Corticosteroid Injection In Treatment Research Articles

Letter to the editor regarding “Hydrodilatation versus corticosteroid injection in treatment for adhesive capsulitis” by Latzka et al

Letter to the editor regarding “Hydrodilatation versus corticosteroid injection in treatment for adhesive capsulitis” by Latzka et al

Comparing the Efficacy of Local Corticosteroid Injection and High-Intensity Laser Therapy in Patients with De Quervain Tenosynovitis

Background and Objective: De Quervain's tenosynovitis is one of the common causes of wrist pain. The present study aimed to compare the effectiveness of high-power laser therapy and local corticosteroid injection in the treatment of De Quervain's tenosynovitis. Materials and Methods: In this clinical trial, 30 patients diagnosed with De tenosynovitis were randomly assigned to two groups of 15, A and B. Group A underwent high-power laser therapy, five sessions for three consecutive weeks, and group B received corticosteroid injections of 1 ml triamcinolone and 1 ml lidocaine 2% in the wrist under ultrasound guidance. Tendon thickness, pain intensity, quality of life, and treatment satisfaction were measured and compared in both groups pre-treatment, month one, and month three post-treatment. Results: In groups A and B, respectively, the mean scores of the thickness of extensor abductor pollicis longus and abductor pollicis brevis muscles before the treatment were 7.57±0.63 and 7.25±0.58 (P=0.120). these value were calculated at 6.55±0.61 and 6.54±0.40 one month later (P=0.955). They were 5.71±0.75 and 5.99±0.45 (P=0.239) mm three months post-treatment. In addition, pain scores before the treatment were 8.60±1.18 and 8.47±1.46 (P=0.785). One month later, they were 2.73±1.66 and 4.27±1.16 (C=0.785), and three months post-treatment, they were 1.73±1.33 and 2.47±1.06 (P=0.007). There was no significant difference between the two groups in terms of quality of life and satisfaction with treatment (P<0.05 for all). Conclusion: Both local corticosteroid injection and high-power laser treatment methods were safe in the treatment of De Quervain's tenosynovitis, leading to a reduction in pain and tendon thickness, as well as an increase in the patient's quality of life

Extra-corporeal shock wave therapy versus local corticosteroid injection in treatment of chronic trigger finger in diabetic patients

BackgroundTrigger finger is one of the most common causes of pain and dysfunction. The aim of our study was to compare the effectiveness of shock wave therapy versus local corticosteroid injection in the treatment of trigger finger in diabetic patients.ResultsThe two groups were matched on age, HbA1c, VAS score, and grip force at week zero. There was statistically significant improvement in both groups after treatment. In comparing the two groups after 6 weeks of starting treatment either by shockwave therapy or by local corticosteroid injection, there was a statistically significant improvement in group 1 as regards VAS pain score (p = 0.012), clinical signs (finger extension and locking) (p = 0.018), hand grip dynamometer (p < 0.001), and musculoskeletal ultrasound findings in comparison to group 2.ConclusionTrigger finger is a common complication of DM. Shockwave therapy was able to reduce pain and improve hand functional level and quality of life. Shockwave is an effective, safe, non-invasive method for conservative management of trigger finger.

Comparison of corticosteroid injection, physiotherapy and combined treatment for patients with chronic subacromial bursitis – A randomised controlled trial

Objective To investigate whether combination of corticosteroid subdeltoid injections and physiotherapy was more effective than either treatment alone in chronic subacromial bursitis. Design Prospective, three-arm randomised controlled trial. Setting Rehabilitation department of an academic hospital. Subjects Patients with chronic subacromial bursitis. Interventions Patients were divided into corticosteroid injection (N = 36), physiotherapy (N = 40) and combined (N = 35) groups. Two corticosteroid subdeltoid injections in corticosteroid group, 8-week physical therapy emphasising on therapeutic exercise in physiotherapy group, and combined both treatments in combined group. Main outcome measures The primary outcome measures were pain visual analogue scale and Shoulder Pain and Disability Index at 8 weeks after finishing treatment. The secondary outcome measures were active range of motion, Shoulder Disability Questionnaire, Western Ontario Rotator Cuff Index, patient's evaluation of treatment effect, and symptom recurrence. Results Group comparison showed significant statistical difference in shoulder flexion (P < 0.003) and patient's evaluation of treatment effect (P < 0.001). The time and group interactions comparison revealed significant statistical differences in pain score (P < 0.024), external rotation (P < 0.044) and patient's evaluation of treatment effect (P < 0.001). The above statistics were in favour of the corticosteroid and combined groups rather than physiotherapy group. The percentage of recurrence was 36.1, 7.5 and 17.1 in the corticosteroid, physiotherapy and combined groups, respectively (P < 0.001). Conclusion Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group.

