Corticosteroid Injection Group Research Articles

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.

Comparison of Radial Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection Effectiveness in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Study.

The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome. A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale-pain, a Visual Analog Scale-numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment. Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale-pain, Visual Analog Scale-numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale-pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups. Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection.

Acupuncture Treatment for Shoulder Impingement Syndrome: A Review of Randomized Controlled Trials

To evaluate the effectiveness of acupuncture treatment for shoulder impingement syndrome (SIS) a literature review was conducted of randomized controlled trials (RCTs) where acupuncture was used as an intervention for patients diagnosed with SIS. Relevant clinical studies (N = 181) were retrieved from several databases based on the inclusion/exclusion criteria, and the interventions and results were analyzed. Six RCTs were selected to review based on the inclusion and exclusion criteria. In all 6 studies, the acupuncture treatment group showed significant positive changes in indicators evaluating pain, disability, and quality of life. A significant decrease in the evaluation indicators (Shoulder Pain and Disability Index, numeric rating scale, Visual Analogue Scale, Constant Murley Shoulder Assessment Score, patient’s global assessment, and doctor’s global assessment) and a significant increase in the questionnaire scores (UCLA, AL-score, EuroQol 5 Dimension Self-Report Questionnaire, and disabilities of the arm, shoulder, and hand) were observed. In addition, 1 study showed similar improvements in pain and quality of life measures in the acupuncture group and corticosteroid injection group. No major side effects were reported. Acupuncture may be an effective and safe treatment for SIS however, further RCTs are required.

Hip Corticosteroid/Anesthetic Injections—Are the reported rates of osteoarthritis progression and femoral head collapse real?

Objectives:In the absence of definitive Level I evidence regarding the safety of hip CSI, there have been an increasing number of retrospective case series studying outcomes after hip corticosteroid injection (CSI). Recent studies have suggested that hip CSI may be associated with increased rates of avascular necrosis (AVN), subchondral insufficiency fracture (SIF), femoral head articular surface collapse, and accelerated progression of osteoarthritis (OA), but these studies do not compare against a control arm matched for baseline OA severity or exclude patients with pre-injection AVN or SIF from analysis, causing selection bias. The purpose of this study was to compare complication rates in patients treated with and without CSI, while minimizing the aforementioned selection bias.Methods:For all patients at our institution who had undergone hip CSI between 2007 and 2019 and hip magnetic resonance imaging (MRI) within the preceding 12 months (CSI cohort), two musculoskeletal radiologists retrospectively reviewed hip radiographs taken within 12 months prior to and after CSI and graded OA severity (modified Kellgren-Lawrence classification) and femoral head collapse, blinded to cohort and timepoint. The same was done for a hip control cohort (matched for age, sex, BMI, and OA severity on baseline radiograph reports) that had undergone hip MRI and pre- and post-MRI hip radiographs within 12 months. A third reader arbitrated discrepant reads. OA progression was defined as an increase in modified Kellgren-Lawrence grade ≥1 between radiographs. Matched pairs with at least one incidence of pre-existing AVN or SIF on index MRI were excluded for analysis.Results:186 hips in the CSI group [mean ±95% CI age: 55.8±2.1, mean±95% CI BMI: 27.5±0.8, 69 (37.1%) males, 100 (53.8%) right hips] and 186 hips in the control group [mean ±95% CI age: 55.7±2.3, mean±95% CI BMI: 28.0±0.8, 69 (37.1%) males, 96 (51.6%) right hips] were included in this study. There were no significant differences between groups in age, gender, BMI, laterality, baseline OA severity, or baseline AVN/SIF on index MRI. Analysis of adjudicated radiographic outcomes were performed after exclusion of 61 matched pairs with at least 1 instance of pre-existing AVN or SI (Table 1). Rates of OA progression (5.6% vs. 2.4%; p=0.33), new AVN or SIF (1.6% vs. 0.0%; p=0.50), and new femoral head collapse (3.2% vs. 2.4%; p=1.000) were all similar between groups. Of the 4 cases of new femoral head collapse in the CSI group, 2 were classified as femoral head remodeling secondary to OA, leaving only two (1.6%) definitive femoral head collapses secondary to AVN or SIF. Of the 3 cases of new femoral head collapse in the control group, 2 were classified as femoral head remodeling due to an unknown etiology, leaving only one (0.8%) definitive femoral head collapses secondary to AVN or SIF. (Tables 1, 2, 3)Conclusions:When controlling for baseline OA severity and pre-existing AVN or SIF, patients treated by CSI in our study showed OA progression in only 6% of cases and new femoral head collapse in only 3% of cases, which was not significantly greater than control and similar to the expected progression of natural disease. Future multicenter, randomized, double-blind, placebo-controlled trials investigating safety of hip CSI are needed.

