Use Of Corticosteroid Injections Research Articles

The use of corticosteroid injection in the treatment of chronic shoulder pain.

The use of corticosteroid injection in the treatment of chronic shoulder pain.

Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise outcomes at a minimum of 2 years following surgery

BackgroundThe use of total shoulder arthroplasty is continuing to rise with its expanding indications. For patients with chronic conditions, such as glenohumeral arthritis and rotator cuff arthropathy, nonoperative treatment is typically done prior to arthroplasty and often includes corticosteroid injections. Recent studies in the shoulder arthroplasty literature as well as applied from the hip and knee literature have focused on the risk of periprosthetic infection. Literature is lacking as to whether the judicious use of corticosteroids in the year prior to arthroplasty influences patient reported outcomes. The purpose of this study was to determine if preoperative corticosteroid injections prior to shoulder arthroplasty affected two-year patient-reported outcomes. MethodsRetrospective review of anatomic and reverse total shoulder arthroplasty patients (n=230) was performed at a single institution including multiple surgeons. Patients were included if they had preoperative and a minimum of 2-year postoperative patient reported outcomes, including: ASES, VAS, SANE, VR12-PCS, and VR12-MCS. Patients were included in the injection group if they had received an injection, either glenohumeral or subacromial, within twelve months prior to arthroplasty (inject=134). Subgroup analysis included anatomic (TSA=92) and reverse total shoulder arthroplasty (RSA=138) as well as those with no injection within 12 months prior to surgery. An ANOVA was used to compare outcomes between patients who received an injection and those who did not prior to TSA and RSA. ResultsThere were 230 patients included with 134 patients in the injection group and 96 in the no injection group. Patients who received an injection in the year prior to arthroplasty displayed a significantly higher ASES [82 (16.23SD) vs. 76 (19.43SD), p < .01] and SANE [70 (24.49SD) vs. 63 (29.22SD), p < .01] scores versus those who had not received injection. There was no difference when comparing preoperative injection versus no injection in patients undergoing TSA. Those patients undergoing RSA displayed significantly higher ASES scores (p<.01). There were no significant differences in VAS, VR12-PCS, and VR12-MCS among any analysis (P>0.05), and the MCID in ASES was not different between groups (p.09). ConclusionCorticosteroid injections within twelve months prior to anatomic and reverse total shoulder arthroplasty do not compromise patient reported outcomes during a minimum of two-year follow-up. Although more complications occurred in the injection group, it did not reach statistical significance and warrants further study in a larger population.

Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications.

Corticosteroid injections can be associated with a range of potential side effects, which may be classified as local or systemic and further stratified as immediate or delayed in onset. Radiologists performing image-guided musculoskeletal injections should recognize the potential side effects of corticosteroid medication when counseling patients before injection and consider such side effects in planning individual injections. This Review summarizes the available evidence regarding the local and systemic side effects of corticosteroid injections performed for musculoskeletal indications. Local side effects include postinjection flare, skin hypopigmentation and atrophy, infection, tendon rupture, accelerated progression of osteoarthritis, and osseous injury. Systemic side effects include adrenal suppression or insufficiency, facial flushing, hypertension, hyperglycemia, and osteoporosis. Additional targeted counseling is warranted regarding side effects that are specific to certain patient populations (i.e., premenopausal women, patients with diabetes, athletes, and pediatric patients). Corticosteroid injections are contraindicated in the presence of superficial or deep infection, fracture, or a prosthetic joint. Guidelines on the frequency, duration, and maximal lifetime use of corticosteroid injections are currently lacking. Further research is needed regarding the long-term complications of continuous corticosteroid use, particularly with regard to osseous effects.

Intra-articular corticosteroid injections provide a clinically relevant benefit compared to placebo only at short-term follow-up in patients with knee osteoarthritis: A systematic review and meta-analysis.