Nonorganic (Behavioral) Signs and Their Association With Epidural Corticosteroid Injection Treatment Outcomes and Psychiatric Comorbidity in Cervical Radiculopathy: A Multicenter Study

ObjectiveTo determine the association between cervical nonorganic pain signs and epidural corticosteroid injection outcomes and coexisting pain and psychiatric conditions. Patients and MethodsSeventy-eight patients with cervical radiculopathy who received epidural corticosteroid injection were observed to determine the effects that nonorganic signs have on treatment outcome. A positive outcome was a decrease of 2 or more points in average arm pain, coupled with a score of 5 on a 7-point Patient Global Impression of Change scale 4 weeks after treatment. Nine tests in 5 categories (abnormal tenderness, regional disturbances deviating from normal anatomy, overreaction, discrepancies in examination findings with distraction, and pain during sham stimulation) were modified from previous studies and standardized. Other variables examined for their association with nonorganic signs and outcomes included disease burden, psychopathology, coexisting pain conditions, and somatization. ResultsOf the 78 patients, 29% (n=23) had no nonorganic signs, 21% (n=16) had signs in 1 category, 10% (n=8) had signs in 2 categories, 21% (n=16) had signs in 3 categories, 10% (n=8) had signs in 4 categories, and 9% (n=7) had signs in 5 categories. The most common nonorganic sign was superficial tenderness (44%; n=34). Mean number of positive nonorganic categories was higher in individuals with negative treatment outcomes (2.5±1.8; 95% CI, 2.0 to 3.1) compared with those with positive outcomes (1.1±1.3; 95% CI, 0.7 to 1.5; P=.0002). Negative treatment outcomes were most strongly associated with regional disturbances and overreaction. Positive associations were noted between nonorganic signs and multiple pain (P=.011) and multiple psychiatric (P=.028) conditions. ConclusionCervical nonorganic signs correlate with treatment outcome, pain, and psychiatric comorbidities. Screening for these signs and psychiatric symptoms may improve treatment outcomes. Trial RegistrationClinicalTrials.gov identifier: NCT04320836.

Effects of Intra-Articular Corticosteroid Injection Treatment According to Whether Hydrodilatation in Idiopathic Hip Joint Adhesive Capsulitis: A Retrospective Comparative Study

Effects of Intra-Articular Corticosteroid Injection Treatment According to Whether Hydrodilatation in Idiopathic Hip Joint Adhesive Capsulitis: A Retrospective Comparative Study

Frequency of Destructive Hip Disease Post Intra-Articular Cortecosteroid Hip Injection

Objective: This study aims to quantify the prevalence of destructive hip disease following intra-articular corticosteroid hip injections. Study design: A retrospective study Place and duration of study: Department of Orthopaedic, Khyber Teaching Hospital Peshawar during the period from January, 2022 to June, 2022. Methods: This study was conducted on two hundred cases of corticosteroid injection treatment. For finding the frequency of destructive hip disease, the radiological imaging was used. Patients were compared with their clinical, paraclinical, and demographic data. Observations of pain, joint mobility, and radiographic evaluation served as the foundation for the recently suggested clinico-radiological diagnostic criteria. The inter- and intraobserver reliability of the radiological grading system was evaluated. For statistical analysis, SPSS-20 was employed.. Results: From the total 200 cases, patients with POH were 80(40%), with RPOH were 20(10%), with femoral head avascular necrosis were 20(10%) and with secondary osteoarthritis of hip were 40(20%), patients went for THA were 90%. There were 30% males and 160% females with mean age of 53.9 ±3.3 and BMI &gt;32. The corticosteroidal injection of 40mg triamcinolone-acetonide with 4 mL 1% lidocaine was placed in 21(77.8%). Conclusion: An elevated chance of quickly degenerative hip disease can result from intra-articular corticosteroid hip injection. Hip injections with intra-articular corticosteroids are probably not as safe as we had believed. Hip injections should only be used when absolutely necessary, and their usage should be reduced. Before administering a large and repeated dose of corticosteroids, the patient should also be warned about the possibility of the condition progressing faster. Keywords: RDHD, intra-articular corticosteroid hip injection, frequency.

