Effectiveness Of Local Corticosteroid Injection Research Articles

Comparison of the Effectiveness of Local Corticosteroid Injection and Extracorporeal Shockwave Therapy in Patients With Pes Anserine Bursitis: An Open-Label Randomized Clinical Trial.

Background: The success rate of extracorporeal shock wave therapy (ESWT) in treating epicondylitis, plantar fasciitis, rotator cuff tendonitis, Achilles tendonitis, and Jumper knee has been reported to be 60% to 80%. Most published studies have compared focused ESWT at different intensities with local corticosteroid injection (LCI). We only identified a few studies that specifically compared ESWT with LCI in patients with pes anserine bursitis (PAB). This study aimed to compare the effectiveness of ESWT and LCI in patients with PAB. Methods: The present study was a randomized clinical trial. Patients diagnosed with PAB who were referred to the physical medicine and rehabilitation clinic underwent a complete physical examination. They (n = 60 patients) were randomly assigned to the ESWT and LCI groups if they met the study criteria. In the ESWT group, 1 ESWT session was performed weekly for 3 consecutive weeks. In the LCI group, 1 injection was performed under an ultrasonography guide. Pes anserine thickness, pain intensity, and treatment satisfaction were measured with visual analog scale (VAS) and quality of life (Short Form-12). A paired-samples t test was used to compare the results obtained in the pre-and posttests. Analysis of variance for repeated measures was used to detect differences over time. The null hypothesis would not be confirmed if the P value was less than the 0.05 level of significance. Results: Pes anserine thickness and pain intensity decreased significantly during the study in both groups (P < 0.001). However, the mean difference of pes anserine thickness was more in the LCI group the ESWT group [(-0.6; 95% CI, -1.0 to -0.3) than (-0.1; 95% CI, -0.5, -0.2); P = 0.008]. Also, the mean difference of pain intensity was lower in the ESWT group] than the LCI group [(-2.9; 95% CI, -3.7 to -2.1) (1.0; 95% CI, 0.1to 1.8); P < 0.001]. Patients' quality of life in both groups increased significantly during the study period (P < 0.001), but the increase in quality of life in patients in the ESWT group (mean difference, 15.3 [95% CI, 10.6-19.9]) was considerably more than in the LCI group (mean difference, -5.3 (95% CI, -10.0 to -0.6). Conclusion: Overall, the results of this study showed that both local corticosteroid injections and extracorporeal shock wave therapy are safe and effective in PAB patients.

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

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

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material &amp; Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

Corticosteroid Injection by Palpation Guide versus Palpation Guide and Needling Method for Coccydynia

Background: Coccydynia is a painful condition with tenderness and ache in sacrococcygeal area which may radiate to the buttocks and lower back. Coccydynia is a multifactorial disorder and the most common cause of it is trauma. The initial treatment of the disease is conservative methods. One of the most common conservative treatments of chronic coccydynia is the local corticosteroid injection, which performed usually by palpation-guided method. This study was conducted to compare the effectiveness of local corticosteroid injection using palpation and needling method with palpation method alone. Patients and Methods: In this prospective study, 50 patients with the diagnosis of coccydynia were enrolled between 2010 and 2017. All patients had chronic coccydynia which did not respond to conservative therapy for at least three months. Participants were divided into two groups and each group consisted of 25 individuals. Patients who underwent local corticosteroid injection using palpation guide technique alone were assigned as group A and others who underwent palpation guiding injection with needling technique were considered as group B. Results: There was a statistically significant difference between the mean VAS scores in preinjection and final follow up visit in each groups (P value , the difference between the mean VAS scores of the final visit in groups A and B was statistically significant (P value Conclusion: Local corticosteroid injection using palpation guiding technique with needling is an uncomplicated, inexpensive, and effective invasive conservative treatment for refractory chronic coccydynia.

Management of Dequervain’s tenosynovitis with splint and intra-sheath steroid: A comparative study

Background: De Quervain’s tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment. This can be managed very well medically and surgical treatment is rarely needed. Different studies have shown the effectiveness of local corticosteroid injection, splinting or both. This study was performed to compare the outcome of corticosteroid injection against splinting for the treatment of De Quervain’s tenosynovitis.Methods: This prospective comparative study was conducted from May 2019 to June 2020 in the out patient department. A total of 98 patients with De-Quervain’s tenosynovitis were treated with either of these methods: 1. Corticosteroid injection in first dorsal compartment of wrist, 2. Splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel. Results: In the first group, a total of 49 patients were included (corticosteroid injection), and 49 patients in the second group (splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel). There were 82 women and 16 men. Overall success rate was 82.71% in the first and 65.31% in the second groups, with a significant difference for both groups with respect to pain score and cure rate (P< 0.05). Temporary pain was the most common adverse reaction at the site of injection and was noted in most of the patients. Conclusion: Though steroid injection has excellent outcome, splinting can be an alternative viable treatment option for DQ especially in patients with low grade disease or reluctant to injection because of fear of probable adverse reactions.

