Abstract
Musculoskeletal corticosteroid injection is commonly used as an adjunct to help patients in pain management. In this current COVID-19 pandemic, many clinicians would differ from this treatment as steroid is considered an immunosuppressive drug and could risk the patient of developing severe adverse effects if contracting COVID-19. This is a retrospective study based in Sabah, Malaysia, examining the prevalence of COVID-19 infection following musculoskeletal corticosteroid injection from 1 December 2019 until 30 June 2020 in the sports medicine clinic and the orthopedic clinic. Patients who received musculoskeletal corticosteroid injection were called by telephone and asked about visits to the emergency department or government health clinic for influenza-like illness symptoms or severe acute respiratory infection that would require screening of COVID-19. Thirty-five patients who responded to the call were included, with mean ages of 47.9 years ± 15.1. 52% were male respondents, while 48% were female. 25% of them were diabetics, and 2.9% of them had a history of lymphoproliferative disorders. The mean pain score before injection was 6.74 ± 1.03 and after injection pain was 2.27 ± 1.63. In this study, there were 11.4% (n = 4) with minor complications of steroid injection, that is, skin discoloration. Nonetheless, there were no severe complications due to corticosteroids reported. There were no reported cases of COVID-19 among the respondents following corticosteroid injection. Musculoskeletal pain would affect a person's well-being and activities; thus, its management requires that careful consideration with risk-benefit analysis be made before administering musculoskeletal corticosteroid injection during COVID-19 pandemic.
Highlights
Musculoskeletal corticosteroid injection is a common procedure seen in a sports medicine clinic. e injection is used as an adjunct to treat various musculoskeletal diseases such as arthritic joint pain, bursitis, tendinopathy, and synovial inflammation
Numerous studies have reported that epidural steroid injection causes hypothalamic-pituitary axis (HPA) suppression from 4 to 12 weeks, and a single dose of intra-articular steroid injection could cause HPA suppression for up to 4 weeks [2,3,4,5,6]. us, in the early pandemic era, many professional national bodies have recommended against the usage of corticosteroid injection during this pandemic, as the fear of an asymptomatic patient infected with SARS-CoV-2 could put them at increased risk of an adverse outcome from the virus if they had received the injection [7]. e rising concern for use of injectable corticosteroids in musculoskeletal care comes from established guidelines from World Health Organization for systemic steroid use in patients under treatment for active COVID
When consent was given by the patients, they were asked about any visit to the emergency department, government clinic, or private hospital for COVID-19 screening with symptoms of InfluenzaLike Illness (ILI) or Severe Acute Respiratory Infection (SARI)
Summary
Musculoskeletal corticosteroid injection is a common procedure seen in a sports medicine clinic. e injection is used as an adjunct to treat various musculoskeletal diseases such as arthritic joint pain, bursitis, tendinopathy, and synovial inflammation. Musculoskeletal corticosteroid injection is a common procedure seen in a sports medicine clinic. Robust studies have shown that corticosteroid injection helps patients control debilitating arthritic joint pain, improve the quality of daily living activities, improve range of motion, and an early return to work and, in certain patients, it helps delay or prevent surgical intervention [1]. Musculoskeletal corticosteroid injection is a safe procedure with a small risk of complications [1]. With the current public health emergency of COVID-19 outbreak, a careful decision of performing corticosteroid injection should be considered. E rising concern for use of injectable corticosteroids in musculoskeletal care comes from established guidelines from World Health Organization for systemic steroid use in patients under treatment for active COVID- Numerous studies have reported that epidural steroid injection causes hypothalamic-pituitary axis (HPA) suppression from 4 to 12 weeks, and a single dose of intra-articular steroid injection could cause HPA suppression for up to 4 weeks [2,3,4,5,6]. us, in the early pandemic era, many professional national bodies have recommended against the usage of corticosteroid injection during this pandemic, as the fear of an asymptomatic patient infected with SARS-CoV-2 could put them at increased risk of an adverse outcome from the virus if they had received the injection [7]. e rising concern for use of injectable corticosteroids in musculoskeletal care comes from established guidelines from World Health Organization for systemic steroid use in patients under treatment for active COVID-
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