To quantify the clinical relevance of intra-articular corticosteroid effects compared to placebo for the injective treatment of knee osteoarthritis (OA). The PubMed, Cochrane Libraryand Web of Science databases were searched on May3, 2023. This study was conducted in accordance with the PRISMA guidelines. The inclusion criteria were randomized controlled trials (RCTs), published in English, with no time limitation regarding publication date, comparing intra-articular corticosteroids and placebo injections for knee OA. The effects were quantified at short- (≤6 weeks), mid- (>6 weeks and ≤3 months), and long-term (≥6 months) follow-ups. The minimal clinically important difference (MCID) for the outcomes (visual analogue scale for pain - VAS: 1.4, Western Ontario and McMaster University Osteoarthritis Index - WOMAC: 9) was used to interpret the clinical improvement provided by intra-articular corticosteroid injections compared to placebo. The quality of each article was assessed using the Cochrane RoB 2 tool and the GRADE guidelines. Among the 1030 articles retrieved, 11 RCTs (842 patients) were included. A comparison of the two groups revealed statistically significant differences in the improvement of VAS and WOMAC scores in terms of the mean difference (MD); this difference was in favour of corticosteroids at short-term (p < 0.001, MD = -1.6 and p < 0.001, MD = -9.9, respectively) and mid-term follow-ups (p = 0.001, mean MD = -1.3 and p = 0.005, MD = -4.9, respectively). No difference was observed at the long-term follow-up. The MDs between the improvements in the two groups reached the MCID values for the VAS and WOMAC only at the short-term follow-up. The RoB 2 tool and the GRADE evaluations showed the presence of risk of bias and limited quality of evidence. This systematic review and meta-analysis demonstrated that intra-articular corticosteroid injections offer clinically perceivable pain relief and functional improvement higher than the placebo effect only at short-term follow-up in patients affected by knee OA, with benefits losing clinical relevance already after 6 weeks. These results, together with the low number and the limited quality of the RCTscomparing this treatment with placebo, question the indication for the use of corticosteroid injections in clinical practice for the treatment of knee OA. Level I.

Treatment of Greater Trochanteric Pain Syndrome With Ultrasound-Guided Bipolar Pulsed Radiofrequency of the Trochanteric Branches of the Femoral Nerve: A Case Series of Nine Patients.

Greater trochanteric pain syndrome (GTPS) is a prevalent cause of lateral hip pain that often leads to significant functional limitations. Conservative treatment options include physical therapy, pharmacological treatment, and more invasive techniques such as corticosteroid injections. However, despite the high success rates reported with corticosteroid injections, a significant number of patients have their symptoms persist or recur. In this case series, we present the outcomes of nine patients with GTPS who underwent ultrasound-guided bipolar pulsed radiofrequency targeting the trochanteric branches of the femoral nerve. We aim to discuss the effectiveness and safety of this approach. Eligible patients referred to our centre underwent ultrasound-guided bipolar pulsed radiofrequency aimed at the trochanteric branches of the femoral nerve. The procedure consisted of one cycle at 42°C for six minutes, followed by the injection of ropivacaine (0.2%, 3 mL) and dexamethasone (12 mg). The Brief Pain Inventory - Short Form (BPI-sf)and Lequesne Algofunctional Index (LAI) were used before the procedure and at the third and sixth months post-procedure. We monitored immediate and late complications, as well as adverse effects. Our results indicate a favourable outcome for most patients, with an average pain reduction of 76.51% according to their report of the BPI-sf. Additionally, eight out of nine patients experienced at least 50% relief. These findings align with a previous case series, which reported a similar average pain reduction. Before the procedure, most patients were classified as "extremely severe" in the LAI, with an average score of 18.17. Although there was only a slight reduction of 16.84% at the six-month follow-up, this suggests a potential improvement in their functional status. We did not observe any immediate complications or adverse effects after the procedure, nor were any reported at the subsequent follow-ups, which is consistent with existing literature. Our study suggests that ultrasound-guided bipolar pulsed radiofrequency treatment is a promising minimally invasive technique for GPTS, especially for patients who do not respond to conservative treatments. Although our case series provides some evidence of effectiveness and safety, further controlled studies on a larger scale are necessary, particularly to compare this intervention with the use of corticosteroid injections alone.