A randomized comparative trial of corticosteroid phonophoresis, local corticosteroid injection, and low-level laser in the treatment of carpal tunnel syndrome.

Carpal tunnel syndrome is the most prevalent peripheral neuropathy and has a considerable burden on health services. We tried to compare the therapeutic effects of local corticosteroid injection, low-level laser, and corticosteroid phonophoresis in the treatment of carpal tunnel syndrome. We performed a randomized clinical trial with three parallel groups. The study was carried out at a University Hospital. In total, 42 participants including 31(73.8%) women were randomly allocated to the treatment groups with equal sizes. We assessed pain, symptom severity and functional status with Boston Carpal Tunnel Questionnaire, and performed median nerve conduction velocity studies. Evaluations were done before the interventions and in the fourth week of study. For the group corticosteroid, under the guidance of sonography, methylprednisolone with lidocaine was injected into the carpal tunnel. For laser therapy, we administered 10 sessions, each lasting 10 seconds. We used topical hydrocortisone acetate gel 10% as the anti-inflammatory agent with phonophoresis, 3 times per week for 10 sessions. Within-group analyses with paired t-test showed that local corticosteroid, laser, and phonophoresis are all effective treatments. Between-group analyses with ANOVA indicated that there were significant differences among the groups after four weeks in terms of pain (p = 0.004), in favor of corticosteroid; and in sensory delay (p = 0.001), in favor of laser. For the Boston Carpal Tunnel Questionnaire and median nerve motor latency, the results were not significant. There was no important side-effect after four weeks of follow-up. The three treatments are comparable and beneficial for carpal tunnel syndrome.

Carpal Tunnel Release Surgery Plus Intraoperative Corticosteroid Injection versus Carpal Tunnel Release Surgery Alone: A Double Blinded Clinical Trial.

Background: Carpal tunnel syndrome is a prevalent disease with significant morbidity. The current treatments range from oral medication and local corticosteroid injection to surgical carpal tunnel release (CTR). In this study, we tried to assess the results of Carpal Tunnel Release surgery in combination with the anti-inflammatory effect of local corticosteroid injection. Methods: 65 patients were enrolled by clinical and electrodiagnostic tests and randomly divided into two groups, 32 in group one which underwent surgery with Dexamethasone injection and 33 in group 2 which intervened with carpal tunnel release surgery alone. Data on Boston questionnaire of patients were conducted before and two weeks after surgery. Distal motor and sensory latencies of patients were recorded before and two months after surgery. Mean values were compared between groups before and after surgery. Results: The mean preoperative Boston index was 35.83 in group one and 37.7 in group two, these data postoperative were 15.83 and 19.15 respectively. The mean preoperative distal sensory latency was 54.8 in group one and 47.6 in group two, these data postoperative were 34.1 and 35.1 respectively. The mean preoperative distal motor latency was 63.2 in group one and 62.3 in group two, these data postoperative were 44.5 and 46.55 respectively. Conclusions: CTR surgery plus local corticosteroid injection did not significantly change in results of Electrodiagnostic test or Boston index compared to the non-injection group.

A comparative study between splinting versus corticosteroid injection in de-quervain’s disease

Background: de Quervain’s disease (DQ) is painful tenosynovitis of first dorsal compartment of hand. It is usually caused by overuse or repetitive activity. There are various modalities of treatment of DQ. Different studies have shown effectiveness of local corticosteroid injection, splinting or both in western population but to our knowledge, there is no effectiveness data available for Indian population. This study was performed to compare the outcome of corticosteroid injection versus splinting for the treatment of de Quervain’s tenosynovitis. Methods: This randomized prospective study was conducted from July 2015 to December 2016 in Orthopaedics OPD of RKMSP.A total of 100 patients with de-Quervain’s tenosynovitis were treated with either of these methods1) corticosteroid injection in first dorsal compartment of wrist, 2) splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel. Treatment effectiveness was measured by Wong-Baker FACES Pain Rating Scale, 0-10 Numeric Pain Rating Scale, size of nodule over radial styloid and grading of tenderness over 1st dorsal compartment. Results: In the first group, a total of 50 patients were included (corticosteroid injection), and 50 patients in the second group (splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel). The mean age was 32.6 years (21 – 61 years) in all patients. There were 90 women and 10 men. Overall success rate was 90% in the first and 60% in the second groups, with a significant difference for both groups with respect to pain score and cure rate (P

The effect of local injection of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis among patients with greater trochanteric pain syndrome.

