ◽  
Ultrasound Guided

scholarly journals Peroneal Tendon Sheath Ultrasound Guided Corticosteroid Injection: Clinical Outcomes and Complications

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Brianna R. Fram ◽  
Ryan Rogero ◽  
Daniel Fuchs ◽  
Rachel J. Shakked ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Pain Relief ◽  
Smoking Status ◽  
Corticosteroid Injection ◽  
Tendon Sheath ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Duration Of Symptoms ◽  
Injection Duration ◽  
Prior Surgery ◽  
Compensation Status

Category: Ankle Introduction/Purpose: Painful peroneal tendon pathologies fall into three primary categories: tendinopathy, tendon subluxation/dislocation, and tendon tears/ruptures. For symptomatic peroneal tendinopathy and tears, treatment traditionally begins with NSAIDs, rest/activity modification, physical therapy, and immobilization and with surgery typically reserved for cases of failed non-operative treatment. Ultrasound-guided peroneal tendon sheath (US PTS) corticosteroid injection is an additional nonoperative modality used by many orthopedists, however limited data has been published on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US PTS corticosteroid injection for chronic tendinopathy or tears. We hypothesized that following injection, patients would have improved pain without increased incidence of spontaneous tendon rupture. Methods: We identified a retrospective cohort of patients who had undergone US PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation. Underlying diagnosis was based on clinical exam, MRI results, and/or intraoperative findings, when available. Medical record data was supplemented by email or telephone follow-up. Collected information included patient age, sex, BMI, smoking status, worker’s compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any perceived adverse outcomes of injection. Results: We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. 24/96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients experienced 0 -1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) >12 weeks of pain relief. Pre-injection duration of symptoms correlated positively with post- injection duration of pain relief (p=0.036). There was no significant difference between progression to surgery or duration of pain relief based on peroneal pathology, prior surgery, smoking status, worker’s compensation status, sex, or BMI. There were 2 reported complications (1.8%): one case of self-limited sural nerve irritation and one of peroneus longus tear progression. Conclusion: In this series of 109 US PTS corticosteroid injections, the complication rate was 1.8%. Pre-injection symptom duration correlated positively with post-injection pain relief duration. Our study demonstrates US PTS corticosteroid injection is safe in patients with pain originating from peroneal tendon tears or tendinopathy, including those who have undergone prior surgery, and should be considered in a comprehensive protocol of nonoperative management. Further research is needed to elucidate the effect of multiple injections and of injection timing, as well as whether these injections can decrease the rate of patients progressing to surgery.

scholarly journals Surgical Treatment for Stenosing Peroneal Tenosynovitis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sydney Karnovsky ◽  
Mark Drakos ◽  
David Levine ◽  
Geoffrey Watson
Keyword(s):  
General Health ◽  
Surgical Intervention ◽  
Short Form ◽  
General Health Questionnaire ◽  
Tendon Sheath ◽  
Peroneal Tendon ◽  
Health Questionnaire ◽  
Foot And Ankle ◽  
Ultrasound Guided ◽  
Outcome Score

Category: Ankle Introduction/Purpose: Stenosing Peroneal Tenosynovitis is an uncommon entity that is equally difficult to diagnose. In our practice, we have found 14 patients with this diagnosis. They were all successfully treated with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Further, the ultrasound guided anesthetic injection of the tendon sheath preoperatively essential in confirming this diagnosis and evaluating for successful outcomes after surgical intervention. Methods: 14 patients were diagnosed with Stenosing Peroneal Tenosynovitis. Upon initial presentation, the patients all reported a persistent history of pain along the ankle and had exhausted conservative treatment options. Patients with MRIs had images that appeared normal. In order to confirm the diagnosis as Stenosing Peroneal Tenosynovitis, ultrasound guided injections of anesthetics were administered into the peroneal tendon sheath. If the injection alleviated the pain, this confirmed the diagnosis of Stenosing Peroneal Tenosynovitis. Patients also had neurological consults to rule out possible sural neuritis. In patients with a confirmed diagnosis of stenosing peroneal tenosynovitis, we proceeded with surgical intervention. They underwent surgery between 2006 and 2014 by two fellowship trained orthopedic surgeons at one institution. Retrospective chart review was performed and functional outcomes were assessed pre-and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Results: All patients that underwent this procedure were given the Foot and Ankle Outcome Score (FAOS) and Short Form 12 (SF-12) general health questionnaire pre-operatively. Questionnaire results were collected post-operatively and were successfully obtained at one year or greater from 11 patients. Of these 11 patients, all showed significant improvements (student t test used, p<0.05) in four of five categories of the FAOS (pain, daily activities, quality of life) as well as significant improvement in their overall SF-12 score and pain scale score (Table). Conclusion: Stenosing peroneal tenosynovitis is an uncommon entity. The presentation of the disease is one of persistent lateral sided ankle pain with minimal radiologic findings. We present a case series in which the peroneal tendon sheath was diagnostically injected with an anesthetic to determine if the pain could be relieved. In each of the cases, symptomatic improvement was obtained following the injection, helping to confirm the diagnosis. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe, this diagnostic injection is paramount in assisting with determining the success of surgical outcome.

