Corticosteroid Injection In Patients Research Articles

Periocular Corticosteroid Injections in Uveitis: Effects and Complications

To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. Multicenter, retrospective cohort study. A total of 914 patients (1192 eyes) who had received ≥ 1 periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. Control of inflammation, improvement of visual acuity (VA) to ≥ 20/40, improvement of VA loss attributed to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery. Among 914 patients (1192 eyes) who received ≥ 1 periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤ 6 months, 72.7% (95% CI, 69.1-76.3) of the eyes achieved complete control of inflammation and 49.7% (95% CI, 45.5-54.1) showed an improvement in VA from <20/40 to ≥ 20/40. Among the subset with VA <20/40 attributed to ME, 33.1% (95% CI, 25.2-42.7) improved to ≥ 20/40. By 12 months, the cumulative incidence of ≥ 1 visits with an intraocular pressure of ≥ 24 mmHg and ≥ 30 mmHg was 34.0% (95% CI, 24.8-45.4) and 15.0% (95% CI, 11.8-19.1) respectively; glaucoma surgery was performed in 2.4% of eyes (95% CI, 1.4-3.9). Within 12 months, among phakic eyes initially ≥ 20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2% (95% CI, 15.9-25.6); cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes (95% CI, 11.1-17.2). Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, VA improved in one half of the patients at some point within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.

THU0335 Identification of the Optimum Puncture Level by A Lumbar Spine Ultrasonography Decreases the Pain during the Epidural Injection Procedure in Patients with A Presumed Difficult Puncture

BackgroundUltrasound (US) is widely used in rheumatology to study and guide infiltration of peripheral joints. This imaging modality can also provide useful information about the anatomy of the lumbar spine....

Intra-Sheath Versus Extra-Sheath Image-Guided Corticosteroid Injection in Patients with Trigger Finger: Results from a Triple-Blind Randomized Control Trial

Background: The impingement of flexor tendon sheath in A1 pulley, named as trigger finger, leads to pain and difficulty during flexion and extension. Local corticosteroid injection into the affected tendon sheath is the treatment of choice. To the best of the authors knowledge, no study has been conducted so far to compare intra-sheath and extra- sheath corticosteroid injection in patients with trigger finger. Objectives: The aim of this study was to determine if injection directly into the tendon sheath will make any difference in the long term outcome of the patients. Patients and Methods: One hundred-sixty-six patients with the diagnosis of trigger finger were enrolled based on the following clinical criteria: 1, Tenderness in A1 pulley; 2, Pain and discomfort during flexion and extension; 3, Presence of nodule. The Quinnell scale was used to evaluate the severity of the disease before the launch of the treatment. Thereafter, with a random block method, patients were divided into two groups: Group A (n=83), with ultrasound-guided extra-sheath corticosteroid injection and Group B (n=83), with ultrasound-guided intra-sheath corticosteroid injection directly into the sheath. All patients have been followed up to one year according to the following timeline: 3, 6, 12, 24, and 48 months after the treatment. The Quinnell scale was obtained again during each follow-up session. If patients score did not change until the third visit, either reinjection or surgery would had been considered as the next proper treatment option, if any. Results: The ethic committee of our center had approved of this survey, and written informed consent was obtained from all patients. The mean age of the enrolled patient was 49.9 years. Right hand was more commonly involved in our patients. No tendon rupture, infection, fat necrosis, finger necrosis, hematoma, nerve rapture, or A1 pulley injury was detected. There was no statistically significant difference between the groups A and B in the frequency of required injections at the follow up sessions, based on their lack of improvement in the Quinnell scale. The follow-up sessions, the patients group, and the corresponding number of patients in whom reinjection was required were as follows: First follow-up session, 2 cases in group A, 1 case in group B; Second follow-up session, 10 cases in group A, 7 cases in group B; Third follow-up session, no case in group A, 1 case in group B; Fourth follow-up session, 1 case in group A, 1 case in group B. Surgery was required to be done in none of our patients. Overall, the frequency of high Quinnell scales (scales 3 and 4) were reduced in all patients at the end of our study. : There is no significant difference between the patients with trigger finger who undergo intra-sheath corticosteroid injection and those with extra-sheath corticosteroid injection in their outcomes; thus, it will be postulated that the injected corticosteroid may sufficiently pass through the tendon sheath even though it is injected in an extra-sheath location. Given the fact that after injection under no ultrasound guidance, the injected corticosteroid may accumulate either in an intra- or extra-sheath location, the findings of our study suggest that blind injection might be as effective as ultrasound-guided intervention; albeit, at a lower cost burden.