Effectiveness of Shock Wave Therapy versus Intra-Articular Corticosteroid Injection in Diabetic Frozen Shoulder Patients’ Management: Randomized Controlled Trial

Frozen shoulder is a major musculoskeletal illness in diabetic patients. This study aimed to compare the effectiveness of shock wave and corticosteroid injection in the management of diabetic frozen shoulder patients. Fifty subjects with diabetic frozen shoulder were divided randomly into group A (the intra-articular corticosteroid injection group) and group B that received 12 sessions of shock wave therapy, while each patient in both groups received the traditional physiotherapy program. The level of pain and disability, the range of motion, as well as the glucose triad were evaluated before patient assignment to each group, during the study and at the end of the study. Compared to the pretreatment evaluations there were significant improvements of shoulder pain and disability and in shoulder flexion and abduction range of motion in both groups (p < 0.05). The shock wave group revealed a more significant improvement the intra-articular corticosteroid injection group, where p was 0.001 for shoulder pain and disability and shoulder flexion and abduction. Regarding the effect of both interventions on the glucose triad, there were significant improvements in glucose control with group B, where p was 0.001. Shock waves provide a more effective and safer treatment modality for diabetic frozen shoulder treatment than corticosteroid intra-articular injection.

Low-Dose Perioperative Corticosteroids Can Be Administered Without Additional Morbidity in Patients Undergoing Bilateral Total Knee Replacement: A Retrospective Follow-up Study of a Randomized Controlled Trial.

Background: Short-term benefits of perioperative corticosteroid injections (CSIs) for bilateral total knee replacement (BTKR) include suppressed inflammation, improved knee motion, and reduced pain. Very little is known about the long-term benefits, complications, and safety of corticosteroids administered in the perioperative period. Purpose: We sought to compare 3-year follow-up outcomes of BTKR patients who received perioperative CSI with those who received placebo. We hypothesized that there would be no statistically significant differences in functional outcomes or adverse events based on whether or not CSIs were administered in the perioperative period. Methods: We conducted a retrospective review of chart and registry data of BTKR patients from a prior randomized controlled trial to compare outcomes in patients who received hydrocortisone vs placebo injections after BTKR (ClinicalTrials.gov: NCT01399268 and NCT01815918). Outcomes were compared at 6 and 12 weeks and at 1, 2, and 3 years. The Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate clinical outcomes. Cochran-Mantel-Haenszel tests were used to compare the risk of complications between treatments after adjustment for trial. When possible, summary relative risk estimates were calculated using the Mantel-Haenszel method. Results: No BTKR patients in the treatment group developed an infection. The risk of complications did not increase in patients who received CSI compared with those who received placebo. Patients in the CSI group experienced greater reductions in pain and stiffness, though these results were not statistically significant. There were no statistically significant differences in the KOOS-Symptoms, KOOS-Activities of Daily Living, KOOS-Sports, KOOS-Quality of Life, or WOMAC Function scores. Conclusions: Low-dose corticosteroids can be administered in selected patients who undergo BTKR without increasing the risk of adverse events. At 3-year follow-up, administration of low-dose corticosteroids did not result in superior clinical outcomes scores when compared with placebo.

