Corticosteroid Injection Group Research Articles

Surgical versus non-surgical treatment for carpal tunnel syndrome.

Surgical versus non-surgical treatment for carpal tunnel syndrome.

INJECTION OF AUTOLOGOUS WHOLE BLOOD VERSUS CORTICOSTEROID FOR LATERAL EPICONDYLITIS: A COMPARATIVE STUDY

Objective: The objective is to compare the efficacy, in terms of pain relief and functional improvement, of autologous whole blood and corticosteroid injection in managing lateral epicondylitis (Tennis elbow). Methods: This was a comparative study conducted in Department of Orthopedics, National Institute of Medical Sciences Jaipur, Rajasthan, India. Eighty patients diagnosed to be having lateral epicondylitis were included in this study on the basis of predefined inclusion and exclusion criteria. The patients were divided into 2 groups on the basis of whether they were given autologous whole blood (Group B) or corticosteroid injection (Group S). Efficacy of both the treatment modality was compared in terms of Pain relief (as assessed by reduction in visual analogue score [VAS] score) and functional improvement (as assessed by improvement in Mayo Elbow performance score). SSPS 22.0 software was used for statistical analysis and p<0.05 was taken as statistically significant. Results: A total of 80 patients were included in this study out of which there were 37 (46.25%) males and 43 (53.75%) females with a M: F ratio of 1:1.16. The mean age of patients in group B and group S was found to be found to be 52.36±9.98 years and 48.46±10.12 years, respectively. The mean age of patients in both the groups was found to be comparable with no statistically significant difference (p=0.0866). At the time of 4 weeks, 8 weeks, and 12 weeks follow–up, the mean VAS score in Group B was less as compared to group S and the difference was found to be statistically highly significant (p<0.0001). At the time of 4 weeks, 8 weeks, and 12 weeks’ follow-up, the mean MEPS in Group B was more as compared to group S, and the difference was found to be statistically significant (p<0.05). Conclusion: For lateral epicondylitis, whole blood injection demonstrated superior efficacy in terms of pain relief and functional improvement as compared to injection of corticosteroid.

Is there structural change on MRI in gluteal tendinopathy after treatment? Single outcome measure extension of an RCT

BackgroundThe etiology of tendinopathy remains controversial and it is unknown whether degenerative structural changes in tendinopathies are reversible.HypothesisThere will be no structural change on magnetic resonance imaging (MRI) taken > 2-years after treatment for gluteal tendinopathy.Study DesignExtension of a single site, double-blind, prospective randomized-controlled trial to analyze the additional outcome measure; MRI changes.MethodsUniversity of Melbourne ethics approval number: 1852900, trial registration: ACTRN12613000677707. Participants with gluteal tendinopathy who had previously received a leukocyte-rich platelet-rich plasma injection (LR-PRP) or a corticosteroid injection (CSI) had a post treatment MRI between at least 2-years and up to 7 years following trial completion. A blinded, senior musculoskeletal radiologist graded all de-identified MRI scans using the Melbourne Hip Score (MHIP). The primary outcome measure was the change in overall pre- and post-treatment score.ResultsParticipants (n = 20) underwent MRI at mean time of 4.15 (SD 1.11; range 2–7) years after their initial treatment. There was no change in the overall mean MHIP score for the CSI group (Pre 4.3 (SD 2.3) Post 4.3 (SD 1.1), p = 1.00). Although there was an improvement in the LR-PRP group mean MHIP score (Pre 5.3 (SD 3.0) Post 4.77 (SD 2.5), p = 0.56) it was not statistically significant. However, in the LR-PRP intervention group, five out of nine of participants’ MHIP score improved, with four of these improving by 2–4 points.ConclusionThe hypothesis that there would be no improvement in MHIP scores following treatment of gluteal tendinopathy was supported. Findings of improvement in the LR-PRP group at 4 years would support further studies powered to look for structural improvement. These findings suggest that structural change following treatment for tendinopathy may be possible supporting the inclusion of MRI as a core outcome for future studies.Clinical relevanceThe study suggests that degenerative structural changes in tendons may be reversible.