Corticosteroid injections for non-spinal musculoskeletal conditions: Consideration of local and systemic adverse drug reactions and side effects

Following specialist training, physiotherapists in some countries, such as the United Kingdom and Norway perform landmark, and ultrasound guided, soft tissue and joint injections for a wide range of musculoskeletal conditions. Whether they inject or not, physiotherapists may wish to recommend injections, and people requiring care commonly seek physiotherapist’s opinions on injection therapy. Globally, there has been a substantial increase in the use of corticosteroid injections to treat musculoskeletal conditions. Those performing injections or providing advice need be cognisant of the possible harms of the procedures and communicate this information sensitively to those considering the procedures. This review synthesises evidence for local and systemic adverse reactions and side effects related to corticosteroid injections in the treatment of non-spinal musculoskeletal conditions. Multiple databases including PubMed, Medline, PEDro, Cinahl were searched, and all levels of evidence were included if they added to the review. Serious adverse events appear to be rare, possibly in part, due to under-reporting of side effects. Where available, suggestions for minimising risk and aftercare have been made. As substantial gaps in the evidence were found, areas for further research are suggested and a decision-making tool is included to facilitate whether to proceed to injection, proceed with precaution or no injection.

Which Treatment Method Is Better in the Treatment of Chronic Plantar Fasciitis: Corticosteroid Injection, Extracorporeal Shock Wave Therapy, or Radiofrequency Thermal Lesioning?

Chronic plantar fasciitis (CPF) is a common disease that has various treatment options. This study aimed to compare the effectiveness of three of these options: corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL). The records of 229 patients treated with CSI (n = 81), ESWT (n = 76), or RTL (n = 72) were retrospectively analyzed. Visual analog scale scores, patient satisfaction-related success rates, repeated treatment rates, and initial treatment change rates were compared. Mean ± SD follow-up was 19.0 ± 4.5 months. Baseline clinical characteristics, mean visual analog scale scores (before treatment and at months 3, 6, and 12), patient satisfaction and success rates (at months 6 and 12), and repeated treatment and initial treatment change rates were similar between treatment groups. No complications were observed after the treatments. All three options-CSI, ESWT, and RTL-were found to be safe and effective in treating CPF, with similar outcomes up to 1 year. Use of CSIs is advantageous because it is more accessible than the other treatments. Similarly, the noninvasive nature of ESWT is glaring among other minimally invasive options. Therefore, the first-line treatment modality of CPF can be CSI or ESWT, depending on the patient's and physician's joint preference; RTL treatment should be tried in patients who do not respond to these treatments.

Are foot and ankle corticosteroid injections safe during the COVID-19 pandemic? A single center prospective observational study

BackgroundIntra-articular corticosteroid injections (ICSI) are commonly used in orthopedic practice. Due to concerns about their immunosuppressive effects, we conducted a prospective observational audit, to monitor for COVID-19 infection amongst a group of foot and ankle patients who received an ICSI during the pandemic. Patients and methodsIncluded were 68 patients (25 males - 43 females, mean age 59.1 years, SD 15.0, range 19 – 90 years) who received a fluoroscopy-guided ICSI within a two-month period during the pandemic. The American Society of Anaesthesiologists (ASA) grade was I in 35 % of patients, II in 58 % and III in 7 %. 16 % of patients had black, Asian or minority ethnic (BAME) background. The dose of methylprednisolone injected was 20 mg for 28 % of the patients, 40 mg for 29 % and 80 mg for 43 %. ResultsAll patients were available for follow up at one and four weeks post-injection. None reported COVID-19 infection symptoms within this period. The only complication was a flare-up of joint pain. ConclusionOur study showed that the risk of COVID-19 infection to patients receiving foot or ankle ICSI is low. The limitations of this work must be considered, but our findings support the judicious use of corticosteroid injections during the current crisis

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.

Management of lumbar spondylolysis in the adolescent athlete: a review of over 200 cases

