Intra-articular Steroid Injection Research Articles

Intra-articular Steroid Injection as the Etiology of Acute Pancreatitis

Intra-articular Steroid Injection as the Etiology of Acute Pancreatitis

Efficacy of Platelet-Rich Plasma Versus Hyaluronic Acid in Symptomatic Knee Osteoarthritis

Background: Osteoarthritis (OA) is one of the most common forms of arthritis and leading causes of disability. Intra-articular injection of PRP or steroid may provide benefit for patients suffering from osteoarthritis of knees, preventing, and delaying the need of a larger operative measures as many of the senile patients suffering from OA knee are quite hesitant to undergo any operative measure for the same. Materials and Methods: This was prospective type of study, with randomised selection of the patients for the assessment of outcome of treatment of symptomatic knee osteoarthritis with intra articular injections of PRP or hyaluronic acid. This study was carried out in the department of orthopaedics at our institute. In this study both injections given superolaterally weekly for 3 weeks. Study conducted over 2 years, a total of 50 patients suffering from OA knee were included in the study depending upon inclusion criteria. These patients were randomly selected for injection in a sequential manner i.e., case number 1,3,5,7 and so on sequentially were given injection HA. Case number 2,4,6,8 and so on sequentially were given injection PRP. Patients were evaluated prospectively at enrolment and at 6 weeks, 3 and 6-months follow-up with WOMAC and KSS scores. Results: PRP seems to be more efficient as compared to HA in salvaging knee in osteoarthritis. It can work as a salvaging agent in mild to moderate osteoarthritis of knee. HA injection has been found to be effective only in short term cases. Conclusion: The clinical results of this study show that both these non-surgical modalities (intraarticular injections of PRP or HA) are useful for the treatment of osteoarthritis of knee. Treatment with PRP shows significantly better outcome compared with HA group; with respect to WOMAC and KSS scores.

E028 A differential diagnosis for treatment resistant psoriatic arthritis

Abstract Background/Aims This case involves a 45 year old gentleman with established psoriatic arthritis with axial and peripheral joint involvement. His disease was managed with subcutaneous methotrexate and etanercept. Despite improvement in axial symptoms and resolution of symptoms at other peripheral joints, he had ongoing severe monoarthritis of his right knee with significant pain and swelling. Methods In spite of several joint aspirations and intra-articular steroid injections [ten in total], escalation of dose of methotrexate, addition of sulfasalazine and switch of biologic to adalimumab, the patient’s right knee symptoms persisted. Further imaging was performed. An US scan showed chronic synovial hypertrophy with fatty metaplasia and an MRI scan showed frond like synovial thickening, suggestive of lipoma arborescens. Results The patient was referred to the orthopaedic surgeons and underwent excision synovectomy. The histopathology reported fibrofatty tissue with areas of chronic synovitis with presence of lymphoplasmacytic aggregates. The patient’s knee symptoms persisted for five years in total after clinical improvement at other joints; post-synovectomy, his right knee symptoms were improved. Lipoma arborescens is a benign progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium; it frequently affects the knee joint suprapatellar pouch. Villous proliferation of the synovium occurs, with subsequent replacement of synovial connective tissue by adipocytes. Conclusion Lipoma arborescens has been described occasionally in association with psoriatic arthritis. It is felt to occur as a reactive response to chronic synovial irritation; in this case from an inflammatory affront. Given the rarity of lipoma arborescens, coupled with the patient’s known underlying diagnosis of a seronegative arthritis, there was significant delay in his diagnosis. This case highlights the need to consider other causes of persistent joint pain and swelling when maximal therapeutic options have been unsuccessful. Disclosure A. Jacobs: None. M. Callan: None.

Minimally invasive treatment for idiopathic chondrolysis of the hip: analysis of forty-one cases.

Idiopathic chondrolysis of the hip is characterized by the loss of the articular cartilage of the hip joint with spectrum ranging from full recovery to fibrous ankylosis. Study assessed outcomes following intra-articular steroid injections, joint manipulation and traction immobilization. Retrospective (2012-2021) review of 41 cases treated for idiopathic chondrolysis of hip, assessed pre-operatively and post-operatively (minimum 2-year follow-up) using Children's Hospital Oakland Hip Evaluation Score (CHOHES), visual analogue scale (VAS) and range of motion measurements. Twenty-five patients (62%) achieved painless mobility, 6 (14%) had hip stiffness without pain and 10 (24%) had painful and stiff hips at final follow-up. They had a mean age of 12.49 ± 2.4years and a mean follow-up duration of 33.15 ± 13.1months. Range of motion improved significantly (p < 0.05). VAS improved to 3.93 ± 1.3 from 7.8 ± 0.7. CHOHES improved from 29.12 ± 9.9 to 56.37 ± 17.6. Intra-articular steroid injection, manipulation and traction immobilization may effectively treat idiopathic chondrolysis of the hip by enhancing patient function and reducing the need for further surgical intervention.