Corticosteroid injection of the knee within one month prior to meniscus repair increases the risk of repair failure requiring meniscectomy

ABSTRACT Objective Meniscal tears are common knee injuries with limited endogenous healing capacity. This study aimed to investigate the association between the timing and administration of preoperative intra-articular corticosteroid injections (CSIs) and the risk of subsequent meniscectomy following meniscus repair. Methods Using a national insurance claims database, patients aged 18–40 years undergoing meniscus repair within six months of tear diagnosis were studied. Patients were categorized based on whether they received preoperative CSIs within three intervals prior to repair. Multivariable logistic regression was used to analyze the risk of follow-up meniscectomy while controlling for various patient-related variables. Results Among 5,390 patients meeting inclusion criteria, 201 received preoperative CSIs. The CSI group was older and had higher rates of diabetes, obesity, and knee osteoarthritis. The overall rate of follow-up meniscectomy did not differ between groups. However, CSIs performed within one month prior to repair were associated with significantly higher odds of subsequent meniscectomy compared to CSIs performed between three and six months prior. Obesity, tobacco use, and knee osteoarthritis were also independently associated with higher risk, while increasing age was associated with lower risk. Conclusion The study highlights an increased risk of repair failure requiring follow-up meniscectomy for patients receiving intra-articular CSIs within one month prior to meniscus repair. These findings suggest caution when considering CSIs as a treatment option for patients scheduled for meniscus repair. Further research is needed to establish optimal timing guidelines for CSIs in relation to meniscus repair and to understand the underlying mechanisms.

Analysis of patient factors associated with selection of corticosteroid injection in the freezing phase of idiopathic adhesive capsulitis.

Primary idiopathic adhesive capsulitis (AC) is characterized by shoulder pain and global limitations in range of motion (ROM). The aim of this study was to determine (1) if a spectrum of symptom severity exists during the freezing phase of AC and (2) identify factors associated with patient selection of corticosteroid injection (CSI) for treatment. Patients presenting within 6 months of symptom onset of AC (freezing phase) were enrolled in this single-site retrospective case control study. Visual analog pain scale (VAS) score, shoulder ROM, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, and Patient-Reported Outcomes Measurement Information System (PROMIS function and pain) scores were collected. Each patient was offered oral anti-inflammatory medication, physical therapy, and intra-articular CSI. Patients were divided into 2 cohorts: those electing vs. those deferring CSI. Multivariable logistic regression was performed to identify patient or symptom characteristics predictive of electing CSI. A total of 112 patients (mean age=54.7 ± 8.8 years, female=76 [67.9%], mean symptom duration =13.2 ± 7.9 weeks, elected CSI=74 [66.1%]) were included in our analysis. The overall study population demonstrated a wide spectrum of VAS pain scores (6.0 ± 2.8, range: 0-10) and ROM: forward elevation (99° ± 27°, range: 30°-150°), abduction (82° ± 24°, range: 30°-130°), external rotation (47° ± 13°, range: 0°-90°), internal rotation (38° ± 26°, range: 5°-90°). The CSI group had higher mean VAS pain score (6.6 ± 2.5 vs. 4.9 ± 3.0, P=.005) and greater limitations in ROM for forward elevation (92° ± 27° vs. 113° ± 25°, P=.001) and abduction (77° ± 24° vs. 90° ± 21°, P=.005) compared with the non-CSI cohort. The CSI group demonstrated significantly worse shoulder function based on Constant (P<.05), ASES (P=.001), P-UE (P=.016), P-Intensity (P=.002), and P-Interference (P=.004). Logistic regression demonstrated decreased total shoulder ROM in forward elevation and abduction plane (OR=0.98, 95% CI=0.97-0.99, P=.004). Hispanic ethnicity and increased VAS pain score (OR=1.20, 95% CI=1.01-1.43, P=.04) were associated with increased likelihood of electing CSI. A spectrum of symptom severity exists during the freezing phase of primary AC, despite similar etiology. AC patients with greater pain severity, and greater limitations in ROM at initial evaluation were associated with patient selection of CSI.

Comparison of shock wave therapy and corticosteroid injection in the treatment of greater trochanteric pain syndrome: A single-blind, randomized study.

The aim of this study was to compare the efficacy of the corticosteroid (CS) injection and shock wave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). Between 2020 September and 2021 October, a total of 60 patients with GTPS (12 males, 48 females; mean age: 50.8±8.5 years; range, 34 to 65 years) were included. The patients were randomly assigned to two groups as the SWT group (n=32) receiving one session of SWT per week for a total of three weeks and CS injection group (n=28) receiving CS and local anesthetic. Both groups were evaluated using the Short Form-36 (SF-36) at baseline and three months and using the Visual Analog Scale (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) at baseline, three weeks, and three months. The mean VAS, greater trochanter tenderness, and WOMAC scores of both groups were similar at baseline, while the third-week and three-month scores were significantly lower in both groups compared to baseline (p<0.05). There was no significant difference in the treatment efficacy between the groups (p>0.05). There was a similar improvement in SF-36 physical function, physical role difficulty, and pain subscales in both groups (p<0.05). Our study results show that both CS injection and SWT are effective modalities and none of the treatments is superior to each other.