Greater trochanteric pain syndrome (GTPS) is a common clinical entity for which the most effective treatment is local corticosteroid injection (LCI). There are no studies on the effect of LCI among patients with GTPS on the hypothalamic-pituitary-adrenal axis. The present study recruited nonselected patients diagnosed with GTPS. After consenting, participants received low dose (1μg) of adrenocorticotropin hormone (ACTH) stimulation test at 09:00. Immediately following the test, participants received a LCI of 80mg of methylprednisolone acetate at the greater trochanteric region. The ACTH stimulation test was repeated 1, 2, 4, and 6weeks following the LCI. Cortisol samples were obtained at just prior to (basal) and 30min (post-stimulation) following every ACTH stimulation test. Serum cortisol levels of <500μmol/l obtained 30min following the ACTH stimulation test were considered evidence of secondary adrenal insufficiency. The study enrolled 22 patients, 21 of whom completed participation. There were 19 female participants (~90%), and mean age of all the participants was 55.2±8.6years. Four participants showed evidence of secondary adrenal insufficiency, which was observed only at weeks 1 and 2 following the LCI. Mean serum cortisol level among these four participants 30min following the ACTH stimulation test was 354μmol/l, with a range of 268-430μmol/l. LCI of 80mg of methylprednisolone acetate in the greater trochanteric area among patients with GTPS was associated with transient secondary adrenal insufficiency in ~20% of the patients, mainly 1week following the injection.

A Short Communication Based on: A Bayesian Network Meta-analysis: Comparing the Clinical Effectiveness of Local Corticosteroid Injections using Different Treatment Strategies for Carpal Tunnel Syndrome

Why do we choose this topic? Local corticosteroid injections are commonly used to improve the short-term symptomatic severity and the functional status of the hands affected by carpal tunnel syndrome. We searched and categorized different treatment strategies for carpal tunnel syndrome.

A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome

BackgroundLocal corticosteroid injections are commonly used to improve the short-term symptomatic severity and the functional status of the hands affected by carpal tunnel syndrome. We conducted a systematic review and Bayesian network-meta-analysis to compare the clinical effectiveness of local corticosteroid injections using different injection approaches.MethodsElectronic literature in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science, and other sources were searched to identify clinical studies comparing different injection approaches with each other or placebo for carpal tunnel syndrome. Two review authors conducted selection of studies, data extraction, and assessment of risk of bias independently. Random-effects models were used to conduct the pairwise meta-analysis and the Bayesian network meta-analysis.ResultsOverall, 10 studies with 633 patients were included in the systematic review. Among the injection approaches, local corticosteroid injections using the ultrasound-guided in-plane injection (Ulnar-I) approach was the best treatment strategy for clinical response (median OR versus placebo 128.30, 95 % CrI 9.76 to 2299.00), change in symptom severity scale (median MD versus placebo −1.16, 95 % CrI −1.95 to −0.38) , and change in functional status scale (median MD versus placebo −0.74, 95 % CrI −2.00 to 0.52) at short-term follow-up period in the network meta-analysis. Local corticosteroid injections using other injection approaches were better than placebo for clinical response (for the PI approach, median OR versus placebo 8.85, 95 % CrI 3.00 to 33.15; for the DI approach, median OR versus placebo 7.00, 95 % CrI 0.53 to 118.80) , change in symptom severity scale (for the Ulnar-O approach, median MD versus placebo −0.78, 95 % CrI −1.43 to −0.16; for the PI approach, median MD versus placebo −0.58, 95 % CrI −0.95 to −0.22), and change in functional status scale (for the Ulnar-O approach, median MD versus placebo −0.63, 95 % CrI −1.67 to 0.43; for the PI approach, median MD versus placebo −0.46, 95 % CrI −1.11 to 0.21) at short-term follow-up period. The quality of studies is good.ConclusionsAccording to our analyses, the ultrasound-guided in-plane injection (Ulnar-I) approach was the most effective treatment among the injection approaches for carpal tunnel syndrome.

Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

Effects of Local Corticosteroid Injection on Electrical Properties of Aβ-Fibers in Carpal Tunnel Syndrome

Very few data are available on the structural and functional effects of corticosteroids on peripheral nerve fibers. This paper is addressed to verify possible changes in the functional properties of myelinated Aβ fibers of the median nerve in carpal tunnel syndrome (CTS) after a local injection of triamcinolone acetate. Thirteen subjects affected by mild CTS and 13 controls were selected. Clinical, electrophysiological, and ultrasonographic (cross sectional area: CSA) data of the median nerve were quantified at 0 (pre-injection), and 1 month after triamcinolone injection at wrist. We analyzed the input-output curves constructed by plotting the response amplitude as a function of stimulus intensity. After corticosteroid injection, all patients experienced symptom relief, the median nerve CSA decreased, and the plateau value of the input-output curve was significant higher than before the treatment. Pre injection, we observed a significant inverse correlation between median nerve CSA and plateau value of the input-output curve, which remained significant even after the corticosteroid injection. The Aβ fibers with higher electrical threshold undergo conduction recovery after local corticosteroid injection. In CTS, combined mechanisms might contribute to resolution of symptoms: anti-edema/anti-inflammatory action and direct effect on the electrical properties of the nerve fibers.

Cochrane corner: local corticosteroid injection for carpal tunnel syndrome

Carpal tunnel syndrome is a clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the carpal tunnel in the wrist. Local corticosteroid injection for carpal tunnel syndrome has been studied but its effectiveness is unknown. To evaluate the effectiveness of local corticosteroid injection for carpal tunnel syndrome versus placebo injection or other non-surgical interventions. We searched the Cochrane Neuromuscular Disease Group Trials register (searched May 2006), MEDLINE (searched January 1966 to May 2006), EMBASE (searched January 1980 to May 2006) and CINAHL (searched January 1982 to May 2006). Randomized or quasi-randomized studies. Three authors independently selected the trials and rated their overall quality. Relative risks and 95% confidence intervals were calculated for each trial and summary relative risks and 95% confidence intervals were also calculated.

Effect of Local Corticosteroid Injection of the Hand and Wrist on Blood Glucose in Patients With Diabetes Mellitus

Locally administered corticosteroids are a common therapy in many hand and wrist disorders. Corticosteroids pose a theoretical risk to patients with diabetes mellitus by potentially raising blood glucose to hyperglycemic levels. Although oral corticosteroids are known to have an effect on blood glucose control, limited data exist on extra-articular administration. The purpose of this study was to examine the systemic impact of extra-articularly administered corticosteroids in the hand and wrist on serum glucose concentration in patients with diabetes mellitus.Twenty-three patients with diabetes mellitus received a 1-mL triamcinolone acetonide injection for de Quervain's tenosynovitis, trigger finger, flexor carpi ulnaris tendonitis, or carpal tunnel syndrome. Patients recorded their daily morning blood glucose levels for 1 week before injection and for 4 weeks after injection. Average blood glucose levels increased slightly from baseline after injection, reaching statistical significance 1, 5, and 6 days after injection, but were not clinically significant (average increase, 14.2, 9.7, and 32.7 mg/dL, respectively). Isolated increases more than 2 times the standard deviation of preinjection values occurred at least once in the majority of patients. The frequency of hyperglycemic episodes increased after injection, but the proportions of patients with at least 1 hyperglycemic episode before and after injection were not significantly different.These results suggest that local corticosteroid injections are a clinically safe treatment option for inflammatory processes of the hand and wrist in patients with diabetes mellitus. On average, patients experienced slight increases in blood glucose after receiving an injection. Most experienced isolated increases substantially beyond baseline and isolated hyperglycemic effects, but these did not pose an apparent clinical risk.

Methyl prednisolone local injection in carpal tunnel syndrome

BackgroundAlthough treatment of carpal tunnel syndrome includes various modalities, the optimal treatment of carpal tunnel syndrome has not been established yet. The purpose of this study was to evaluate the effect of local corticosteroid injection in the carpal tunnel.Patients and methodsEighty-one

Long term effect of local corticosteroid injection for carpal tunnel syndrome: A relation with electrodiagnostic severity

