THE USE OF JOINT INJECTION IN THE INVESTIGATION OF FOOT AND ANKLE PATHOLOGY IN THE CONTEXT OF ANATOMICAL JOINT COMMUNICATIONS

Abstract

Background: Diagnostic injection plays an increasing role in the diagnosis of foot and ankle pathology. Joint communications have been reported in several studies, and it has been suggested they may impact on clinical management.

Method: We analysed the findings of 389 arthrograms of the foot and ankle, identifying any joint communications noted on imaging. A case note review was then undertaken on a subset of 153 of these patients with the aim of establishing the effect of injection findings on clinical management. All injections were performed and reported by a single consultant radiologist.

Results: Joint communications were seen in 24% of patients with an equal distribution amongst males and females. Rates of individual joint communications were consistent with those previously published.

Injection studies had an impact on subsequent management in 88% of cases. Symptoms resolved with injection alone in 28% of patients with no communication versus 8% in those with a communication. Surgical plans were changed in over 20% of cases if a joint communication was found. There were no major complications reported (Joint sepsis or contrast allergy).

Conclusion: This study confirms the presence of multiple joint communications within the foot and ankle, and highlights the importance of arthrography in the diagnosis of pathology.

We would recommend joint injection be considered in all patients, especially if joint fusion is being considered. Contrast should be used in all cases to demonstrate any potential communications, which should be taken into consideration when surgical management plans are formulated. A significant number of patients will experience resolution of symptoms from injection alone, with no further intervention needed.