Comparison efficacy of ultrasound-guided needle release plus corticosteroid injection and mini-open surgery in patients with carpal tunnel syndrome.

This retrospective study was to compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection vs. mini-open surgery in patients with carpal tunnel syndrome (CTS). From January 2021 to December 2021, 40 patients (40 wrists) with CTS were analyzed in this study. The diagnosis was based on clinical symptoms, electrophysiological imaging, and ultrasound imaging. A total of 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A), and the other 20 wrists were treated with mini-open surgery (Group B). We evaluated the Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of the median nerve), and ultrasound parameters (cross-sectional area, flattening ratio, and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time, and complications were also recorded for the two groups. The Boston carpal tunnel questionnaire and electrophysiological and ultrasound outcomes at preoperatively and 3 months postoperatively had a significant difference for each group (each with P < 0.05). There were no complications such as infection, hemorrhage, vascular, nerve, or tendon injuries in both groups. Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment, and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application.

Effect of Fluoroscopic-Guided Corticosteroid Injection in Patients With Sacroiliac Joint Dysfunction.

Background Sacroiliac joint dysfunction is a major cause of axial low back pain which can masquerade as pain from lumbar disc diseases. Treatment of axial back pain arising due to sacroiliac joint dysfunction remains a challenge. This study was conducted to evaluate the long and short-term effects ofintra-articularcorticosteroid injection in the relief of pain and disability caused by sacroiliac joint dysfunction. Methodology A total of 83 patients with sacroiliac joint dysfunction were included in this prospective randomized control study. Patients were randomized into two groups by a computer-generated randomization table. These two groups were treated with fluoroscopy-guided corticosteroid and local anesthetic injection (group A) and distilled water and local anesthetic injection (group B). Pre and post-intervention assessment of all patients was done based on the Numeric Pain Rating Scale (NPRS) for pain and Oswestry Disability Index (ODI) for disability. The outcome measures of the study were the NPRS and ODI assessed at the initial visit one (pre-injection), two weeks post-injection (visit 2), and four weeks post-injection (visit 3). Results Demographic data were comparable in both groups. There was no significant difference in pre-injection NPRS and ODI values in both groups. The changes in NPRS and ODI values were significant from pre-injection to two weeks to four weeks. Group A patients performed better in terms of a decrease in the perception of pain and a decrease in the perception of disability compared to group B patients in the second and fourth weeks of follow-up. Conclusions Fluoroscopy-guided corticosteroid injection is an effective measure for reducing pain and disability in patients with sacroiliac joint dysfunction.

Effects of glenohumeral corticosteroid injection on stiffness following arthroscopic rotator cuff repair: a prospective, multicentric, case-control study with 18-month follow-up.

This study aimed to analyze the efficacy of single-dose corticosteroid injection (CSI) administered at 6 weeks postoperative to treat stiffness following arthroscopic rotator cuff repair (ARCR). In this prospective, multicentric, case-control study, post-ARCR stiffness at 6 weeks was treated with either a single dose of intra-articular CSI (CSI group) or physical therapy with oral analgesics (non-CSI group). Pain intensity according to visual analog scale (VAS), functional outcome using the Constant Murley Shoulder Score, time to return to activities of daily living (ADLs), and retear rate were recorded at 6 weeks, 9 weeks, 12 weeks, 6 months, 12 months, and 18 months postoperatively in both groups. A total of 149 patients (54.5%) in the CSI group and 124 patients (45.5%) in the non-CSI group were included in this study. Pain and function were significantly better in the CSI group at 9-week, 12-week, and 6-month (P&lt;0.001) follow-up, whereas they were not significantly different when the groups were compared at 12- and 18-month follow-up. The mean duration to return to ADLs was significantly shorter (P&lt;0.001) in the CSI group. The incidence of retears was not significantly different (P=0.36) between groups at the end of 18 months of follow-up. Single-dose intra-articular CSI administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI.

Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections

Background: Corticosteroid injections (CSIs) are effective in alleviating pain in patients with rotator cuff tears, but controversy still exists regarding their potential adverse effects on clinical outcomes after rotator cuff repair. Purpose: To compare both the functional and the structural outcomes in patients who underwent arthroscopic rotator cuff repair with or without preoperative CSIs. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was carried out among patients who underwent arthroscopic rotator cuff repair for partial- and full-thickness tears between 2015 and 2019. The patients who received preoperative CSIs were included in the CSI group and compared with a group without preoperative CSIs (non-CSI group), matched at a ratio of 1:2 based on tear size, age, and follow-up time. Both functional evaluation and structural assessments using magnetic resonance imaging (MRI) were performed at the final follow-up. Clinical outcomes—including retear rate as the primary outcome; pain; functional scores including the Constant-Murley score, American Shoulder and Elbow Surgeons score, and Fudan University Shoulder Score; range of motion (ROM); tendon integrity; tendon healing type; and cartilage thickness—were compared between the 2 groups with a statistical significance of P < .05 and power of 0.9. Results: Thirty-one patients were included in the CSI group, and 62 were included in the non-CSI group. After a mean 3-year follow-up, the 2 groups demonstrated no significant differences in retear rate; visual analog scale for pain; shoulder functional scores; and active ROM including forward flexion, abduction, external rotation, and internal rotation. No significant differences were observed on postoperative MRI scans of the rotator cuff tendon (tendon integrity, healing type, residual tendon attachment area, etc), cartilage thickness, and muscle atrophy. Conclusion: No significant differences were found at a mean 3-year follow-up in the retear rates, pain, ROM, and glenohumeral structure on postoperative MRI scans after arthroscopic rotator cuff repair with or without preoperative CSIs.

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.

REFRACTORY PLANTAR FASCIITIS- PRP OR LOCAL CORTICOSTEROID?

Background/Purpose: Plantar Fasciitis is often a nuisance to treat because of its intractable nature. Corticosteroid injections have been conventionally used to treat such cases.One emerging therapeutic modality is the use of PlateletRich-Plasma.We compare the efficacy of the two modalities.Methods: 60 patients with intractable plantar fasciitis were randomised to receive either autologous PRP or Corticosteroid injection. All patients were assessed with the Visual Analogue Score (VAS) for pain and the Foot &amp; Ankle Disability Index (FADI) Score.Data was collected prospectively on the cohort,pre-treatment,and at 1st,2nd,6th and 12th week post injection and the results were compared. Results:Both treatment cohorts had 30 patients, with the PRP injection group having an average age of 42.0 ± 12.98 years and Corticosteroid injection had an average age of 39.4 ± 10.09 years.PRP injection group had male to female ratio of 0.875 while corticosteroid injection group had a ratio of 0.67.Mean FADI scores and VAS scores on 2nd and 6th week of study were significantly higher in corticosteroid injection group as compared to the PRP injection group,while the mean of two scores had no significant difference between the two groups when measured on 1st and 12th week.Conclusion: Although both techniques have similar immediate and long term results,corticosteroid injection has better pain relief in short term

Title: How should we use corticosteroids in lateral epicondylitis? Local injection or phonophoresis? Running title: Corticosteroid use in lateral epicondylitis

Objective: This study, it was aimed to compare and evaluate the effectiveness of local corticosteroid injection and corticosteroid phonophoresis on grip strength, functional status, pain, and quality of life in lateral epicondylitis. Materials and Methods: Patients with a diagnosis of lateral epicondylitis who underwent corticosteroid phonophoresis or local corticosteroid injection were included in the study. Patients were grouped according to the treatment they received. In the first group, corticosteroid phonophoresis was applied to the lateral epicondyle region using a continuous mode ultrasonic at 1.0 W/cm2 and 1mHz dose with 0.1% betamethasone valerate cream as a conductive agent. In the second group, corticosteroid and local anesthetic injections were applied to the lateral epicondyle region. Two groups received the supervised exercise program. Before treatment and two weeks after treatment, visual analog scale, muscle strength, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand scores, and Nothingom Health Profile results for both groups were recorded from patient files and compared. Results: A total of 43 patients (23 phonophoresis, 20 corticosteroid injections) were enrolled. Although the pain, function, and quality of life of patients improved significantly with both groups, no significant difference was recorded between the groups. Grip and palmar pinch strength significantly increased in only the phonophoresis group. In addition, changing of grip and palmar pinch strength was significantly better in the phonophoresis group than in the corticosteroid injection group. Conclusion: It was determined that corticosteroid administration via phonophoresis instead of injection was more beneficial in terms of grip and palmar pinch strength.

