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.

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.

scholarly journals The Effectiveness of Corticosteroid Injection for De Quervain’s Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis

2015 ◽  
Vol 9 (1) ◽  
pp. 437-444 ◽  
Author(s):  
Patrick Rowland ◽  
Nigel Phelan ◽  
Sean Gardiner ◽  
Kenneth N Linton ◽  
Rose Galvin
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Corticosteroid Injection ◽  
Meta Analysis ◽  
Tendon Sheath ◽  
Control Group ◽  
Dash Score ◽  
Stenosing Tenosynovitis ◽  
Randomized Control ◽  
Totality Of Evidence

De Quervain’s stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included.Outcome measures included impairment, activity limitation and participation restriction.Five RCTs were identified with165 patients, 88 in the treatment group and 77 in the control group.Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05,I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003,I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02,I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.

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.

Bilateral Mirror-Symmetrical Giant Cell Tumor of the Tendon Sheath in the Foot and Ankle: A Case Report

2021 ◽  
Vol 60 (1) ◽  
pp. 163-166
Author(s):  
Naji S. Madi ◽  
Said Saghieh ◽  
Ahmad Salah Naja ◽  
Rachid K. Haidar
Keyword(s):  
Case Report ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Tendon Sheath ◽  
Cell Tumor ◽  
Foot And Ankle

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

2021 ◽  
Vol 15 (11) ◽  
pp. 3288-3292
Author(s):  
Wahid Bakhsh ◽  
Asad Ullah Jan ◽  
Muhammad Shafiq ◽  
Naveed Iqbal ◽  
Muzafar Hussain Buriro ◽  
...  
Keyword(s):  
Pain Score ◽  
Triamcinolone Acetonide ◽  
Corticosteroid Injection ◽  
Mean Value ◽  
Injection Pain ◽  
P Value ◽  
Duration Of Symptoms ◽  
De Quervain’S Tenosynovitis ◽  
Minimum Age ◽  
The Mean

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

scholarly journals Functional assessment of foot and ankle tendinopathies treated with tendoscopy

2021 ◽  
Vol 15 (2) ◽  
pp. 128-132
Author(s):  
Rodrigo Guimarães Huyer ◽  
Mário Sérgio Paulillo Cillo ◽  
Carlos Daniel Cândido Castro Filho ◽  
Hallan Douglas Bertelli ◽  
Renato Morelli Berg
Keyword(s):  
Functional Assessment ◽  
Descriptive Analysis ◽  
Case Series ◽  
P Value ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Treatment Results ◽  
Duration Of Treatment ◽  
Aofas Score ◽  
Level Of Evidence

Objective: To assess postoperative clinical functional outcomes, based on the American Orthopaedic Foot & Ankle Society (AOFAS) score, of tendoscopies performed in the treatment of foot and ankle pathologies. Methods: Our comparative assessment used AOFAS scores obtained preoperatively and at early and late postoperative stages - 1 month and 6 to 12 months after surgery - of 14 patients with foot and ankle tendinopathies. These included peroneal tendon dislocation, peroneal tendonitis, and tearing of the peroneus longus or brevis, all treated with tendoscopy for peroneal reconstruction and tenorrhaphy. The AOFAS score was obtained by functional assessment during outpatient physical examination. We presented a descriptive analysis of cases, comparing scores over time through the Friedman test followed by Dunn’s test. The relationship between score variations and sex was assessed using the Mann-Whitney test; their comparison with age used Spearman’s linear correlation coefficient. Significance levels were 5%.Results: The AOFAS score showed important improvements such as preoperative scores of 56 and 67 followed by postoperative scores of 100 both in the early and late stages, supporting the efficacy and persistence of this treatment strategy. The p-value obtained after statistical analysis was <0.0001. Conclusion: We concluded that the treatment of foot and ankle comorbidities with tendoscopy, in addition to being less invasive, shows consistency and efficacy as demonstrated by the AOFAS score and functional assessment via postoperative physical examinations. AOFAS scores were increased and maintained at high levels in the postoperative period, demonstrating the efficacy of this procedure and the duration of treatment results. Level of Evidence IV; Case Series; Therapeutic Studies - Investigation of Treatment Results.

scholarly journals Extensive giant cell tumor on the foot completely wrapping the extensor hallucis longus

2018 ◽  
Vol 12 (4) ◽  
pp. 352-55
Author(s):  
Anderson Humberto Gomes ◽  
Bruno Janotti Pádua ◽  
Luiz Eduardo Moreira Teixeira ◽  
Claudio Beling Gonçalves Soares
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Surgical Planning ◽  
Treatment Success ◽  
Synovial Cyst ◽  
Tendon Sheath ◽  
Cell Tumor ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Extensor Hallucis Longus

In this study, we report the case of a patient with a lobulated expansile lesion of 16.6 cm in its largest diameter, who was referred as having a simple “synovial cyst” in the foot that actually was a giant cell tumor of the tendon sheath along the extensor hallucis longus. Conducting a differential diagnosis of a “synovial cyst” in the foot and ankle, performing adequate surgical planning and using imaging tests, such as nuclear magnetic resonance, increases the probability of treatment success. Level of Evidence V; Therapeutic Studies; Expert Opinion.

The Peroneal Groove Deepening Procedure: A Biomechanical Study of Pressure Reduction

2005 ◽  
Vol 26 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Craig I. Title ◽  
Hung-Geun Jung ◽  
Brent G. Parks ◽  
Lew C. Schon
Keyword(s):  
Biomechanical Study ◽  
Posterior Tibial Tendon ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Calcaneofibular Ligament ◽  
Significant Difference ◽  
Mean Pressure ◽  
Fresh Frozen ◽  
The Mean ◽  
Pressure Changes

Background: The goal of this study was to identify pressure changes throughout the peroneal groove after a groove deepening procedure. We hypothesized that pressures would decrease. Methods: Twelve fresh-frozen foot and ankle specimens were used. A thin pressure strip containing four sensor pads was secured within the peroneal groove with pads 1 through 4 positioned at the calcaneofibular ligament (CFL) and at the distal, middle, and proximal groove, respectively. The midstance phase of gait was simulated with loads applied to the plantar foot and posterior tibial tendon and to the peroneus longus and brevis tendons. Pressures were recorded with the ankle in neutral, plantarflexion, dorsiflexion, inversion, and eversion. Groove deepening was done by osteotomizing the posterior fibular wall. Pressure readings were then recorded. Average pressures for each of the four sensor pads after the procedure were compared to those obtained before the procedure. Results: The mean pressure overlying the CFL increased at all five ankle positions; however, these changes were not significant. Significant decreases in pressure were noted within the distal and middle groove at all ankle positions after the peroneal groove deepening procedure. Pressure within the proximal groove increased at all but one position, with a significant difference noted in neutral and plantarflexion. Conclusion: Pressures within the middle and distal peroneal groove significantly decreased after a groove deepening procedure. Combining this technique with peroneal tendon debridement may be advantageous for treatment of partial peroneal tendon tears or recalcitrant peroneal tendinitis.

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