Low-level laser and local corticosteroid injection in the treatment of subacromial impingement syndrome: a controlled clinical trial

Objective: To investigate the effectiveness of low-level laser treatment and local corticosteroid injection in patients with subacromial impingement syndrome. Design: Controlled clinical trial. Setting: Physical Medicine and Rehabilitation outpatient clinic. Subjects: One hundred thirty-five patients with subacromial impingement syndrome. Intervention: The patients were allocated to three groups: local corticosteroid injection (group I); sham laser treatment (group II); and low-level laser treatment (group III). Low-level laser treatment was performed three times per week for a total of nine sessions. Local corticosteroid injections were administered twice, with an interval of 10 days between each. The patients were assessed at pre-treatment, post-treatment and three and six months after the first visit. Main measures: The primary outcome of the study was pain intensity (visual analog scale) during activity and at rest. The secondary outcomes were, shoulder functional status and quality of life measured by the University of California at Los Angeles rating score (UCLA) and Nottingham Health Profile (NHP) scale respectively. Results: Significant differences were observed between groups I and II and between groups II and III regarding pain during activity and at rest scores at all of the visits (p<0.05). Nevertheless, significant improvement was observed between groups I and III regarding pain during activity only at post-treatment (p=0.013). The UCLA scores were significantly changed in all three study groups at all of the visits (p<0.05). Conclusion: The effectiveness of low-level laser treatment was similar to that of local corticosteroid injection in patients with subacromial impingement syndrome. We concluded that both low-level laser treatment and corticosteroid injection were more effective than sham laser treatment.

Incidence of full-thickness rotator cuff tear after subacromial corticosteroid injection: A 12-week prospective study

Introduction. Rotator cuff tears (RCT) are a common source of shoulder pain, with an incidence ranging between 5% and 40%. The influence of corticosteroid injections on the incidence of RCT remains unknown. The aim of this study was to estimate the incidence of full-thickness RCT 12 weeks after a subacromial corticosteroid injection in patients with shoulder pain.Patients and method. We made a prospective, open-label study in patients with unilateral painful shoulder without previous local corticosteroid injection. Ultrasound assessments were made at the first (baseline) and last (Week 12) visits by an experienced radiologist. A rheumatologist did the clinical examination. Patients with full-thickness RCT at the first visit were excluded. All patients received a subacromial injection of triamcinolone acetate 40 mg.Results. One hundred and two patients with shoulder pain were initially evaluated: 49 (48%) were excluded due to full-thickness RCT on ultrasound assessment. Therefore, 53 patients completed the study (34 female, mean age 60.8 years, mean time of evolution 9.6 months). In the first ultrasound evaluation, 24 patients (45.3%) had a partial-thickness tear. At 12 weeks after the corticosteroid injection, 9 (17%) patients developed full-thickness RCT, 66.6% of which occurred in patients with previous partial-thickness RCT. Corticosteroid injection significantly improved symptoms (p = 0.0001 for pain VAS score) and range of motion (p = 0.002 for forward elevation and external rotation).Conclusions. Seventeen percent of patients with shoulder pain suffered a full-thickness RCT 12 weeks after subacromial corticosteroid injection. Corticosteroid injection is highly effective in improving clinical symptoms of rotator cuff tendinopathy at 12 weeks.

Commentary on Berger et al. The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

Commentary on Berger et al. The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

AB0599 The oa trial bank: individual patient data meta-analysis of trials investigating the effectiveness of intra-articular corticosteroid injections in patients with knee or hip oa

BackgroundBased on small to moderate effect size of the wide range of symptomatic treatments in osteoarthritis (OA), and the heterogeneity of OA patients, treatment guidelines for OA have stressed the...