Surgical creation of multiple drainage holes versus local injection of corticosteroids for treatment of aural hematomas in dogs: 51 dogs with 71 aural hematomas (2000-2017).

To investigate the outcome of surgical creation of multiple drainage holes (MDHs) versus local corticosteroid injection (LCI) for treatment of aural hematomas (AHs) in dogs and identify risk factors for recurrence and development of new AHs. 51 dogs with 71 AHs. Medical records were reviewed, and information on signalment, clinical findings, and outcome was recorded. Recurrence was defined as development of an AH at the primary site after the first month of treatment. Development of a new AH was defined as an AH occurring at a site different from the treated site. The recurrence rate after the first month of treatment was significantly higher following the LCI procedure (17/48 AHs [33%]) than after the MDH procedure (1/24 AHs [4%]). The odds of recurrence increased as the numbers of LCI in the first month increased (OR, 2.414). Recurrent AHs after LCI resolved with additional LCIs; only 1 AH (2%) required a change to MDHs. No recurrence was observed after the eighth month, and the cosmetic results were good. Sixteen of 51 (31%) dogs had multiple or new AHs. The risk of new AHs was higher in Golden Retrievers and Labrador Retrievers and in dogs with allergic dermatitis. Long-term outcomes suggested that both creation of MDHs and LCI can be therapeutic options for dogs with AHs. However, the risk of new AH development should be considered, especially in retriever breeds and dogs with allergic dermatitis.

Extracorporeal shock wave therapy (ESWT) versus local corticosteroid injection in treatment of lateral epicondylitis (tennis elbow) in athletes: clinical and ultrasonographic evaluation

BackgroundLateral epicondylitis is one of the commonly noticed disorders of the arm described by agony focused over lateral epicondyle which is the site of wrist extensors origin. The purpose of this work was to compare the efficiency of extracorporeal shock wave therapy and local corticoid injection in management of lateral epicondylitis both clinically and ultrasonographically as well as to assess the role of ultrasound in diagnosis and follow-up of lateral epicondylitis. This study was performed on 30 athletes diagnosed as lateral epicondylitis.ResultsBoth corticosteroid injection and shock wave treatment showed a highly significant effectiveness on pain by visual analog scale (VAS). A highly significant difference between before treatment and after 2 as well as 4 weeks of treatment regarding the functional disability parameters as patient-rated tennis elbow evaluation (PRTEE) and quick disabilities of the arm, shoulder, and hand (DASH) was found. Likewise, a statistically significant improvement in favor of shock wave therapy group after 2 weeks was found, inversely insignificant difference after 8 and 12 weeks regarding to VAS occurred. Both PRTEE and Quick DASH test showed a statistically significant difference among groups through all follow-up period.There was a statistically insignificant difference among the studied groups according to ultrasound (US) changes in the form of focal areas of hypo-echogenicity through follow-up periods. A significant improvement in favor of ESWT group is detected among the studied groups regarding tendon thickening in ultrasonography before treatment and after 2 and 4 weeks. However, the difference was insignificant after 8 and 12 weeks.ConclusionsBoth corticosteroid local injection and shock wave therapy are helpful and effective for lateral epicondylitis treatment. However, a shock wave therapy revealed better improvement on long-term clinical and ultrasonogrphic follow-up than corticosteroid injection. Musculoskeletal ultrasound represents a helpful diagnostic and follow-up tool for lateral epicondylitis.