Early Results of Kinesio Taping and Steroid Injections in Elbow Lateral Epicondylitis: A Randomized, Controlled Study.

Background and objectives: This study prospectively compares early results of Kinesio tape (KT) as an alternative method for the treatment of lateral epicondylitis with those of corticosteroid injection and the rest-and-medication group (RMG). Materials and methods: Among the fifty patients (53 elbows), KT was applied to 20 patients (21 elbows), and corticosteroid injection (CSI) was applied to 15 patients (17 elbows). Fifteen patients were included in the RMG. Patients in the RMG were informed about their condition, and necessary warnings were given. No oral or topical treatments were recommended. If needed, paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed. Patients were classified according to the Nirschl scores and evaluated with visual analog scale (VAS); Quick Disability of Arm, Shoulder and Hand (QDASH); and the Turkish version of the Patient Related Elbow Evaluation (PREE-T). Results: Improvements in all scores were statistically significant in all groups at the end of the second week. At the end of the fourth week, there was also a statistically significant improvement in all three groups, but these improvements were not as high as they were in the first 2 weeks. There was a slight deterioration in the functional scores in the RMG and CSI groups, while the improvement in the KT group continued. In the KT group, the average QDASH score was 18.1 (4.5–35), the VAS score was 2 (1–3), the VAS score in resisted wrist extension was 4 (2–5) and the Nirschl score was 2 (1–3) at the fourth week. The KT group had significant superiority in these parameters over the RMG (p = 0.035, p = 0.035, p = 0.029, p = 0.035, respectively). However, there was no significant difference between the KT, the RMG and the CSI groups at the fourth week. Conclusions: CSI, KT and rest-and-medication treatments were all effective in terms of pain reduction and functional scores at the end of week 2, and the only treatment that continued to be effective in the final week was KT.

Management Outcome of de Quervain's Disease with Corticosteroid Injection Versus Surgical Decompression.

This randomized clinical trial was undertaken to document the clinical presentation of de Quervain's disease and evaluate the outcome of management with triamcinolone acetonide (TAC) injection versus surgical decompression. Half of the patients were assigned to the corticosteroid injection group (group A) and half to the surgery group (group B). In group A, 40 mg of TAC was injected into the affected first extensor compartment. In group B, surgical decompression of first extensor compartment was performed. There were 56 patients with 38 (67.85 %) females and 18(32.14%) males. The age range was 23-66 years. In group A, one injection was employed among 7(25%) patients whereas two injections among 21(75%) patients. Local complications with injections were observed among 7 patients. Symptomatic relief with injection at 6-weeks was observed among 25% patients whereas recurrence at one year was observed among 9(32.14%) patients. In group B, no critical complications were encountered following surgery; all the patients had symptomatic relief at 6-weeks and there was no case with recurrence at one year. Surgical decompression provided superior results in terms of providing symptomatic relief at 6-weeks among all patients, absence of complications and no recurrence. The corticosteroid injections (CSI) were associated with the need for repeat injections among 75% cases and a recurrence rate of 32.14% at one year, rendering it to be comparatively a poorer choice.

Symptomatic COVID-19 infections in outpatient image-guided corticosteroid injection patients during the lockdown phase.

