case_images: PMC10937340_01
case_images: Out-of-plane approach for intra-articular injection of the first metatarsophalangeal joint.
case_images: fpain-05-1254216-g001.jpg
case_images: PMC10937340_01_fpain-05-1254216-g001.jpg
case_images: F1
case_images: USA) was used to scan the dorsal forefoot along the sagittal plane and to confirm the symptomatic joint. Using an out-of-plane approach, a 1.5 cm 25-gauge needle was advanced into the joint space under direct visualization, aspirating the joint to confirm intra-articular access (Figure 1).
case_images: Sagittal view under P-US of the 1st MTP joint after injection. (*) marks the proximal phalanx. ( ) marks the distal end of the 1st metatarsal bone. The tip of the needle is seen within the joint space circled in red. The joint space is outlined in yellow, showing the distension of the space following injection (anechoic space). This indicates successful injection of the material intra-articularly.
case_images: fpain-05-1254216-g002.jpg
case_images: PMC10937340_01_fpain-05-1254216-g002.jpg
case_images: F2
case_images: Still under direct visualization, the joint was injected with 2 cc of 1% Lidocaine and 1 cc of Kenalog (40 mg/ml) into the articular joint space (Figure 2).