Hydrodilatation and Intra-articular Steroid Injection are Both Effective in Management of Frozen Shoulder: A Case Series

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Frozen shoulder is a common problem in general orthopaedic practice, affecting about 2% of the population. Intra-articular corticosteroids (IA) and hydrodilatation have been reported as more effective among other conservative treatments. However, it is unclear which treatment is superior for frozen shoulder, and the hydrodilatation procedure leads to more discomfort in patients since it involves stretching of joint capsule. In this case series, we present 10 cases of frozen shoulder that were treated with hydrodilatation or IA steroid injection. The purpose of this study is to show the effectiveness of hydrodilatation and IA steroid injection in managing patient with frozen shoulder.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was a retrospective case series of patients who received IA steroid injection or hydrodilatation. Five patients underwent IA steroid injection, and another five patients underwent hydrodilatation. The American Shoulder and Elbow Score (ASES) was used to evaluate each patient before and six months after treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; Hydrodilatation and IA steroid injection showed significant improvement in ASES score assessed at 6-month follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hydrodilatation and IA steroid injection are both effective to treat frozen shoulder in long term follow up.&lt;/p&gt;

Perioperative steroid injection in elbow arthroscopy.

The goal of the present study was to evaluate the incidence of infection after perioperative intra-articular steroid injection during elbow arthroscopy. Starting from May 2019, we prospectively included all patients that underwent an elbow arthroscopy for various indications. All patients received preoperative antibiotics intravenously and a corticosteroid injection immediately after portal closure. Patients who needed ligamentous repair and aged below 18 years old were excluded. Final follow up of all patients was 3 months. In total, 108 elbow arthroscopies were performed in 100 patients. No major complications and 1 minor complication were seen. One patient developed a seroma that resolved spontaneously after 14 days without intervention or antibiotics. In this patient group, a perioperative corticosteroid injection following elbow arthroscopy did not increase the chance of infection.

Arthroscopic capsular release is more effective in pain relief than conservative treatment in patients with frozen shoulder

BackgroundFrozen shoulder is a common medical condition, but the ideal therapeutic method is yet to be determined. Our aim was to analyze the pain-relieving effect of different treatment options used for the management of this disease.MethodsMedical records of 59 patients (22 male, 37 female, average age: 55.5 years ±9.9) with early stage primary frozen shoulder were evaluated, their demographic data, physical examination, concomitant diseases and treatment specific data were registered. Life quality and the level of pain were assessed using the Oxford Shoulder Score (OSS) and Numeric Rating Scale (NRS). Different treatment modalities and their effect on pain relief were recorded. Any existing correlation between life quality, pain and demographic data, concomitant diseases or the therapeutic method used was investigated.ResultsThe level of pain measured on NRS improved from 7.9 ± 1.6 to 1.9 ± 2.2. The most effective therapeutic method in terms of pain relief was surgery, followed by physiotherapy and intraarticular steroid injection (NRS score after treatment: 2 - p < 0.0001; 3.3 - p < 0.0001; 4.9 - p < 0.0001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs) did not reduce pain significantly. OSS improved from 24 to 43.6 and was not affected by the investigated variables, time to recovery was not influenced by the demographic data, the type of treatment or concomitant diseases.ConclusionsArthroscopic capsular release, physiotherapy and intraarticular steroid injection outperformed physical therapy and NSAID treatment in terms of pain relief. Despite of slight but persistent post-therapeutic pain found in half of the cases, treatment was considered satisfactory by the patients. Nor patient specific neither therapy specific data had a significant effect on the course of the disease.

Lessons in clinical reasoning- pitfalls, myths, and pearls: a woman brought to a halt.

Limitations in human cognition commonly result in clinical reasoning failures that can lead to diagnostic errors. A metacognitive structured reflection on what clinical findings fit and/or do not fit with a diagnosis, as well as how discordance of data can help advance the reasoning process, may reduce such errors. A 60-year-old woman with Hashimoto thyroiditis, diabetes, and generalized anxiety disorder presented with diffuse arthralgias and myalgias. She had been evaluated by physicians of various specialties and undergone multiple modalities of imaging, as well as a electromyography/nerve conduction study (EMG/NCS), leading to diagnoses of fibromyalgia, osteoarthritis, and lumbosacral plexopathy. Despite treatment for these conditions, she experienced persistent functional decline. The only definitive alleviation of her symptoms identified was in the few days following intra-articular steroid injections for osteoarthritis. On presentation to our institution, she appeared fitwith a normal BMI. She was a long-time athlete and had been training consistently until her symptoms began. Prediabetes had been diagnosed the year prior and her A1c progressed despite lifestyle modifications and 10 pounds of intentional weight loss. She reported fatigue, intermittent nausea without emesis, and reduced appetite. Examination revealed intact strength and range of motion in both the shoulders and hips, though testing elicited pain. She had symmetric hyperreflexia as well as a slowed, rigid gait. Autoantibody testing revealed strongly positive serum GAD-65 antibodies which were confirmed in the CSF. Adiagnosis of stiff-person syndrome was made. She had an incomplete response to first-line therapy with high-dose benzodiazepines. IVIg was initiated with excellent response and symptom resolution. Through integrated commentary on the diagnostic reasoning process from clinical reasoning experts, this case underscores the importance of frequent assessment of fit along with explicit explanation of dissonant features in order to avoid misdiagnosis and halt diagnostic inertia. A fishbone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic error. The case discussant demonstrates the power of iterative reasoning, case progression without commitment to a single diagnosis, and the dangers of both explicit and implicit bias. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl specific to overcoming diagnostic inertia.