Retrospective Analysis of Patients Undergoing Arthroscopic Rotator Cuff Repair at a Single Institution Yields a 0.11% Postoperative Infection Rate

PurposeTo establish an infection rate following primary arthroscopic rotator cuff repair (ARCR) from a single institutional database and to ascertain whether there is a relationship between the use of preoperative corticosteroid injection (CSI) and the risk of postoperative infection.MethodsAll medical records at a single institution were retrospectively reviewed to identify patients who had undergone arthroscopic repair from January 2016 to December 2018. Patient charts were reviewed for CSI treatment within 6 months of surgery, superficial or deep infection within 2 months postoperatively, and specific treatment of the infection. Patient characteristics were summarized by descriptive statistics using means with standard deviations for continuous variables and frequencies with percentages for categorical variables. A χ2 correlation analysis was performed to determine the association between receiving an injection and having an infection.ResultsA total of 1773 patients were included for analysis with an average age of 59.24 ± 9.4 years. The overall infection rate was 0.11% (2/1773 patients). Both patients were treated with oral antibiotics. Of the included patients, 616 had a preoperative CSI within 6 months of their surgery, and 102 injections were administered within 1 month of surgery. None of these patients had a postoperative infection. A χ2 correlation analysis showed a negligible relationship between preoperative injections and postoperative infection (φ = 0.02, χ2 = 0.84).ConclusionsThrough this single-institution, large cohort retrospective review, we found an overall 0.11% rate of postoperative infection following primary arthroscopic RCR. In addition, we found no correlation between the use of preoperative CSI ahead of elective ARCR at any time point and risk of developing a postoperative infection. Infection is uncommon following ARCR, and preoperative steroid injection did not increase infection risk in our study population.Level of EvidenceLevel IV, therapeutic case series.

The use and safety of corticosteroid injections for shoulder pain in general practice: a retrospective cohort study.

BackgroundGuidelines for shoulder pain in general practice recommend treatment with corticosteroid injections (CSI) if initial pain management fails. However, little is known about the actual use and safety of CSIs in treatment by general practitioners (GP).ObjectiveThe objective of this study was to gain insight into the use and safety of CSIs for patients with a new episode of shoulder pain in general practice.MethodsA retrospective cohort study was conducted using a healthcare database containing the electronic medical records of approximately 200,000 patients in general practice. A search algorithm was constructed to identify patients with a new episode of shoulder pain between January 2012 and December 2017. Data on the use of CSIs in 2 random samples (n = 1,000) were manually validated for a 12-month period after the diagnosis.ResultsIn total, 26% of the patients with a new episode of shoulder pain received a CSI. The patient’s age (OR 1.03, 95% CI 1.02–1.04) and a history of shoulder pain (OR 1.52, 95% CI 1.13–2.12) were significantly associated with the administration of a CSI. Half of the patients received the CSI in the first consultation. The patient’s age was positively associated with the likelihood of receiving the CSI in the first consultation (OR 1.01, 95% CI 1.00–1.02). No serious adverse reactions were recorded by the GP.ConclusionIn contrast to the guidelines, CSIs were frequently administered in the first consultation. Older patients and patients with a history of shoulder pain were more likely to receive a CSI for shoulder pain.

The effectiveness of corticosteroid injection and splint in diabetic de Quervain's tenosynovitis patients: A single-blind, randomized clinical consort study.

Background:There is no clear information on the efficacy of corticosteroids, and splints in the treatment of patients with diabetes mellitus (DM). The aim of this study was to compare the outcomes of isolated corticosteroid injection therapy with splint treatment with corticosteroid injection in patients with and without DM.Methods:84 diabetics, and 84 healthy patients with a diagnosis of de Quervain's tenosynovitis were included in our study. The patients were randomly distributed into four subgroups with and without DM. Groups 1 and group 2 consisted of diabetic patients, while group 3 and group 4 consisted of healthy patients. Corticosteroid injections were administered to groups 1 and 3, and corticosteroid injection and splint treatment were administered to groups 2 and 4.Results:There was no significant difference in terms of age, gender, dominant/non-dominant hand, pre-treatment Quick Disabilities of the Arm, Shoulder and Hand score and visual analog scale scores score between the four groups. Quick Disabilities of the Arm, Shoulder and Hand and visual analog scale scores in the four groups were found to be significantly better than pre-treatment at the 12th month. Finkelstein test results were positive in 37.5% of the patients in the first group, 35% of the patients in the second group, 20% of the patients in the third group and 9.5% of the patients in the fourth group. Groups 1 and 2 and, groups 3 and 4 were compared to evaluate the effect of the splint. While forearm-based thumb splint affected the results positively in healthy individuals, it was determined that it had no effect on the results in diabetic patients.Conclusion:Although corticosteroid treatment is effective in the treatment of de Quervain's tenosynovitis in healthy and diabetic individuals, the results are worse in diabetic patients than in healthy patients. In addition, the use of splint with corticosteroid injection in healthy individuals positively affects the results, while it does not affect the results in diabetic patients.