The OA trial bank: individual patient data meta-analysis of trials investigating the effectiveness of intra-articular corticosteroid injections in patients with knee or hip OA

s / Osteoarthritis and Cartilage 21 (2013) S63–S312 S259 activities as putting on their clothes. In addition, individuals with multiple co-morbidities had even more complex and challenging selfmanagement experiences, which resulted in family and friends taking on additional “work” to compensate. The multi-joint nature of OA and other co-morbidities further complicated self-management. Many participants described experiencing pain or stiffness in multiple joints at the same time as a result of OA. Additionally, several participants had other health conditions that affected their ability to participate in selfmanagement activities. Conclusions: These findings suggest that previous research on OA selfmanagement overlooks the everyday modifications patients already make to manage their disease prior to surgery, and additionally focuses solely on the individual patient, ignoring the social context of their lives. We found that self-management is not an individual activity but rather can involve the individual's spouse, children, friends and/or co-workers. Further, self-management is complicated by the multi-joint nature of OA and by comorbidities. Future approaches to self-management in OA need to consider these additional issues/aspects as well as the various psychosocial factors that may influence patients’ experiences. 498 THE OA TRIAL BANK: INDIVIDUAL PATIENT DATA META-ANALYSIS OF TRIALS INVESTIGATING THE EFFECTIVENESS OF INTRA-ARTICULAR CORTICOSTEROID INJECTIONS IN PATIENTS WITH KNEE OR HIP OA M. van Middelkoop y, K. Dziedzic z, M. Doherty x, W. Zhang x, J. Bijlsma k, T. McAlindon {, S. Lohmander , S.M. BiermaZeinstra y. y Erasmus MC Med. Univ., Rotterdam, The Netherlands; z Primary Care Sci. Keele Univ., Keele, United Kingdom; xUniv. of Nottingham, Nottingham, United Kingdom; kUniv. Med. Ctr. Utrecht, Utrecht, The Netherlands; { Tufts Univ., Boston, MA; # Lund Univ., Lund,

Intra-articular Corticosteroid Injection in Osteoarthritis of the Knee and Hip: Factors Predicting Pain Relief—A Systematic Review

Variations in the degree of pain relief reported by patients with osteoarthritis following intra-articular corticosteroid injections are well recognized but the reasons for this are not widely understood and factors which might predict variations in response have not been subjected to systematic review. We set out to review systematically the literature relating to predictors of pain reduction following intra-articular corticosteroid injections in patients with knee and hip osteoarthritis. Searches were performed using Medline, EMBASE, Web of Knowledge and MeSH search of Pubmed, the last search being performed in August 2012. Search terms included knee osteoarthritis, hip osteoarthritis, corticosteroid and related terms, and intra-articular injection. Papers were selected and reviewed by 2 reviewers. For inclusion, papers were required to describe studies in which patients with osteoarthritis of the knee or hip received intra-articular corticosteroid injection as an intervention, contain clearly defined outcome measures relating to pain and contain analysis relating to predictors of clinical response to treatment. Twenty-one studies met criteria for inclusion from a total of 54 papers reviewed in full. Eight of these related to hip OA and 13 related to knee OA. No factors that were investigated as potential predictors of response, including radiographic grade and clinical or sonographic evidence of inflammation or synovial hypertrophy were supported by strong evidence. The review also identified that several plausible potential predictors had not been studied to date. Previous research has not identified reliable predictors of response to IA corticosteroid injections, a widely practised intervention in knee and hip OA. Further studies are required if this question is to be answered.

The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

The objective of this prospective study was to investigate the long-term effect of one or more local corticosteroid injections in patients with carpal tunnel syndrome and whether a good response can be predicted. Follow-up visits took place at 3 weeks, 6 months, and 1 year after the first corticosteroid injection. Thirty of the 120 patients (25%) had a good outcome with a single injection, 11 additional patients (9%) needed a second injection, and five patients (4%) needed a third injection to reach a good outcome after 1 year. Of patients with an initial good treatment response, 28 (52%) had a good outcome after 1 year compared with 18 (27 %) who had an initially moderate or no response to treatment. One-third of patients with carpal tunnel syndrome had a long-term beneficial effect from corticosteroid injection, especially when they had a good initial response.