BackgroundMusculoskeletal pain is a debilitating problem treated with image-guided corticosteroid injections. During the COVID-19 pandemic, multiple societies issued caution statements because of the unknown effect of corticosteroids on the patient’s immune system. The purpose is to determine if image-guided corticosteroid injections administered during the COVID-19 lockdown phase were associated with a higher infection rate compared to the general population.Materials and methodsIn a prospective study, patients undergoing image-guided corticosteroid injections for pain management during the lockdown phase between April 15 and May 22, 2020, were enrolled. One month after the injection, patients were surveyed by telephone for any COVID-19-related symptoms, and the electronic medical record (EMR) was reviewed for symptoms and test results.ResultsSeventy-one subjects were recruited, 31 (44%) females, 40 (56%) males, ages 58 ± 17 (20–92) years. Follow-up was available in 66 (93%) of subjects, 60 (91%) by phone survey and EMR, 6 (9%) by EMR only, 45 ± 22 (19–83) days after injection. One (1/66, 1.52%; 95% CI 0.04–8.2%) 25-year-old male subject developed symptomatic infection 19 days after a tibiotalar injection. The prevalence of COVID-19 cases in the state of Massachusetts was 0.91% (62,726/6,892,503) during the study period. There was no significant difference in the rate of occurrence of new cases of COVID-19 infection between the corticosteroid injection group and the general population (p = 0.44).ConclusionImage-guided corticosteroid injections for pain management performed during the lockdown phase of the COVID-19 pandemic were not associated with a higher infection rate compared to the general population.

Outcome of Corticosteroid Injections, Extracorporeal Shock Wave Therapy, and Radiofrequency Thermal Lesioning for Chronic Plantar Fasciitis

Chronic heel pain with plantar fasciitis is relatively common and can affect adults of all ages regardless of an active or sedentary lifestyle. The purpose of the present study was to evaluate the effectiveness of corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL) treatments in chronic plantar heel pain that has been unresponsive to other conservative treatments. We retrospectively analyzed the results of 217 patients treated with CSI (n = 73), ESWT (n = 75), and RTL (n = 69). The treatment efficacy and pain intensity, as measured using the visual analog scale, were recorded and compared at the 6-month follow-up. Pain intensity decreased significantly in all patients. However, it decreased significantly more in the CSI and RTL groups than in the ESWT group (P < .001). Age, sex, body mass index, calcaneal spur presence, and symptom duration were similar among 3 groups (P > .05). No complications were noted after the CSI, ESWT, or RTL sessions. CSI, ESWT, and RTL successfully treated chronic plantar heel pain that did not respond to other conservative treatments; however, CSI and RTL yielded better therapeutic outcomes. Level III, retrospective comparative study.

Comparison of the effect of therapeutic elastic bandage, submucosal dexamethasone, or dexketoprofen trometamol on inflammatory symptoms and quality of life following third molar surgery: a randomized clinical trial.

We aimed to compare the effects of preoperative single-dose submucosal corticosteroid injection and postoperative elastic therapeutic bandage application with postoperative non-steroid anti-inflammatory drug therapy on postoperative inflammatory symptoms and quality of life following mandibular third molar surgeries. A single-center, randomized, clinical trial was conducted with 52 patients (36 female, 16 male) who expected severe postoperative sequelae as a result of the extraction of impacted mandibular third molars. The patients were randomized into three groups. In the preoperative submucosal corticosteroid injection group (n = 16), 8 mg/2 ml dexamethasone 21-phosphate was administered near operated sites. In the postoperative therapeutic elastic bandage application group (n = 19), Kinesio tapes were applied to operated sites. Paracetamol 500 mg was prescribed for the patients in the corticosteroid and elastic bandage application groups. In the postoperative non-steroid anti-inflammatory drug group (n = 17), 25 mg dexketoprofen trometamol was prescribed. Maximal mouth opening, swelling, pain, and Oral Health Impaction Profile scores were quantified preoperatively and postoperatively on the second and seventh days. Additionally, all patients were asked to evaluate the postoperative period by the Postoperative Symptom Severity Scale. Analysis of the obtained data revealed that on the second postoperative day, postoperative edema and trismus were significantly lower in the submucosal corticosteroid (p = 0.025, p = 0.03) and therapeutic elastic bandage (p = 0.032, p = 0.014) groups, and the patients in these groups had a more comfortable postoperative period than the group prescribed a postoperative non-steroid anti-inflammatory drug (p = 0.016). In oral surgery, postoperative elastic bandage application can provide results similar to those of preoperative submucosal corticosteroid injection with respect to inflammatory symptoms and quality of life. ClinicalTrials.gov Identifier: NCT04200885. Date of Registration: December 2019 (retrospectively registered).

