Image-guided injections versus anatomical-based injections for carpometacarpal (CMC) arthritis: A Systematic Review

Introduction Thumb carpometacarpal (tCMC) arthritis is a common and debilitating condition for aging people worldwide. Conservative treatments including activity modification, bracing, anti-inflammatory medications, and steroid injections remain the initial treatment of choice. Given the size of the tCMC joint, intra-articular image-guided injections (IGI) may provide more consistent and superior outcomes with comparison to peri-articular anatomic landmark injections (ALI). This study systematically reviews the accuracy and efficacy of intra-articular IGA versus ALI. Methods To evaluate the accuracy and efficacy of intra-articular IGI versus ALI of tCMC injections for arthritis, a systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) across Pubmed/Medline, Cochrane, and Embase databases. The search used a combination of keywords and MeSH terms. Inclusion criteria were studies conducted on human subjects that contained a comparison of anatomic landmark-based injections to image guided tCMC injections. Statistical analysis was not performed due to the lack of total studies that met inclusion criteria and absence of level 1 evidence studies. Results A preliminary search of three databases provided 245 studies. Five studies ultimately met the final inclusion criteria and were represented in this study. The two human-based studies showed no clinically significant difference in outcomes between IGI and ALI. The three cadaveric studies showed no statistical difference in the accuracy of either fluoroscopy or ultrasound-guided injections when compared with ALI. The cost of ALI was, on average, $203 less than intra-articular ultrasound IGI. Conclusion While the current literature on this topic is limited, the current literature appears to show no significant difference between the accuracy or efficacy of intra-articular IGI and ALI. ALI injections appear to be a more cost-effective option without sacrificing outcome. These results also highlight that intra-articular placement may not be necessary for injection benefit, and future research and larger studies can be beneficial to improve comparisons and outcomes.