Effects of Local Microwave Diathermy on Shoulder Pain and Function in Patients With Rotator Cuff Tendinopathy in Comparison to Subacromial Corticosteroid Injections: A Single-Blind Randomized Trial

Single-blind randomized clinical trial, with a follow-up of 24 weeks. To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy. Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established. Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment. At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms. In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections.

Paper # 174: PRP or Steroids In Lateral Epicondylitis? RCT with Two Year Follow Up

Platelet rich plasma in lateral apicondylitis safe and effective: the two year results. Platelet Rich Plasma (PRP) has shown to be a general stimulation for repair. To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis. A double blind randomized controlled trial with a two-year follow-up between May 2006 and January 2008. The trial was conducted in two teaching hospitals in The THE NETHERLANDS. 100 patients with chronic lateral epicondylitis were randomly assigned in the PRP group (n=51) or in the corticosteroid group (n=49). Randomization and allocation to the trial group were carried out by a central computer system. Patients were randomized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique. The primary analysis included VAS and DASH scores. Successful treatment was defined as more than a 25% reduction in VAS or DASH score without a reintervention after 2 years. The results resembled the results after 1 year follow up (published in AJSM 2010) but the 51 % success in the corticosteroid group dropped to 35% and the 73 % success in the PRP group increased to 80%. These figures were significantly different from each other and from baseline measurements (p<0.001). Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and increases function significantly, exceeding the effect of corticosteroid injection, not only in the 6 monts and 1 year results, but also in the 2 year follow up, making PRP as a treatment more cost effective. After two years again no harmful effects were observed. Trial registration: ClinicalTrials.gov. Identifier: 2007-004947-31. http://www.clinicaltrials.gov

Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis

Background: Platelet-rich plasma (PRP) has been shown to be a general stimulation for repair and 1-year results showed promising success percentages. Purpose: This trial was undertaken to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a 2-year follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The trial was conducted in 2 Dutch teaching hospitals. One hundred patients with chronic lateral epicondylitis were randomly assigned to a leukocyte-enriched PRP group (n = 51) or the corticosteroid group (n = 49). Randomization and allocation to the trial group were carried out by a central computer system. Patients received either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique. The primary analysis included visual analog scale (VAS) pain scores and Disabilities of the Arm, Shoulder and Hand (DASH) outcome scores. Results: The PRP group was more often successfully treated than the corticosteroid group (P < .0001). Success was defined as a reduction of 25% on VAS or DASH scores without a reintervention after 2 years. When baseline VAS and DASH scores were compared with the scores at 2-year follow-up, both groups significantly improved across time (intention-to-treat principle). However, the DASH scores of the corticosteroid group returned to baseline levels, while those of the PRP group significantly improved (as-treated principle). There were no complications related to the use of PRP. Conclusion: Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and increases function significantly, exceeding the effect of corticosteroid injection even after a follow-up of 2 years. Future decisions for application of PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.

Comparison of High-Dose Extracorporeal Shockwave Therapy and Intralesional Corticosteroid Injection in the Treatment of Plantar Fasciitis

The aim of this study was to evaluate the results of high-dose extracorporeal shockwave therapy applied with an ankle block and corticosteroid injection in patients with plantar fasciitis whose symptoms persisted for more than 6 months. Sixty patients were assessed clinically at presentation and at 3-month follow-up with a patient-assessed 100-mm visual analog scale of pain and a physician-assessed heel tenderness index. A therapeutic response rate was evaluated. A decrease of at least 50% from baseline to 3 months in visual analog scale or heel tenderness index scores was accepted as a successful result. Extracorporeal shockwave therapy and corticosteroid injection provided significant improvements in visual analog scale and heel tenderness index scores, but between the two groups there was no significant difference in the visual analog scale score change 3 months after treatment (P > .05). Twenty-seven of 33 patients (82%) in the extracorporeal shockwave therapy group and 23 of 27 (85%) in the corticosteroid injection group had a successful therapeutic response after 3 months. Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results.

Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial

Background Platelet-rich plasma (PRP) has shown to be a general stimulation for repair. Purpose To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis. Study Design Randomized controlled trial; Level of evidence, 1. Patients The trial was conducted in 2 teaching hospitals in the Netherlands. One hundred patients with chronic lateral epicondylitis were randomly assigned in the PRP group (n = 51) or the corticosteroid group (n = 49). A central computer system carried out randomization and allocation to the trial group. Patients were randomized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering technique. The primary analysis included visual analog scores and DASH Outcome Measure scores (DASH: Disabilities of the Arm, Shoulder, and Hand). Results Successful treatment was defined as more than a 25% reduction in visual analog score or DASH score without a reintervention after 1 year. The results showed that, according to the visual analog scores, 24 of the 49 patients (49%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was significantly different (P < .001). Furthermore, according to the DASH scores, 25 of the 49 patients (51%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was also significantly different (P = .005). The corticosteroid group was better initially and then declined, whereas the PRP group progressively improved. Conclusion Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injection. Future decisions for application of the PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.

Inflammatory Characteristics on Ultrasound Predict Poorer Longterm Response to Intraarticular Corticosteroid Injections in Knee Osteoarthritis

To assess whether inflammation on ultrasound is predictive of clinical response to intraarticular (IA) corticosteroid injections in patients with knee osteoarthritis (OA). Patients with symptomatic knee OA were randomized to receive either an IA injection of 40 mg triamcinolone acetonide in the treatment group or 1 cc 0.9% saline in the placebo group. Clinical response was assessed by changes in baseline Western Ontario and McMaster Universities (WOMAC) index scores and physician global assessment at 4 and 12 weeks. Ultrasounds were performed at each visit. Patients and assessors were blinded to treatment status. Seventy-nine patients were enrolled into the study. Four-week data were available for 67 patients in the primary analysis comparing change in WOMAC pain score from baseline to 4 weeks. There was almost no change in the WOMAC pain subscale score from baseline to 4 weeks in the control group, but there was a significant improvement in WOMAC pain subscale score from 10.8 (SD +/- 3.2) at baseline to 8.75 (SD +/- 4.0) at 4 weeks in the treatment group (adjusted p = 0.001). Of the 34 patients in the treatment group; 16 (47%) had inflammatory disease and 18 (53%) had noninflammatory disease as determined by ultrasound. There was no difference in the change in WOMAC pain score between the inflammatory and noninflammatory patients in the treatment group at 4 weeks. There was a statistically significant greater improvement in pain subscale scores among noninflammatory patients than among inflammatory patients at 12 weeks. Intraarticular corticosteroid injections are an effective short-term treatment for symptomatic knee OA compared to placebo. Patients with noninflammatory characteristics on ultrasound had a more prolonged benefit from IA corticosteroids compared to inflammatory patients.

Study of Long Term Effects of Laser Therapy Versus Local Corticosteroid Injection in Patients with Carpal Tunnel Syndrome