BACKGROUNDSpondylolysis is a defect of the pars interarticularis of vertebrae, most commonly seen at L5 and L4. The etiology of spondylolysis and isthmic spondylolisthesis is generally considered to be a result of repetitive mechanical stress to the weak portion of the vertebrae. A higher incidence of spondylolysis is observed in young athletes. Symptomatic spondylolysis can be successfully treated conservatively, but there is currently a limited consensus on treatment modalities and a lack of large-scale clinical trials. PURPOSEThe purpose of the present study was to investigate the optimal treatment algorithm for symptomatic spondylolysis in adolescent athletes and evaluate the functional outcomes of those undergoing the nonoperative treatment. STUDY DESIGNA retrospective review. PATIENT SAMPLETwo hundred one adolescent patients ranging from age 10 to 19 involved in athletics OUTCOME MEASURESInjury characteristics (age, mechanism, time), sports played, bone stimulator use, bony healing at 3 months on computed tomography (CT) scans, return to sports, corticosteroid injection use. METHODSTwo hundred one adolescent athlete patients (62 females and 139 males) diagnosed with spondylolysis between 2007 and 2019 were retrospectively reviewed. Diagnosis was based on plain radiography followed by magnetic resonance imaging. All patients were treated conservatively with cessation of sports activity, thoracolumbosacral orthosis, and external bone stimulator for three months after diagnosis. CT scans were obtained for the 3-month follow-up visits to assess bony healing. Subsequently the patients received 6 weeks of rehabilitation focused on core strengthening. Symptomatic patients after the treatment were referred for steroid injections and continued with the rehabilitation protocol. RESULTSThe most common age of injury was 15 years old, following a strong normal distribution. The most commonly played sport was football, followed by baseball/softball. The primary mechanism of injury was weight training closely followed by a football injury. The first quarter of the calendar year had the highest incidence of injuries with the most injuries occurring in March and the least occurring in December. One hundred fifty-two athletes reported using bone stimulators as prescribed, and these patients showed a significantly higher rate of bony healing on follow-up CT scans than those who did not use bone stimulators. One hundred ninety-seven patients (98%) returned to sports or similar level of activities. Thirty-seven patients (18%) received facet or epidural steroid injections due to continued pain and one patient underwent a surgical procedure. Follow-up CT scans showed 49.8% bony healing. CONCLUSIONSConservative treatment of spondylolysis in adolescent athletes with cessation of sports, thoracolumbosacral orthosis, and bone stimulator followed by rehabilitation was associated with excellent outcomes in terms of return to sports.

Comparing the Risk of Osteonecrosis of the Femoral Head Following Intra-Articular Corticosteroid and Hyaluronic Acid Injections.

Although intra-articular corticosteroid injections (CSIs) are a cornerstone in the nonoperative management of hip pathology, recent reports have raised concerns that they may cause osteonecrosis of the femoral head (ONFH). However, these studies might have been limited by nonrepresentative patient samples. Therefore, the purpose of this study was to assess the incidence of ONFH after CSI and compare it with the incidence in a similar patient population that received a non-CSI injection. This was a retrospective propensity-matched cohort study of patients in the MarketScan database who underwent an intra-articular hip injection from 2007 to 2017. Patients receiving hip CSIs were matched 4:1 with patients receiving hip hyaluronic acid injections (HAIs) based on age, sex, geographic region, comorbidities, type of hip pathology, injection year, and baseline and follow-up time using propensity scores. The patients' first injections were identified, and the time to development of ONFH was analyzed using Kaplan-Meier curves and Cox proportional-hazards models. Patients with a history of osteonecrosis or those who received both types of injections were excluded. A total of 3,710 patients undergoing intra-articular hip injection were included (2,968 CSIs and 742 HAIs; mean [standard deviation] age, 53.1 [9.2] years; 55.4% men). All baseline factors were successfully matched between the groups (all p > 0.57). The estimated cumulative incidence (95% confidence interval [CI]) of ONFH for CSI and HAI patients was 2.4% (1.8% to 3.1%) versus 2.1% (1.1% to 3.5%) at 1 year and 2.9% (2.2% to 3.7%) versus 3.0% (1.7% to 4.8%) at 2 years (hazard ratio, 1.05; 95% CI, 0.59 to 1.84; p = 0.88). The results held across a range of sensitivity analyses. The incidence of ONFH after intra-articular hip injection was similar between patients who received CSIs and those who received HAIs. Although this study could not determine whether intra-articular injections themselves (regardless of the drug that was used) lead to ONFH, the results suggest that ONFH after CSI often may be due, in part, to the natural course of the underlying disease. Future randomized controlled trials are needed to definitively answer this question; in the interim, clinicians may be reassured that they may continue judicious use of CSIs as clinically indicated. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sports Related Injuries and Suggested Treatments: A Research Synthesis

In this study, I reviewed scholarly research articles on sports related injuries and selected 19 represented articles to review and analyze. Through analysis I realized that there are typically two types of treatment, noninvasive/nonoperative and invasive/operative. There are other types of treatment such as the use of corticosteroid injections, and dietary suggestions such as sticking to an omega 3 diet and doing yoga (these two are not very popular). Through this review, I learned that physicians mainly treat sports-related injuries based on the patient’s age, ability to recover and type of injury.