Effectiveness of local injection of autologous blood versus corticosteroid in treatment of tennis elbow

Background: Tennis elbow or lateral epicondylitis is characterised by pain and tenderness at the lateral epicondyle of humerus. There are various treatment modalities recommended, but there is no universally accepted therapeutic modality yet. Objectives: To compare the functional outcomes of local injection of corticosteroid versus autologous whole blood for tennis elbow. Methods: This was a non-randomised trial conducted from May 2020 to January 2021 after ethical clearance. Patients attending orthopaedic surgery outpatient department, Kathmandu Medical College with lateral epicondylitis of the humerus were included by convenience sampling into corticosteroid group or autologous blood injection group based on whether they presented on odd or even calendar days respectively. There were 38 patients in corticosteroid group and 36 patients in autologous blood group. The visual analogue scale (VAS) and Nirschl staging system were calculated before injection, and then at one week, six weeks, and six months after injection. Results: Patients in both groups showed statistically significant decrease in pain from preinjection scores on both VAS and Nirschl scale at all follow-ups. There was no statistically significant difference between the two groups up to six weeks. At six months, autologous blood injection group showed statistically significant decrease in pain compared with corticosteroid injection group on both scoring systems. Conclusion: Both groups showed comparable improvement up to six-week follow-up. Autologous blood injection group had significantly better improvement at six months. Autologous blood injection was more effective than corticosteroid injection at midterm follow-up, and had lower recurrence rate.

A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis

IntroductionPlantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population.ObjectivesTo compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment.Materials and methodsThe study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections. Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness.DiscussionIn this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up.ConclusionThis study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.

Corticosteroid Injection for the Treatment of Trigger Finger: A Meta-Analysis of Randomised Control Trials.

Background: The purpose of this meta-analysis is to provide an evidence-based overview of the effectiveness of corticosteroid injection for the treatment of stenosing tenosynovitis (trigger digits). We have analysed only randomised control trials (RCTs) which compared the effectiveness of corticosteroid injections with control injections. Methods: The Cochrane Library, PubMed, Medline, Web of Science and Scopus were searched to identify relevant studies. The keywords for search in the database were ('stenosing tenosynovitis' OR 'trigger finger') AND injections. After screening titles and abstracts of these studies, full-text articles of studies that fulfilled the selection criteria were obtained. For the meta-analysis, we determined the pooled mean failure rate, odds ratio (OR), relative risk (RR) and 95% confidence intervals (CI) for the risk of failure rate between the corticosteroid injection group and the control group through the random-effects model. Results: Six RCTs were found that involved 368 participants. The corticosteroid injection group included 190 patients and 178 patients were included in the control group. The pooled estimate of successful treatment in the corticosteroid injections group was 63.68 ± 5.32% and that in the control group was 27.53 ± 11.52%. The pooled RR of treatment failure between the corticosteroid injection group and the control group was 0.49 (95% CI 0.40-0.60). The pooled OR of treatment failure between the corticosteroid injection group and the control group was 0.18 (95% CI 0.08-0.44). All the included studies reported either mild or no complications with corticosteroids or placebo injections. Conclusions: In the treatment of stenosing tenosynovitis, the corticosteroid injections have better outcomes compared to the control injections and this meta-analysis provides significant evidence of the effectiveness of corticosteroid injection for stenosing tenosynovitis with minimal adverse effects. Level of Evidence: Level II (Therapeutic).

Electrical Dry Needling Plus Corticosteroid Injection for Osteoarthritis of the Knee: A Randomized Controlled Trial

ObjectiveTo investigate the effects of electrical dry needling (DN) plus corticosteroid injection (CSI) on pain, physical function, and global change in patients with osteoarthritis of the knee (KOA). DesignA prospective, single-blinded, randomized controlled trial. SettingPain treatment clinic. ParticipantsSixty patients with KOA were randomly assigned to the electrical dry needling plus corticosteroid injection (electrical-DN+CSI) group or CSI group. InterventionsThe CSI group received glucocorticoid injection only once during the trial, and the electrical-DN+CSI group received glucocorticoid injection combined with 4 sessions of electrical-DN. Main Outcomes MeasuresThe primary outcome was the numerical rating scale at 3 months. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index, the time to complete the Timed Up and Go test, and the score of the global rating of change scale at 3 months. A generalized linear mixed-effects model was used to analyze the repeated measurement data. ResultsBaseline characteristics and measurements were similar in the 2 groups. The group by time interaction effect was significant for all variables (P<.05). The electrical-DN+CSI group obtained a more significant reduction in pain intensity and more significant improvement in dysfunction than the CSI group at 3 months (P<.05). The median global rating of change score for the CSI group was +3 (somewhat better), and that for the electrical-DN+CSI group was +4 (moderately better). ConclusionElectrical-DN therapy at myofascial trigger points combined with CSI is more effective at alleviating pain, improving dysfunction, and creating global change than CSI alone for patients with KOA. Electrical-DN may be an essential part of treatment for KOA rehabilitation.

