Superior Tibiofibular Joint Injection

Indications and Clinical Considerations

The tibiofibular joint is susceptible to developing arthritis from a variety of conditions that all have the ability to damage the joint cartilage. Osteoarthritis of the joint is the most common form of arthritis that results in tibiofibular joint pain. However, rheumatoid arthritis and posttraumatic arthritis also are common causes of tibiofibular pain secondary to arthritis. The tibiofibular joint frequently is damaged from falls with the foot fully medially rotated and the knee flexed, and such trauma frequently results in posttraumatic arthritis. Less common causes of arthritis-induced tibiofibular pain include the collagen vascular diseases, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis usually is accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized by the astute clinician and treated appropriately with culture and antibiotics, rather than injection therapy. The collagen vascular diseases generally manifest as a polyarthropathy rather than a monoarthropathy limited to the tibiofibular joint, although tibiofibular pain secondary to collagen vascular disease responds exceedingly well to the intra-articular injection technique described later. The joint can also be affected by ganglion cysts and tumors ( Fig. 151.1 ).

The majority of patients with tibiofibular pain secondary to osteoarthritis and posttraumatic arthritis report pain localized around the tibiofibular joint and the lateral aspect of the knee. Activity, especially involving flexion and medial rotation of the knee, will make the pain worse; rest and heat provide some relief. The pain is constant and is characterized as aching. The pain may interfere with sleep. Some patients note a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.

In addition to the previously mentioned pain, patients with arthritis of the tibiofibular joint often experience a gradual decrease in functional ability with decreasing tibiofibular joint range of motion, making simple, everyday tasks such as walking, climbing stairs, and getting in and out of cars quite difficult. Morning stiffness and stiffness after sitting for prolonged periods are commonly reported by patients with arthritis of the tibiofibular joint. With continued disuse, muscle weakness and wasting may occur, and loss of support from the muscles and ligaments eventually makes the tibiofibular joint unstable. This instability is most evident when the patient attempts to walk on uneven surfaces or climb stairs.

Plain radiographs are indicated for all patients with tibiofibular joint pain. On the basis of the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging of the tibiofibular joint is indicated if internal derangement or occult mass or tumor is suspected ( Fig. 151.2 ). Bone scan may be useful to identify occult stress fractures involving the joint, especially if trauma has occurred.

Clinically Relevant Anatomy

The lateral epicondyle of the tibia and the head of the fibula articulate at the superior tibiofibular joint ( Fig. 151.3 ). The flattened articular surfaces are covered with hyaline cartilage, which is susceptible to arthritis. The joint is surrounded by a capsule that provides support to the joint. Anterior and posterior ligaments strengthen the joint. The joint capsule is lined with a synovial membrane that attaches to the articular cartilage and may give rise to bursae. The tibiofibular joint is innervated by the common peroneal nerves ( Fig. 151.4 ). In addition to arthritis, the tibiofibular joint is susceptible to the development of tendinitis, bursitis, and disruption of the ligaments, cartilage, and tendons.