Comparison of steroid injection and platelet-rich plasma injection in the treatment of De-Quervain Tenosynovitis

Aim: The aim of this study was to evaluate the therapeutic effect of corticosteroid and platelet-rich plasma (PRP) injections in the treatment of De Quervain Tenosynovitis. Methods: The study group comprised of 49 patients with 50 hands divided into two groups. In the corticosteroid group (Group A; n=28), 1 ml of methylprednisolone (40 mg/ml) was injected along with 1 ml of 0.5% bupivacaine. In the PRP group (Group B; n=22), PRP was obtained from the patients’ own blood and injected in a single dose. Patients were evaluated using Visual analogue scale (VAS), the shortened disabilities of the arm, shoulder and hand questionnaire (DASH) at baseline, one and three months after the injection. Results: Overall, 44 females and 5 males were included with 28 hands in Group A and 22 hands in Group B. The CS group had better pain relief, hand function tests at 1 month and at 3 months follow-up, the PRP group had better pain relief, hand function tests than CS group. Conclusion: PRP therapy proves to be more effective in relieving pain than corticosteroid injections in treatment of De-Quervain Tenosynovitis.

Comparison between the effect of single-dose radial extracorporeal shock wave and local corticosteroid injection in treatment of patients with carpal tunnel syndrome

Objective To evaluate the efficacy of radial extracorporeal shock wave therapy (rESWT) compared with local corticosteroid injection (LCsI) in reducing pain and improving the function of patients with mild and moderate carpal tunnel syndrome (CTS) over 6 months. Patients and methods We studied 40 patients with mild and moderate CTS, where 20 patients received single-dose rESWT and the second group was treated with LCsI. Both groups had been assessed at baseline and at 1, 3, and 6 months after treatment using Boston self-assessment questionnaire (BQ) and visual analog scale (VAS) and at baseline and after 3 months using neurophysiological studies. Our prospective study compared efficacy in relieving pain and improving clinical function between single-dose rESWT and LCsI over 6 months. We subdivided our patients into mild and moderate groups and comparing improvement in outcome variables after treatment with rESWT and LCsI. Results There was a significantly higher improvement in symptom severity scores, functional scores, and BQ scores and decrease in VAS at 3 and 6 months, with significant improvement in sensory nerve conduction parameters at 3 months in the rESWT group compared with the LCsI group. When compared with the baseline, there was a significant reduction of VAS and functional score, symptom severity scores, BQ scores at third and sixth months, and electrophysiologic parameters at third month in the rESWT group. The LCsI group had no statistically significant improvement in all outcome variables at sixth month. Moreover, there were highly positive significant correlations between peak sensory latency of median nerve and the clinical outcomes (VAS and BQ score) at the sixth month after rESWT and between motor latency of median nerve and BQ score in mild and moderate CTS groups. Conclusion Single-dose rESWT is a noninvasive and convenient method for treating mild and moderate CTS with long-term beneficial effect lasting up to 6 months compared with LCsI.

Corticosteroid injection treatment for dactylitis in psoriatic arthritis.

Dactylitis – a hallmark clinical feature of psoriatic arthritis (PsA) – that occurs in 30–50% of PsA patients, is a marker of disease severity for PsA progression, an independent predictor of cardiovascular morbidity and impairs the motor functions of PsA patients. There is a paucity of evidence for the treatment due to the absence of randomized controlled trials assessing dactylitis as a primary endpoint and current practice arises from the analysis of dactylitis as a secondary outcome. Corticosteroid (CS) injections for dactylitis in PsA patients are a therapeutic treatment option for patients with isolated dactylitis or for patients with flares in tendon sheaths, despite stable and effective systemic treatment. The aim of this narrative review is to briefly illustrate the clinical aspects of dactylitis in PsA, the imaging and clinimetric tools used to diagnose and monitor dactylitis, the current treatment strategies and principally to provide a comprehensive picture of the clinical efficacy and safety with ultrasound-guide and blind techniques of CS injections for dactylitis in PsA patients.