Treatment of carpal tunnel syndrome by low-level laser therapy versus corticosteroid injection: a randomized, prospective clinical study.

To compare the effects of low level laser therapy (LLLT) and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS). Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or LLLT groups. 40mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). LLLT was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions (fluence of 6 j/cm2 for 1min per point at a wavelength of 830nm). Outcome measures were numbness and pain, QuickDASH questionnaire, grasping tests, Tinel and Phalen tests, electrophysiological tests and MRI evaluations, which were tested at the baseline and 1st and 6th months after the treatment. Eighty patients (133 wrists) completed the study at the end of 6months. VAS and Quick DASH scores were better in the corticosteroid group in the 1st month, but there were no significant differences between groups in the 6th month. Phalen and Tinel tests, strength tests, and motor distal latency improved significantly and similarly in both groups at the 1st and 6th months. Sensory distal latency and sensory nerve conduction velocity showed significant improvements in the 1st and 6th months only in the corticosteroid group. In both groups, median nerve intensity rate and palmary spring rate improved significantly after the treatment. Based on this study, corticosteroid injection and LLLT groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).

Greater Trochanteric Pain Syndrome (GTPS): A clinical prospective study of treatment options

Background: There are few prospective studies evaluating the efficacy of various non-operative strategies for treatment of greater trochanter pain syndrome (GTPS). There is a diversity of available interventions and lack of clear consensus for the best modality thus far. Design: Observational prospective cohort study performed during the period of October 2017 and March 2019. Methods: The main objective was to determine if there is a difference in outcome of the Lower Extremity Functional Scale (LEFS) for subjects treated with conservative management (PT), corticosteroid injection (CSI), or percutaneous ultrasonic tenotomy (PUT). Participants were assigned based on physician treatment in a non-randomized manner to PT, a single CSI, or the PUT treatment arm. Subjects participated in outcome assessments at baseline and at 1-, 3-, 6-, and 12-months post intervention. Results: 112 individuals with unilateral GTPS were recruited for this study with 69 PT patients, 31 CSI patients, and 12 PUT patients. The adjusted mean LEFS scores averaged across all time periods remained statistically different between PT, CSI, and PUT (p = 0.0093), indicating significant difference between each treatment arm. PT group saw the greatest improvements from baseline score starting at 1 month and up to 1 year (p = .0004). CSI group did not see significant LEFS improvement until 6 months (p = 0.04) and did not maintain clinically significant improvement by 1 year. PUT group saw significant LEFS improvement at 3 months (p = 0.0001) and maintained clinically significant improvements (≥ 9 LEFS points) throughout the course of the study. Conclusion: PT patients over the study period showed the greatest improvements in LEFS scores compared to CSI and PUT patients. We believe that PT is the best indicated course of treatment for GTPS. PUT may be considered as an additional option if patients have failed other treatment modalities. CSI shows benefit at 6 months, but overall inferior to PT and PUT.

Retrospective comparison of the efficacy of corticosteroid and dry needling in lateral epicondylitis

Lateral epicondylitis (LE) commonly known as tennis elbow (as it affects 50% of tennis players) is also a general public health issue as it affects a high number of the general population.The preferred method of treatment most commonly is a local corticosteroid (CS) injection with or without the addition of a local anesthetic 6. Dry needling (DN) is another treatment modality which is commonly employed for the management of LE.The purpose of our study was to evaluate whether DN is as effective as CS injections in the management of LE. The number of patients included in our study was 146. Patients were divided into two groups. One that had been treated with corticosteroid injections (Group A) and one that had been treated with dry needling (Group B).Patient evaluation forms/records at 4 weeks and 12 weeks, were retrieved and analyzed. For this modified criteria of Verhaar et al was utilized.The study suggests that both the techniques, i.e dry needling as well as corticosteroid injections are reliable methods for treatment of lateral epicondylitis.