INTRODUCTION: Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy. Several surgical and nonsurgical treatments have been proposed for this syndrome, but there is no consensus regarding the prioritization of the suggested nonsurgical treatments. The goal of this study was to compare the long term effects of laser therapy versus local corticosteroid injection in the treatment of CTS. METHODS: During this single-blind randomized clinical trial, 65 hands with mild or moderate CTS were divided randomly into two groups. One group received local corticosteroid injection (Hydrocortisone 50 mg) and the other received low level laser therapy (20J/cm² in 11 seconds/session for each of 5 points, 775nm, 10 sessions and 3sessions/week). Furthermore, wrist splints with extension degree of 0° (neutral position) were prescribed simultaneously for 6 weeks in each group.Pain severity and electrodiagnostic measurements were compared from before to 10 months after completing each treatment. Data were analyzed with SPSS 11.5 software and parametric tests. RESULTS: Generally, the mean age of patients was 43.9 years, duration of pain was 7.4 months, male to female ratio was 1:3, pain severity using Visual Analogue Scale (VAS) was 6.1 cm, and functional status measure was 15.5. The severity of the disease based on electrodiagnostic studies was 43.2% mild (41.2% in injection group and 45.2% in laser therapy group) and 56.8% moderate. The electrodiagnostic characteristics of the median nerve prior to treatment were included mean sensory peak latency of 4.3ms, mean sensory amplitude of 23.5μv, mean motor onset latency of 4.3ms and mean motor amplitude of 4.6mv. There was no meaningful difference between two groups regarding the demographic characteristics and electrodiagnostic measures (p>0.05). Ten months after treatments, the mean of pain severity was decreased 1.9cm in injection group and 1.7cm in laser therapy group, the mean of median sensory peak latencies was decreased 0.4ms in injection group and 0.25ms in laser therapy group and the mean of motor onset latencies was decreased 0.15ms in both groups,with no significant difference between the observed treatments variables (P>0.05). The severity of disease based on electrodiagnostic studies became 32.4% normal,23.5% mild, 41.2% moderate and 2.9% severe in the injection group and 38.7% normal,22.6% mild, 35.5% moderate and 3.2% severe in the laser therapy group. There was no meaningful difference between two groups regarding the changes in the pain severity, functional status and electrodiagnostic measures. CONCLUSION : Low level laser therapy can be as effective as local injection in reducing pain and severity of disease (based on electrodiagnostic medicine classification) in patients with mild and moderate CTS even in long term (after 10 months).

Percutaneous Corticosteroid Injection for Vocal Fold Polyp

To evaluate the applicability and effectiveness of percutaneous corticosteroid injection in patients with vocal fold polyp and to describe its advantages and limitations in this group of patients. Prospective case series. Tertiary care teaching hospital. Twenty-four patients with vocal fold polyp treated between March 1 and December 31, 2007. Percutaneous corticosteroid injection performed with the patient under topical anesthesia. Stroboscopic examination was carried out to evaluate the postoperative response. The Grade of the Severity of Dysphonia, Roughness, Breathiness, Asthenicity, and Strain (GRBAS) scale and the Voice Handicap Index were used for subjective assessments. Phonatory results including maximum phonation time, mean flow rate, jitter, shimmer, and noise to harmonic ratio were also collected for objective evaluations. The surgery was completed smoothly in 22 of the 24 patients, typically within 20 minutes. No complications were noted. The overall response rate by stroboscopy was 91% (20 of 22 patients) and complete remission rate was 59% (13 of 22). A significant improvement was noted between preoperative and postoperative results on the GRBAS scale (P < .001, P < .001, P = .003, P = .001, and P = .002, respectively, for the 5 measures). Mean Voice Handicap Index (P = .001), maximum phonation time (P = .02), jitter (P = .006), shimmer (P = .001), and noise to harmonic ratio (P = .01) also improved significantly after percutaneous corticosteroid injection. Percutaneous corticosteroid injection can be used to manage vocal fold polyps with low invasiveness and minimal morbidity. It offers a simple and cost-effective alternative to traditional direct microlaryngoscopic procedures.

Outcome in shoulder capsulitis (frozen shoulder) treated with corticosteroid and corticosteroid with distension: a randomised pilot study

In this single-blinded, randomized, pilot study, a series of corticosteroid injections in patients with shoulder capsulitis induced about 40% reduction of complaints over an 8-week period from baseline measurements of function and pain, measured with the shoulder pain and disability index (SPADI) and numerical visual analogue pain scale (NVAS). To our knowledge, this is the first randomized study in primary care where distension without capsule rupture was used in patients with frozen shoulder.

Subacromial ultrasound guided or systemic steroid injection for rotator cuff disease: randomised double blind study

Objective To compare the effectiveness of ultrasound guided corticosteroid injection in the subacromial bursa with systemic corticosteroid injection in patients with rotator cuff disease.Design Double blind randomised clinical trial.Setting Outpatient...