A comparative study of passive stretching vs corticosteroid injection vs therapeutic ultrasound in plantar fasciitis

Background and Objective: This study compares passive stretching, corticosteroid injection and therapeutic ultrasound in plantar fasciitis. Materials and Methods: A total of 75 patients (age range, 18-60 years; 38 females) with PF were randomly assigned to receive either passive stretching (n = 25) or corticosteroid injection (n = 25) or therapeutic ultrasound (n=25). Passive stretching included both plantar fascia specific stretching exercise and Achilles tendon stretching exercise each applied in 10 sets of 10-second stretch and a 10-second rest 3 times a day for 6 months and supervised two times per week for 4 weeks to ensure that patients were doing the passive stretching exercise properly as they were advised. The corticosteroid injection group received a single palpation guided mixture of 40 mg of methylprednisolone and 2 ml of 2% lignocaine injection at baseline. Therapeutic ultrasound group received continuous mode, base frequency of 1MHz, power 2 w/cm2, applied during three minutes each on calcaneus medial tuberosity and on the 2 cm distal to tuberosity three times a week, for four weeks duration (total 12 sessions). Also the patients in all the 3 groups were advised to use silicon heel pads as a common modality of treatment. The patients’ functional outcome was assessed using the Foot and Ankle Ability Measure (FAAM), and relief of pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were recorded before the treatment and at 1 month, 3 month & 6 month follow-ups. Results: Age, sex and body mass index did not significantly impact pain relief or functional outcome (P > 0.05). Out of 75 planned subjects only 68 patients could be followed up. Planned pair-wise comparisons demonstrated significant improvements in pain relief and functional outcomes in terms of both VAS (P passive stretching >therapeutic ultrasound. But for the long term improvements (6 months), passive stretching was more effective than corticosteroid injection and therapeutic ultrasound was not effective. Hence passive stretching exercise is recommended as a primary line of treatment as it is a non-invasive modality, avoids complications associated with steroid injection and has long lasting effects.

A comparative study of functional outcome between platelet rich plasma injection versus steroid infiltration in plantar fasciitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Plantar fasciitis (PF) is considered as degenerative tendinopathies. Repeated micro trauma is the major etiology of these diseases. Autologous platelet rich plasma (PRP) injections are becoming more popular in the treatment of enthesopathies like PF. The growth factors in PRP cause tissue healing. We compared the result of injecting intra-lesional autologous PRP injections versus steroid infiltration in chronic PF.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective, interventional and analytic comparative study was done and 81 patients (120 heels) were included in this study and were followed up for 6 months. We assessed the outcome of each patient using visual analog score (VAS) and foot and ankle disability index (FADI) on follow-up at 1, 3, and 6 months. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, female preponderance was seen. Left side was more common as compared to right side. Unilateral PF is more common than bilateral. The difference with in the individual group at baseline and at 1,3 and 6 months was statistically highly significant in terms of VAS and FADI (p=0.0001) But the difference in the between the two groups was insignificant for VAS and FADI at 1, 3 and 6 months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study, as there is no significant difference in VAS and FADI score between corticosteroid injection group and PRP injection group at 1, 3 and 6 months follow up. So, it’s reasonable to conclude that both are equally effective in PF. But as PRP injection comes out to be more time consuming and more costly, corticosteroid seems to be more efficient, cost and time wise. Hence, the latter should be a better choice. &lt;/p&gt;

Carpal Tunnel Syndrome Treatment Using Ultrasound-Guided Versus Landmark-Guided Corticosteroid Injection: A Randomized Prospective Trial

Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy occurring due to increased pressure in the carpal tunnel. Objectives: The study aimed to evaluate the degree of symptom improvement, safety, and the change in electrophysiological findings after ultrasound (US)-guided versus Landmark (LM)-guided local steroid injection for the treatment of CTS. Methods: This randomized clinical trial recruited 52 patients with moderate or moderate-to-severe CTS. The subjects were randomly assigned to US-guided or LM-guided corticosteroid injection groups and received 40 mg methylprednisolone. After four weeks and 12 weeks of treatment, the patients were evaluated using the Boston questionnaire and electrophysiological parameters were determined. Results: All variables, including symptom/functional scores and electrophysiological findings, improved significantly in both groups after four weeks (all P 0.05). Conclusions: The symptom severity, functional status, and all electrophysiological parameters improved significantly in both US-guided and LM-guided corticosteroid injection groups and generally, no statistically significant difference was observed between both methods.

Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up

Background: A previously published trial showed that patients with chronic gluteal tendinopathy achieved greater clinical improvement at 12 weeks when treated with a single platelet-rich plasma (PRP) injection than those treated with a single corticosteroid injection (CSI). Purpose: This follow-up study was conducted to determine whether there would be a sustained long-term difference in the modified Harris Hip Score (mHHS) at 2 years for a leucocyte-rich PRP (LR-PRP) injection in the treatment of chronic gluteal tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This trial included 80 patients randomized 1:1 to receive LR-PRP or CSI intratendinously under ultrasound guidance. Patients had a mean age of 60 years, a 9:1 ratio of women to men, a mean body mass index of 27, and a mean length of symptoms >15 months. No patients had full-thickness tears of the gluteal tendons. An open-labeled extension allowed patients to receive crossover treatment after 3 months. The main outcome measure was the mHHS. Results: The mean mHHS improved significantly at 12 weeks in the PRP group (74.05; SD, 13.92) as compared with the CSI group (67.13; SD, 16.04) (P = .048). At 24 weeks, the LR-PRP group (77.60; SD, 11.88) improved further than the CSI group (65.72; SD, 15.28; P = .0003). Twenty-seven patients were deemed to have failed the CSI treatment at 16 to 24 weeks, with an exit score of 59.22 (SD, 11.54), and then had treatment with LR-PRP. The crossover group improved with the LR-PRP: from 59.22 (SD, 11.22) at baseline to 75.55 (SD, 16.05) at 12 weeks, 77.69 (SD, 15.30) at 24 weeks, and 77.53 (SD, 14.54) at 104 weeks. The LR-PRP group retained 38 of 39 patients to 52 weeks and continued to improve. Their baseline scores of 53.77 (SD, 12.08) improved to 82.59 (SD, 9.71) at 104 weeks (P < .0001). Conclusion: Among patients with chronic gluteal tendinopathy and a length of symptoms >15 months, a single intratendinous LR-PRP injection performed under ultrasound guidance results in greater improvement in pain and function than a single CSI. The improvement after LR-PRP injection is sustained at 2 years, whereas the improvement from a CSI is maximal at 6 weeks and not maintained beyond 24 weeks. Registration: ACTRN12613000677707 (Australian New Zealand Clinical Trials identifier).

Role of platelet-rich plasma versus corticosteroid injection in the treatment of plantar fasciitis: A comparative study

Introduction: Platelet-rich plasma (PRP) is promoted nowadays as an ideal autologous biological blood-derived product. It enhances wound healing, bone healing, tendon healing and is currently being widely used. Aims and Objectives: A prospective cohort study was conducted to assess the efficacy of autologous PRP injection and to compare it with corticosteroid injection in the treatment of plantar fasciitis (PF). Materials and Methods: Fifty patients were included in the study and divided into two groups. Group I (25 patients) received PRP injection and Group II (25 patients) were given steroid injection. Patients were clinically assessed at different intervals. Functional outcome was evaluated on the basis of the visual analog scale (VAS) and foot and ankle ability measure (FAAM) scores. Plantar fascia thickness was assessed pre- and post-injection by ultrasound. Results: PRP and corticosteroid injection groups at the initial visit had VAS score of 8.86 and 8.60, respectively, which was reduced to 1.52 and 3.10 at the end of 6 months. The PRP and corticosteroid injection groups at the initial visit had FAAM score of 29.2 and 30.8, respectively, which increased to 84.2 and 68.3 at the end of 6 months. After injection, the PRP group had a significant reduction (34.80%) in the thickness of plantar fascia as compared to corticosteroid group (29.54%). Conclusion: Treatment of PF with PRP extract reduces pain and significantly increases function, exceeding the effect of steroid on long-term follow-up.

