Osteoarthritis Of The Second Metatarsophalangeal Joint

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Osteoarthritis Of The Second Metatarsophalangeal Joint

Authors, Editors, Case Information Author: Tamzid Hassan, DO Affiliation: Inspira Health / Rowan-Virtua School of Osteopathic Medicine Co Author(s): Michael Serra-Jovenich, DO; Altamash Raja, DO, RMSK Senior Editor: Nick Moore, MD Clinical Vignette: A 68-year-old male presented with pain in the right second toe. He has a remote history of a second toe fracture, and an x-ray revealed a questionable right second phalangeal loose body. Type of Probe Used: 15-4 MHz Linear Transducer Labeled Long Axis View of the 2nd MTP with Power Doppler Labeled long axis view of the right second metatarsophalangeal joint. Power doppler is placed over a hypoechoic area surrounding the osteophyte (likely representing a joint effusion). There is no hyperemia or neovascularization. #2 - Video View Video Long axis video: Medial to lateral scan of the right second MTP joint in long axis. Osteophytes are present at the distal end of the metatarsus. Effusion is appreciated at the joint space and around the osteophytes. #3 - Video View Video Short axis video: Proximal to distal scan of the right second metatarsal in short axis. Several cortical irregularities are appreciated. Unlabeled Long Axis View of the 2nd MTP with Power Doppler Unlabeled long axis view of the right second metatarsophalangeal joint with Power Doppler placed over a hypoechoic area. Labeled Short Axis View of the 2nd Metatarsal Short axis view of the second metatarsal demonstrating several cortical irregularities. Labeled Long Axis View of the 2nd MTP Joint Long axis view of the right second MTP joint demonstrating a prominent osteophyte along with distension of the capsule and synovial thickening Unlabeled Short Axis View of the 2nd Metatarsal Short axis view of the second metatarsal, just proximal to the MTP joint. Unlabeled Long Axis View of the 2nd MTP Joint Long axis view of the right second metatarsophalangeal joint. Interpretation Image Interpretation: The right second metatarsophalangeal joint recess is distended. Several hyperechoic, irregularly shaped bodies are noted which likely represent osteophytic changes. In the presence of prior trauma, these findings are suggestive of osteoarthritis. Teaching Pearl: Ultrasound is a valuable imaging modality for detecting arthritis in the small joints of the feet. While x-rays are commonly used to diagnose osteoarthritis, significant structural damage may already have occurred by the time changes are visible. In contrast, ultrasound can reveal changes before irreversible damage occurs, for example by detecting synovitis which forms early in the disease process. The first-line treatment of osteoarthritis in the small joint are conservative measures such as weight loss, activity modification, NSAIDs, and corticosteroid injections. Surgical procedures, such as arthroscopic debridement and joint fusions, are reserved for severe cases.
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Authors, Editors, Case Information

Labeled Long Axis View of the 2nd MTP with Power Doppler

#2 - Video

#3 - Video

Unlabeled Long Axis View of the 2nd MTP with Power Doppler

Labeled Short Axis View of the 2nd Metatarsal

Labeled Long Axis View of the 2nd MTP Joint

Unlabeled Short Axis View of the 2nd Metatarsal

Unlabeled Long Axis View of the 2nd MTP Joint

Interpretation

UPCOMING EVENTS

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