A randomized control study to assess the efficacy of platelet rich plasma and local corticosteroid injection in treatment of chronic plantar fasciitis

Introduction and Objectives: Among all the known tendinopathies plantar fasciitis and tennis elbow account for most cases.Corticosteroid injections considered the treatment of choice for tendinopathies. Emerging therapeutic modalities is the use of platelet rich plasma for tendinopathies having the advantage of being autologous and concentrated that are rich in growth factor proteins. The study was done to find the efficacy of these two modalities. Materials and Methods: The study was done at Rajarajeshwari Medical College and Hospital, satisfying the inclusion criteria and exclusion criteria. In this study, 3 ml of the extracted PRP or 40 mg of prednisolone was injected into the affected area. Post-intervention pain and functional assessment at 2 weeks, 6 weeks, 3 months and 6 months with visual analogue score and ankle hind foot scale and foot and ankle disability index score. Results: The age in our study was 18 to 55 years, the mean in the steroid group was 37. 3 and in the PRP group was 37.43, right side was most commonly involved 52%. In both the groups there was significant difference in the VAS scores p In both the groups there was significant difference p Interpretation and Conclusion: PRP has better effect pain in patients with longer duration as compared to local steroids but the difference is not statistically significant. The making of PRP is cumbersome but the patients did prefer to steroids due to the adverse effects. Keywords: FADI- Foot and ankle disability index score, PRP- Platelet-rich plasma.

Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial

BackgroundTrigger finger is a common hand disorder that limits finger range of motion and causes pain and snapping of the affected finger. Trigger finger is caused by an imbalance of the tendon sheath and the flexor tendon. The initial treatment is generally a local corticosteroid injection around the first annular (A1) pulley. However, it is not unusual that surgical release of the A1 pulley is required. Moreover, adverse events after local corticosteroid injection or operative treatment may occur. Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease. However, the effects of PRP on trigger finger have not been studied. The aim of this single-center triple-blind randomized controlled trial is to study whether PRP is non-inferior to corticosteroid injection in treating trigger finger. The secondary outcome is to assess the safety and efficacy of PRP in comparison to placebo.MethodsThe trial is designed as a randomized, controlled, patient-, investigator-, and outcome assessor-blinded, single-center, three-armed 1:1:1 non-inferiority trial. The patients with clinical symptoms of trigger finger will be randomly assigned to treatment with PRP, corticosteroid, or normal saline injection. The primary outcome is Patient-Rated Wrist Evaluation and symptom resolution. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand; pain; grip strength; finger active range of motion; and complications. Appropriate statistical methods will be applied.DiscussionWe present a novel RCT study design on the use of PRP for the treatment of trigger finger compared to corticosteroid and normal saline injection. The results of the trial will indicate if PRP is appropriate for the treatment of trigger finger.Trial registrationClinicalTrials.gov NCT04167098. Registered on November 18, 2019.

Are low-dose corticosteroid injections as effective as high-dose corticosteroid injections for treatment of painful adhesive capsulitis?

Are low-dose corticosteroid injections as effective as high-dose corticosteroid injections for treatment of painful adhesive capsulitis?

Predictors of the effects of treatment for shoulder pain: protocol of an individual participant data meta-analysis