The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial

SummaryBackgroundTo our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome.MethodsWe did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and ClinicalTrial.gov, number NCT02038452.FindingsBetween April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference −0·32; 95% CI −0·48 to −0·16; p=0·0001). No adverse events were reported.InterpretationA single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.FundingArthritis Research UK.

Dilemas in management of plantar fascitis

Background: Plantar fascitis is a common condition that occurs in the heel, and approximately 11% to 15% of adult foot symptoms are plantar fascitis. In terms of treatment, various methods have been used in the treatment of plantar fascitis, both conservative and surgical methods. When these conservative treatments fail, injecting steroids and Platelet rich plasma injection is considered an option. Both methods have proven good results in different studies. The purpose of this study was to assess the role and efficacy of isolated corticosteroids injection versus platelet rich plasma injection versus combination of both in the treatment of plantar fascitis. Materials and Methods: A total of 95 patients were studied. Patients were divided into three groups. Group A had 35 patients of which 25 were females and 10 were males and they received only platelet rich plasma injection. The Group B had 30 patients 16females and 14maleswho received corticosteroid injection only and Group C had 40 patients of which 20 were males and 20 were females who received both corticosteroid injection and platelet rich plasma. The evaluation of pain was done using VAS score. Results: Visual Analog Scores on 0 day, the day of injection for group A, B, C were 6.75, 4 and 5.85 respectively. The study showed a lower VAS scores with the combined and corticosteroid group till 3 months and no significant change at the end of 6 months. Conclusion: Our study has shown that corticosteroid injection group is effective for immediate pain relief, group but in long term there is no significant change in all the three groups.

The Effect Of Perioperative I.V. Corticosteroids On Hearing Outcome Following Stapedotomy

Objective: The purpose of this study is to investigate the effect of steroids on postoperative hearing outcome in patients with a clinical diagnosis of otosclerosis, who received intraoperative steroid treat ment during surgery for conductive-type hearing loss. Methods: Between January 2014 and January 2017, 106 patients, comprising 43 men (40.6%) and 63 women (59.4%) between the ages of 18-64 (mean age: 44.1 ± 11.5 years), who had been diag nosed with otosclerosis resulting in conductive-type hearing loss, were included in the study. The audiometric values obtained for patients who had received intraoperative intravenous steroids were analysed on a retrospective basis by comparing the pre- and post-operative sit uation. The group of all patients was then subdivided into two groups on the basis of whether or not they had received intraoperative ster oids. These groups were then evaluated in terms of pre- and post-op erative bone and air conduction levels and the differences investigated statistically. Results: Postoperative bone conduction averages for all the patients in both Group 1 and Group 2 were significantly improved at all fre quencies, except at 4000 Hz, compared to the preoperative mean val ue. However, there was no statistically significant difference observed between patients who did receive intra-operative single-dose IV corti costeroid injections and patients who did not receive IV corticosteroid injections group in terms of preoperative and postoperative air-bone conduction levels. Conclusion: It is not necessary routinely to administer systemic corti costeroids in order to prevent perioperative sensorineural hearing loss during surgery for otosclerosis. However, perioperative corticosteroids may be helpful in preventing sensorineural hearing loss when there are conditions present that can lead to inner ear damage during the operation.