Abstract
BackgroundTo estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection.MethodsA systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case reports were included, as were prospective and retrospective studies that reported adverse events of corticosteroid injection. All clinical trials which used extra-articular corticosteroid injections were examined. We divided the reported adverse events into major (defined as those needing intervention or not disappearing) and minor ones (transient, not requiring intervention).ResultsThe search yielded 87 relevant studies:44 case reports, 37 prospective studies and 6 retrospective studies. The major adverse events included osteomyelitis and protothecosis; one fatal necrotizing fasciitis; cellulitis and ecchymosis; tendon ruptures; atrophy of the plantar fat was described after injecting a neuroma; and local skin effects appeared as atrophy, hypopigmentation or as skin defect. The minor adverse events effects ranged from skin rash to flushing and disturbed menstrual pattern. Increased pain or steroid flare after injection was reported in 19 studies. After extra-articular injection, the incidence of major adverse events ranged from 0-5.8% and that of minor adverse events from 0-81%. It was not feasible to pool the risk for adverse effects due to heterogeneity of study populations and difference in interventions and variance in reporting.ConclusionIn this literature review it was difficult to accurately quantify the incidence of adverse effects after extra-articular corticosteroid injection. The reported adverse events were relatively mild, although one fatal reaction was reported.
Highlights
To estimate the occurrence and type of adverse effects after application of an extra-articular corticosteroid injection
After studying the full-text articles and references of the included articles and relevant reviews, there were 87 relevant articles, i.e. 44 case reports, 37 prospective studies and 6 retrospective studies reporting on the adverse events of extra-articular local corticosteroid injections
Types of adverse events Case studies Only two articles mentioned an adverse event after a corticosteroid injection in the bursa round the hip
Summary
To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection. Corticosteroid injections are frequently included as treatment option in clinical guidelines in the field of musculoskeletal disorders. Injectable corticosteroids are nowadays registered for local treatment of (rheumatic) arthritis, synovitis, bursitis, epicondylitis, tendonitis, neuromas, ganglion cysts, entrapment syndromes, fasciitis and back pain [3,4]. A systematic therapeutic overview showed that 14-38% of patients with a tennis elbow in general practice were treated with corticosteroid injections [7]. In another study in general practice patients with tendosynovitis or nerve entrapment were injected with corticosteroid injection in 11% and 13% respectively [8]. The aim of the present study was to estimate the occurrence of and describe the type of adverse effects due to extra-articular corticosteroid injections
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