BackgroundShoulder pain is one of the most common presentations of musculoskeletal pain with a 1-month population prevalence of between 7 and 26%. The overall prognosis of shoulder pain is highly variable with 40% of patients reporting persistent pain 1 year after consulting their primary care clinician. Despite evidence for prognostic value of a range of patient and disease characteristics, it is not clear whether these factors also predict (moderate) the effect of specific treatments (such as corticosteroid injection, exercise, or surgery).ObjectivesThis study aims to identify predictors of treatment effect (i.e. treatment moderators or effect modifiers) by investigating the association between a number of pre-defined individual-level factors and the effects of commonly used treatments on shoulder pain and disability outcomes.MethodsThis will be a meta-analysis using individual participant data (IPD). Eligible trials investigating the effectiveness of advice and analgesics, corticosteroid injection, physiotherapy-led exercise, psychological interventions, and/or surgical treatment in patients with shoulder conditions will be identified from systematic reviews and an updated systematic search for trials, and risk of bias will be assessed. Authors of all eligible trials will be approached for data sharing. Outcomes measured will be shoulder pain and disability, and our previous work has identified candidate predictors. The main analysis will be conducted using hierarchical one-stage IPD meta-analysis models, examining the effect of treatment-predictor interaction on outcome for each of the candidate predictors and describing relevant subgroup effects where significant interaction effects are detected. Random effects will be used to account for clustering and heterogeneity. Sensitivity analyses will be based on (i) exclusion of trials at high risk of bias, (ii) use of restricted cubic splines to model potential non-linear associations for candidate predictors measured on a continuous scale, and (iii) the use of a two-stage IPD meta-analysis framework.DiscussionOur study will collate, appraise, and synthesise IPD from multiple studies to examine potential predictors of treatment effect in order to assess the potential for better and more efficient targeting of specific treatments for individuals with shoulder pain.Systematic review registrationPROSPERO CRD42018088298

The evaluation of the effectiveness of intra-articular steroid, tenoxicam, and combined steroid-tenoxicam injections in the treatment of patients with knee osteoarthritis.

Although intra-articular corticosteroid injections are widely applied in the treatment of knee osteoarthritis (OA), its effect is short term. Additionally, apart from oral use, tenoxicam is also applied as an intra-articular treatment option to minimize gastrointestinal side effects of NSAIDs. Clinical evidence suggests that the combined use of NSAIDs and corticosteroids is synergistic (especially macular edema after cataract surgery in ophthalmology). Therefore, the aim of this study is to determine whether the combination of intra-articular steroid and tenoxicam was more effective for a long period rather than only tenoxicam and steroid injection alone in OA treatment. Ninety patients were randomly divided into three groups (30 patients per group): group 1, group 2, and group 3 were treated by intra-articular injection of tenoxicam, triamcinolone hexacetonide, and triamcinolone hexacetonide plus tenoxicam, respectively. Visual analog scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were enrolled at baseline and 1, 3, and 6months post-injection. The mean age of patients was 68.07 ± 8.08, 65.83 ± 10.13, and 67.07 ± 6.01 in group 1, group 2, and group 3, respectively. In tenoxicam group, median pre- and post-treatment (at 1, 3, and 6months) VAS/WOMAC scores were 7.30 ± 0.53/32.50 ± 3.79, 2.27 ± 0.98/10.83 ± 2.61, 6.73 ± 1.14/30.33 ± 5.93, and 7.03 ± 0.80/31.37 ± 4.38, respectively. In steroid group, median pre- and post-treatment VAS/WOMAC scores were 7.60 ± 0.49/34.33 ± 3.40, 1.37 ± 1.21/8.83 ± 2.70, 6.87 ± 1.35/30.80 ± 7.70, and 7.27 ± 0.86/32.83 ± 4.87, respectively. In steroid plus tenoxicam group, median pre- and post-treatment VAS/WOMAC scores were 7.57 ± 0.50/33.20 ± 3.66, 0.33 ± 0.47/6.67 ± 0.95, 0.93 ± 0.98/7.87 ± 1.96, and 1.97 ± 1.12/10.43 ± 3.70, respectively. VAS and WOMAC scores in 1month after the injection significantly decreased in both groups compared to baseline (p < 0.01). Steroid plus tenoxicam group showed significantly improved VAS and WOMAC scores when compared to only steroid and tenoxicam group at follow-up 3 and 6months (p < 0.01). The combined therapy seems to produce a more effective result for a long period than monotherapy in reducing pain and improving functional recovery. • There is an evidence of short-term effects of intra-articular corticosteroid injection in treatment of knee OA; however, there is no consensus for the long-term benefit of this treatment yet. • Apart from oral use, tenoxicam is also applied as an intra-articular treatment option to minimize gastrointestinal side effects of NSAIDs. • Clinical evidence suggests that the combined use of NSAIDs and corticosteroids is synergistic (especially macular edema after cataract surgery in ophthalmology). • The combined therapy seems to produce a more effective result for a long period than alone therapy.