Ultrasound-guided interdigital neuroma injections: Short term clinical outcomes after a single percutaneous injection – preliminary results


Carolyn M. Sofka, MD

Associate Attending Radiologist, Hospital for Special Surgery
Associate Professor of Radiology, Weill Cornell Medical College

Helene Pavlov, MD, FACR

Radiologist-in-Chief, Hospital for Special Surgery

Gina A. Ciavarra, MD, Department of Radiology and Imaging, Hospital for Special Surgery

Abstract
Purpose:
To describe the procedure of ultrasound-guided Morton’s neuroma and recurrent stump neuroma injections and early clinical outcomes after a single injection. 
Materials and Methods: Retrospective review of forty-four percutaneous ultrasound-guided neuroma injections in 24 patients who had completed clinical outcomes questionnaires. A 10-point pain scale (scale of 1 (no pain) to 10 (severe pain)) in a seven day pain log format was distributed to patients at the time percutaneous neuroma injection was performed.

Results: Neuromas were clearly visualized with sonography as hypoechoic nodules and were distinguishable from other causes of forefoot pain, such as metatarsophalangeal joint synovitis and intermetatarsal bursae. The sizes of the neuromas injected ranged between 4-19mm. Post-injection, all neuromas displayed increased echogenicity and/or the appearance of fluid surrounding it, confirming localization of the therapeutic mixture. We arbitrarily subdivided the pain ratings into symptomatic (greater than 4) and asymptomatic (less or equal to 4) for statistical analysis.  Average pain level pre injection was 5.2 and average pain level was 3.7 at 7 days post single injection with 62% of the initially symptomatic patients asymptomatic on day 7 (p<0.000001). Overall, 76% of the total number of neuromas injected once were asymptomatic on day 7.

Conclusion: Ultrasound can be used to accurately target Morton’s neuromas and therefore appropriately direct therapeutic interventions, with good short term clinical results.

This article appears in HSS Journal: Volume 3, Number 1. View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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