Drop Arm Test

The Drop Arm Test is used for diagnosing rotator cuff tendon tears, specifically the supraspinatus tendon tear. The test helps in determining if there is a tear in the supraspinatus tendon and the can be done by many techniques. The patient should be instructed to fully abduct the arm. Then, the patient should slowly lower the arm to the side. If there is a tear in the rotator cuff tendon, the arm will drop from a position of about 90° of abduction. tearEven if the patient attempts this several times, the patient with a supraspinatus tendon tear cannot lower the arm smoothly and slowly. If the patient with the supraspinatus tendon tear is able to hold the arm in abduction, a small amount of pressure on the forearm will cause the arm to fall to the side.

Another method of performing the test begins with the physician instructing the patient to fully abduct the arm and the examiner supporting the arm so that it is able to be tested in 90° of abduction. The patient is asked to actively lower the arm from abduction to the side, slowly andtendon tear smoothly in a controlled way. A positive test occurs when the patient is unable to hold the arm in 90° of abduction or is unable to control lowering the arm to the side. The practical way of performing the test is when the examiner holds the arm fully abducted by the side of the patient and then will release it. If the arm drops, this will mean that there is a large rotator cuff tear present. The test is positive when pain and weakness causes the arm to drop to the side.

 

 

Common Foot Conditions and Injections

 

Conditions which cause pain and inflammation are treatable with the use of diagnostic and therapeutic injections. The purpose of this article is to shed some light on common ankle and foot conditions that may require injections and where the proper sites to perform these injections are located.

anklejoint

Ankle Joint

The ankle joint is formed by articulation of the tibia and talus. Injections are performed here to alleviate pain occurring from trauma, arthritis, gout, or other ankleeeeinflammatory conditions. Anterolateral Ankle Impingement can occur due to the build-up of scar tissue in the ankle joint or from the presence of bony spurs. When executing an injection here, the ankle will need to be in a neutral position. The physician will mark the injection site just above the talus and medial to the tibialis anterior tendon. The injection site should be disinfected with betadine. Then, the needle is inserted into the identified site and directed posterolaterally. The solution is injected into the joint space and should flow smoothly without resistance. It may be helpful to pull on the foot in order to distract the ankle joint.

First Metatarsophalangeal Joint

The MTP joint is a common injection site frequently affected by gout and firstmetaosteoarthritis. The injection site is first disinfected with betadine and then the needle is inserted on the dorsomedial or dorsolateral surface. The needle is angled at 60-70° of the plane to match the slope of the joint. The solution is injected into the joint space and should flow smoothly without resistance. Pulling on the big toe is sometimes helpful in distracting the joint.

 

Peroneal Tendonitis

Peroneal Tendonitis is an irritation to the tendons that run on the outside area of the ankle, the peroneus longus and peroneus brevis. First, the injection site is disinfected with betadine. Then, the needle should be carefully inserted in a proximal direction when injecting the peroneus brevis and longus tendon sheath. The needle will need to advance distally to inject the peroneus brevis alone at its bony insertion.

peroneal

Achilles Tendonitis

Achilles Tendonitis is an irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common overuse injury that occurs in athletes. needlingInjections of steroids should be given around the tendon, not through the tendon. The injections inserted directly into the tendon is not recommended due to the increased risk of tendon rupture. A platelet injection can be done through the tendon with needling and fenestration.

 

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is a condition of pain and paresthesia caused by irritation to the posterior tibial nerve. When performing an injection for this condition, the tarsal tunnelphysician will want to feel the pulse of the posterior tibial artery. The nerve is posterior and the physician will want to find the area of maximum tenderness. The injection site should be 1-2cm above the tender area, which is marked on the medial side of the foot and disinfected with betadine. The solution is injected at a 30° angle and directed distally. It is important to inform the patient that the foot may become numb and that care should be taken when walking and driving. Injections for Tarsal Tunnel Syndrome are usually performed after a treatment program which can include rest stretching and the use of shoe inserts.

 

Plantar Fasciitis

The plantar fascia is a band of connective tissue deep to the fat pad on the plantar aspect of the foot. Patients with plantar fasciitis complain of chronic pain symptoms that are often worse in the morning with walking. The injection site is identified and marked on the medial side of the foot and betadine is used as a disinfectant. The physician will need to avoid injecting through the fat pad at the bottom of the foot to avoid fat atrophy. The needle is inserted in a medial to lateral direction one finger breath above the sole of the foot, in a line that corresponds to the posterior aspect of the tibia. The solution is injected past the midline of the width of the foot.plantar