scholarly journals Comparison of Clinical Outcomes between Idiopathic Frozen Shoulder and Diabetic Frozen Shoulder After a Single Ultrasound-Guided Intra-Articular Corticosteroid Injection

Diagnostics ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 370
Author(s):  
Chul-Hyun Cho ◽  
Hyo-Joon Jin ◽  
Du Hwan Kim
Keyword(s):  
Conservative Treatment ◽  
Range Of Motion ◽  
Clinical Outcomes ◽  
Glenohumeral Joint ◽  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Frozen Shoulder ◽  
Ultrasound Guided ◽  
Analog Scale ◽  
Corticosteroid Injections

There is no consensus on the use of intra-articular corticosteroid injections in diabetic frozen shoulder (FS). Thus, we aimed to compare clinical outcomes after intra-articular corticosteroid injections in patients with diabetic FS and idiopathic FS. Data collected from 142 FS patients who received glenohumeral joint intra-articular corticosteroid injections were retrospectively reviewed. Thirty-two patients were diagnosed with diabetic FS and 110 patients with idiopathic FS. Data including visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and passive range of motion (ROM) were compared before the injection and at 3, 6, and 12 weeks after the injection. There were significant improvements in all outcomes (p < 0.001 for all parameters) through 12 weeks in both groups. There were no significant differences in all outcomes, except for ASES scores, between both groups at 3 weeks. However, there were significant differences in VAS score, SSVs, ASES scores, and passive ROMs, except for angle of abduction, between the two groups at 6 weeks and 12 weeks after injection. A single intra-articular steroid injection can be used as a conservative treatment for diabetic FS, but less effective than for idiopathic FS.

Effectiveness of Ultrasound-Guided Corticosteroid Injection in the Treatment of Morton's Neuroma

2008 ◽  
Vol 29 (5) ◽  
pp. 483-487 ◽  
Author(s):  
Maja Markovic ◽  
Ken Crichton ◽  
John W. Read ◽  
Peter Lam ◽  
Henry Kim Slater
Keyword(s):  
Corticosteroid Injection ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Morton's Neuroma

Ultrasound-Guided Injection of Dextrose Versus Corticosteroid in Chronic Plantar Fasciitis Management: A Randomized, Double-Blind Clinical Trial

2021 ◽  
pp. 193864002098092
Author(s):  
Gholamreza Raissi ◽  
Amin Arbabi ◽  
Maryam Rafiei ◽  
Bijan Forogh ◽  
Arash Babaei-Ghazani ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Plantar Fasciitis ◽  
Rating Scale ◽  
Corticosteroid Injection ◽  
Treatment Options ◽  
Plantar Fascia ◽  
Numeric Rating Scale ◽  
Therapeutic Effects ◽  
Ultrasound Guided ◽  
Double Blind

Design Chronic plantar fasciitis (PF) is a common cause of chronic heel pain, with different conventional treatment options. In this randomized clinical trial, the effect of ultrasound-guided injection of dextrose versus corticosteroid in chronic PF was evaluated and compared. Methods A total of 44 patients suffering from chronic PF who visited the physical medicine and rehabilitation clinic were enrolled in the study. Two table-randomized groups were formed. They received an ultrasonography-guided, single injection of either 40 mg methylprednisolone or 20% dextrose. Numeric Rating Scale (NRS), Foot and Ankle Ability Measure questionnaire with 2 subscales, Activities of Daily Living (FAAM-A) and Sports (FAAM-S), along with ultrasonographic parameters were evaluated before and at 2 and 12 weeks after the injection. Results. A total of 40 participants completed the study. Both interventions significantly improved pain and function at 2 and 12 weeks postinjection. After 2 weeks, compared with the dextrose prolotherapy, the corticosteroid group had significantly lower daytime and morning NRS scores (2.55 vs 4.1, P = .012, and 2.75 vs 4.65, P = .004), higher FAAM-S (66.84 vs 54.19; P = .047), and lower plantar fascia thickness at insertion and 1 cm distal to the insertion zone (3.89 vs 4.29 mm, P = .004, and 3.13 vs 3.48 mm, P = .002), whereas FAAM-A was similar in both groups ( P = .219). After 12 weeks, all study variables were statistically similar between corticosteroid and dextrose prolotherapy groups. No injection-related side effects were recorded in either group. Conclusion Both methods are effective. Compared with dextrose prolotherapy, our results show that corticosteroid injection may have superior therapeutic effects early after injection, accompanied by a similar outcome at 12 weeks postinjection. Levels of Evidence: Level II

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