Background The utility of ultrasound in combination with the clinical examination (CE) for the evaluation of inflammatory arthritis is used in routine clinical practice. The assessment of hand osteoarthritis (HOA) is known to be challenging and clinical examination alone may underestimate co-existing soft-tissue pathologies. Corticosteroids (CS) injections are used for symptom modification in OA, however their efficacy in HOA is unknown.Furthermore the response to CS injections in patients may vary due to the clinician injecting an unaffected site or failing to inject all affected sites.
Objectives To determine if the knowledge of an US scan influences clinical decision making in the planning of sites for targeted CS injections in HOA involving the carpometacarpal joint with other co-existing pathologies.
Methods 34 consecutive HOA patients (31 female, 3 male) with a mean ± SD age of 61.2±9.4 years were recruited. These patients were initially diagnosed with symptomatic HOA involving the CMC joint and agreed to targeted CS injections. All patients had 2 independent assessments of their symptomatic hand, an US scan undertaken by a principal physiotherapist (MB) trained in sonography and a routine CE by an advanced physiotherapy practitioner (LF). Subsequently the patients were randomised into two groups GA and GB for targeted interventions. In GA, the physiotherapy practitioner (LF) performed a CE and was then given the US scan results prior to treatment. In GB US scans were made available after treatment had been initiated. The sites identified for CS injections were recorded along with rate of treatment decision changes based on US results before and after treatment.
Results A possible 65 CS injection sites were identified by US (GA=42 sites and GB=23 sites) and 45 sites by CE (GA=24 sites and GB=21 sites).The clinician reported at least one change in the anticipated treatment plan of CS injections in 25 (74%) of 34 patients with only complete agreement in 9 patients.In GA 9 (45%) patient’s treatment plan was changed due to the influence of the US scan results. There were 11 sites changed in total with 5 sites added (1 joint, 1 median nerve, 3 De Quervains). In GB 9 (64%) patient’s treatment plan would have changed if the scan results were available. This would have involved 17 sites comprising of 10 additional sites identified (3 joints, 4 nerves, 3 soft tissue structures), 7 sites would have been removed (4 joints, 3 soft tissue). The actual injections to be performed were/would have been changed by the clinician in a total of 28/45 sites.
Conclusions This study shows that findings from the US scan did influence the clinical decision making in the management of symptomatic HOA using targeted CS injections hand. US assessment did identify additional pathologies undetected by routine clinical examination relating to soft tissue structures especially De Quervains tenosynovitis and carpal tunnel syndrome.
Disclosure of Interest M. Brandon: None Declared, L. Friel: None Declared, S. Budai: None Declared, R. Madhok: None Declared, D. Turner Grant/Research support from: ARUK 17832, J. Woodburn: None Declared
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