ObjectiveCarpal tunnel syndrome (CTS) is a common entrapment neuropathy. A local corticosteroid injection at the carpal tunnel inlet is often given to reduce the signs and symptoms. The long term effect of a local corticosteroid injection is not known yet. The aims of the study were to assess the long term effect of a local corticosteroid injection and the rognostic factors. MethodsAssessment of 419 consecutive patients, seen between November 2004 and November 2007 at our Neurology out-patient clinic. After confirmation of the diagnosis CTS the treating neurologist decided on the patients eligibility for a local corticosteroid injection, containing 40mg methylprednisolone. ResultsLocal corticosteroid injection was given to 273 of the 419 patients with CTS (65%), 122 (29%) were treated surgically and 24 (6%) were treated by another therapy. Of the 273 patients long term follow-up was available for 211 (77%) patients. A beneficial effect of more than 6months was seen in 132 patients (63%), longer than 12months in 102 patients (48%), and longer than 18months in 71 patients (34%).Only severity of electrodiagnostic testing was a predictor of outcome. The median time until treatment failure was 15months for mild, 5months for moderate and 4.5months for severe CTS (logrank test p=0.02). ConclusionPatients with an electrodiagnostically mild CTS (i.e., abnormal comparative tests or prolonged median DSL>3.5ms but normal median DML) are good candidates for a local steroid injection with 50% having a good long term effect for more than 15months. SignificanceThis study shows that the EMG severity of CTS is an important prognostic factor for the long term effect of a local steroid injection.

The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome.

The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P < 0.01). At the end of follow-up period, the median sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment.

Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice

BackgroundDe Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local corticosteroid injections for de Quervain's tenosynovitis provided by general practitioners was assessed.MethodsParticipants with de Quervain's tenosynovitis were recruited by general practitioners. Short-term outcomes (one week after injections) were assessed in a randomised, placebo-controlled trial. Long-term effectiveness was evaluated in an open prospective cohort-study of steroid responders during a follow-up period of 12 months. Participants were randomised to one or two local injections of 1 ml of triamcinolonacetonide (TCA) or 1 ml of NaCl 0.9% (placebo). Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment response, severity of pain, improvement as perceived by participant and functional disability using sub items hand and finger function of the Dutch Arthritis Impact Measurement Scale (Dutch AIMS-2-HFF).Results11 general practitioners included 21 wrists in 21 patients. The TCA-group had better results for short-term outcomes treatment response (78% vs. 25%; p = 0.015), perceived improvement (78% vs. 33%; p = 0.047) and severity of pain (4.27 vs. 1.33; p = 0.031) but not for the Dutch-AIMS-HFF (2.71 vs. 1.92; p = 0.112). Absolute risk reduction for the main outcome short-term treatment response was 0.55 (95% CI: 0.34, 0.76) with a number needed to treat of 2 (95% CI: 1, 3). In the cohort of steroid responders (n = 12) the beneficial effects of steroid injections were sustained during the follow-up of 12 months regarding severity of pain (p = 0.67) and scores of Dutch AIMS-2-HFF (p = 0.36), but not for patient perceived improvement (p = 0.02). No adverse events were observed during the 12 months of follow-up.ConclusionOne or two local injections of 1 ml triamcinolonacetonide 10 mg/ml provided by general practitioners leads to improvement in the short term in participants with de Quervain's tenosynovitis when compared to placebo. The short-term beneficial effects of steroid injections for symptoms were maintained during the follow-up after 12 months.Trial registrationCurrent Controlled Trials ISRCTN53171398

Evaluation of the Effect of Local Corticosteroid Injection and Anti-inflammatory Medication in Carpal Tunnel Syndrome

To evaluate the effect of local corticosteroid injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of carpal tunnel syndrome (CTS), 32 patients were included in this study. A prospective, randomised clinical trial, assessing functional findings by Functional Status Scale (FSS), (JTT) Jebsen Taylor Test and electrophysiologic examinations, analysed on initial visit and at the third month after treatment. Group A was treated with betamethasone injection and group B with NSAIDs, both with concomitant use of wrist splints. The mean age of the patients was 40.8 +/- 11.2 (range 21-64) years. There was a significant improvement in FSS in groups A and B at the third month. In JTT, 'writing', 'picking up small common objects' and 'picking up large heavy objects' activities were improved in group A; 'writing' and 'stacking checkers' activities were improved in group B. Statistically significant improvement was observed in peak sensory conduction velocity and distal motor latency in groups A and B. Mixed nerve conduction velocity and compound sensory action potential were improved in group A. The results showed that neither of the groups demonstrated superior results. We conclude that local steroid injection and NSAIDs with concomitant use of wrist splints may offer patients with CTS variable and effective treatment options for the management of functional scores and nerve conduction parameters.