Comparison of intralesional corticosteroid injection with and without thumb Spica cast for de-Quervain tenosynovitis.

Objective: To compare efficacy of methyl prednisolone acetate injection with and without thumb spica cast for the treatment of de-Quervain tenosynovitis. Study Design: Randomized Controlled Trial. Setting: Orthopedic Unit, Allied Hospital, Faisalabad. Period: April 2016 to September 2016. Material &amp; Methods: In each group 41 patients were included with non-probability consecutive sampling. Results: Eighty two patients were enrolled in the study. Out of 82 patients in the study, 3 (3.7%) were males and 79 (96.3%) were females. There were 10 (12.20%) pateints with age &gt;40 years, and 36 (43.90%) patient in each of age group 21-30 and 31-40 years. The proportions of cured persons between two groups i.e., treated with corticosteroid injection and those treated with combination of injection and thumb Spica splint were found same with p-value 0.19 for Z=1.31. The efficacy was independent of treatment methods with χ2=1.10 (p-value = 0.30). The same independence pattern was also observed in different age groups. Age range was between 18 and 70 years. Statistical analysis was performed using chi-square test. Six weeks following treatment, 29 (35.37%) patients from group A and 34 (41.46%) patients from group B showed relief of pain, swelling and tenderness and a negative Finkelstein test (p-value 0.295). post stratification of gender showed no significant association (p-value 0.388 and 0.328 in groups A and B respectively). Conclusion: It has been concluded that use of corticosteroid injection alone is sufficient to treat de-Quervain syndrome as compared to the use of thumb Spica splint with corticosteroid injection. It is therefore recommended that in patients suffering from de-Quervain syndrome, corticosteroid injection may be the choice of treatment.

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.

Comparison of combined intra-articular and sub-acromial injection with intra-articular injection in adhesive capsulitis

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive. Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis. Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score. Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week. Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.

Trends in Corticosteroid Injections for Treatment of Lateral Epicondylitis: An Analysis of 80,169 Patients.

Introduction:Corticosteroid (CS) injections are a frequently used treatment modality for lateral epicondylitis (LE) despite an increasing number of studies suggesting their lack of efficacy. The objective of this study was to review the annual utilization of CS injections for treatment of LE, as well as that of other nonsurgical treatments and surgical treatments, to understand how recent publications have affected the practice of physicians in treating LE.Methods:Patients with LE from 2010 to 2017 were identified within a national insurance database and grouped by treatment modalities of CS injections, physical therapy, bracing treatment, and surgery. Epidemiologic and demographic data were reported using descriptive statistics. The number of patients receiving each treatment and the number of CS injections per patient were quantified for each year, and annual trends were analyzed using logistic regression.Results:Among 80,169 qualifying patients, 16,476 received CS injections, 12,180 received physical therapy, 1,874 received bracing treatment, and 2,650 underwent surgery, with patients receiving multiple modalities being members of each respective group. We found a significant decrease in the proportion of patients with LE receiving CS injections from 23.3% in 2010 to 18.8% in 2017 (R2 = 0.956, P < 0.001). Interestingly, the number of CS injections per patient increased during this period from 1.33 to 1.83 (R2 = 0.843, P = 0.001). No notable changes in utilization trends for other modalities were found.Discussion:Overall, our data support a decline in the use of CS injection as a treatment modality for LE from 2010 to 2017. Although correlational, this trend may reflect the increasing body of published evidence demonstrating the ineffectiveness of CS injections for the treatment of LE. In addition, the increasing number of injections per patient among those who received injections contrasts with the overall decrease in steroid utilization among all patients. Further study is needed to fully understand the mechanisms behind these trends.

To study risk factors of degenerative rotator cuff tear

Background: Rotator cuff has been a known entity for orthopaedic surgeons for more than two hundred years [1]. Rotator cuff disease is a common condition that causes shoulder pain and functional disability with a prevalence rate of 2.8-15%, affecting approximately 40% of population who are more than 60 years of age and substantially impacting on individual’s function [2]. Aims and Objectives: To study risk factors in patients with symptomatic atraumatic rotator cuff tear –Age, Obesity, Gender, Smoking, Diabetes mellitus, Hypertension, Hand dominance, Use of corticosteroid injections, Hyperlipidemia, Osteoarthritis of knee. Materials and Methods: Inclusion criteria § Pain in the shoulder of duration more than three weeks. § Normal range of motion of the shoulder. § One or more than one positive clinical tests for rotator cuff tear. Diagnostic imaging like ultrasound and magnetic resonance imaging pointing to diagnosis of rotator cuff tear. Exclusion criteria § History of trauma. § History of any surgery. § Patients using assisted devices for walking. Results:Our study proved that the metabolic factors of diabetes, BMI, age, hand dominance, osteoarthritis of knee, hypertension, gender were independent significant risk factors associated with the development of atraumatic rotator cuff tears. Out of all the risk factors evaluated, osteoarthritis of knee, age, obesity were the most significant risk factors for atraumatic rotator cuff tear. Conclusions:Out of all risk factors evaluated, osteoarthritis of knee, obesity and age were the most important risk factors for atraumatic rotator cuff tear Evaluation of various risk factors results in enhanced understanding of the prevention and management of various other common conditions and comorbidities associated with degenerative rotator cuff tears [26].

Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant.

There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus. A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months. In all, 81.2% of patients reported that their foot was "much improved" (55.2%) or "improved" (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were "extremely satisfied" (41.7%) or "satisfied" (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036). The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome. Level IV: Retrospective case series.

An indirect evaluation between corticosteroid injections and gluteal exercises in the management of pain in greater trochanteric pain syndrome

Introduction Greater trochanteric pain syndrome (GTPS) is an umbrella term used to describe several pathologies contributing to lateral hip pain. The most prevalent pathology is gluteal tendinopathy. Conservative management of GTPS is predominantly now focused on the use of corticosteroid injections (CSIs) and gluteal exercises. Aim To compare CSIs and gluteal exercises on pain in adults with GTPS. Method A systematic search of AMED, CINAHL, MEDLINE, EMBASE, TRIP and the Cochrane Library was conducted from inception to January 2021. Critical appraisal was completed using the Critical Appraisal Skills Programme tool. Data were extracted to obtain population characteristics and procedural details. Results Seven articles met the eligibility criteria out of a total of 336; five articles were randomised control trials (RCT) and two were cohort studies, equivalent to 758 and 70 participants, respectively. Studies generally reported significant benefits of CSIs <12 weeks and gluteal exercises >8 weeks for the reduction in lateral hip pain (p < .05). Critical appraisal demonstrated varied study quality and significant heterogeneity. Conclusion CSIs appear to be a successful treatment intervention in the short-term to decrease lateral hip pain but not in the long-term. Gluteal exercises plus education on avoiding tendon compression appears to be as successful as CSIs in the short and superior in the long-term.

Geographical differences in carpometacarpal joint osteoarthritis treatment of the thumb: A survey of 1138 hand surgeons from the USA and Europe

Carpometacarpal osteoarthritis of the thumb (CMC OA) is treated with various therapeutic approaches. However, the literature remains inconclusive regarding the ideal procedure for each disease stage. In this study, we assessed the international application of surgical treatment options including CMC I implants and non-surgical treatment options for CMC OA depending on the disease stage, with a strong focus on the detection of geographical disparities. We conducted a large international online survey with members of hand surgical societies of the International Federation of Societies for Surgery of the Hand (IFSSH). The first part of the survey asked about general therapy options of CMC OA depending on the severity of the disease, whereas the second part specifically dealt with the use of prostheses. We could include 10 of 56 IFSSH member societies (6807 surgeons) and received answers from 1138 members (16.7%). Significant differences were detected in an increased use of corticosteroid injections in the USA, and a growing frequency of fat injections in Europe. Regarding use and frequency of the resection arthroplasty, we found similar results in all participating countries. Prosthetic implantation showed a significant difference between the USA and Europe, with far larger numbers stated by European hand surgeons. CMC OA is treated differently in the participating countries depending on the stage of the disease. We give an insight into geographical differences in treatment paradigms, with corticosteroid injections being more prevalent in the USA, and prosthesis implantation being more frequently chosen in the selected European countries.