High satisfaction rate and range of motion can be expected in frozen shoulder after awake manipulation with brachial plexus block

BackgroundAdhesive capsulitis (AC) is a disease of the glenohumeral joint that is characterized by pain and both passive and active global stiffness with a slow and insidious onset. The disease can occur spontaneously (primary AC) or it can be secondary to other comorbidities, surgery, or trauma, such as fracture or dislocation. Multiple treatment approaches have been suggested: intra-articular steroid injection, physical therapy, manipulation under total anesthesia, and arthroscopic or open surgery. Shoulder manipulation under anesthesia is usually proposed to patients that suffer from severe AC and have already undergone several nonoperative treatments without benefit. Different techniques have been proposed. This study presents our manipulation technique and the clinical results we achieved after shoulder mobilization under brachial plexus block in patients with phase III primary AC.Materials and methodsA retrospective cohort study was performed on a sample of 110 patients with phase III AC who were treated with this manipulation and followed up for 1 year. Patients underwent two assessments—before the procedure (T0) and 4 months after it (T1)—based on the Numerical Rating Scale, Simple Shoulder Test, and joint range of motion to assess shoulder pain, function, and joint articulation, respectively. Furthermore, the patients had to express their degree of satisfaction with the procedure and the results achieved.ResultsPositive and statistically significant results were recorded in terms of pain reduction (ΔNPRS = − 5.4; p < 0.01) and improved functionality (Simple Shoulder Test Δ = 5; p < 0.01). Passive range of motion was statistically significantly increased for each movement at T1. Large increases were observed in extrarotation range of motion (ROM): R1 (Δ = 77.5°) and R2 (Δ = 70°), whereas little improvements were observed in intrarotation ROM. Patients achieved satisfying functional and articular recovery in all cases. Complications that needed further treatment occurred in three cases: a brachial plexus injury, a glenoid flake fracture, and persistent pain and stiffness.ConclusionsIn this study, we proposed a standardized method of manipulation under brachial plexus block for patients affected by phase III adhesive capsulitis. The technique was applied among a large cohort of patients, who reported a high satisfaction rate and range-of-motion recovery after 4 months. This could represent an alternative treatment to surgery that has a shorter timeline and does not require patient hospitalization.Level of evidence: Level III, retrospective cohort study.

Physiatry for Treating Hip, Knee, and Back Pain.

Physical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients who have disabilities or physical impairments affecting the musculoskeletal system, brain, and spinal cord. Physiatrists may work in an inpatient or outpatient setting, with outpatient physiatrists being an invaluable resource in treating patients experiencing pain. It is worthwhile to refer patients experiencing hip, knee, or back pain to a PM&R specialist because of their skill in making specific and accurate diagnoses, as well as providing a wide range of modalities to treat pain and augment function such as management of pain medications, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures. Emphasis is on the use of the least invasive modality before employing more invasive treatments. The need for physiatrists to help individuals maximize function and enhance quality of life is increasing with the aging population, expanding workforce of older adults, and a growing population of people with a disability, especially since the COVID-19 pandemic.

A rare case of very late recurrence of CSCR-induced CNVM following intra-articular injection of depot steroid

Choroidal neovascular membrane (CNVM) is a major cause of long-term vision loss in patients with chronic central serous chorioretinopathy (CSCR). External steroid medications, both oral and injectable, have long been proven as one of the major contributors to CSCR pathogenesis. Here, we report an old case of CSCR with CNVM, who presented with reactivation of CSCR and CNVM, 6 weeks following intra-articular steroid injection for chondromalacia patellae after an unusual gap of 8 years. Exposure to high doses of steroids can be a significant risk factor for reactivation of CSCR CNVM in susceptible individuals, even after a long disease-free interval. The disease process responded well to intravitreal anti-vascular endothelial growth factor (anti-VEGF; ranibizumab) treatment with good visual and anatomical outcomes.

Platelet-rich plasma injections for hip osteoarthritis : a systematic review

Osteoarthritis (OA) is the most prevalent type of joint disorder. Symptomatic hip OA was observed in 9.2% of adults aged 45 and above, with 27% displaying radiographic evidence of the condition. While there is no definitive cure for OA, numerous research studies have explored the application of PRP (Platelet-Rich Plasma) for addressing knee OA, there is a relatively limited number of investigations dedicated to hip OA. It is important to note that the hip joint possesses distinct characteristics compared to the other three joints. Therefore, in this systematic review, we wanted to focus on hip osteoarthritis and gave a brief update from the previous studies. This systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines. All randomized control trials that compared injection of Platelet-Rich Plasma and Hyaluronic Acid in hip osteoarthritis patients using English language from 2018 until 2023 will be included. Six studies involved in this study with total samples of 237 in PRP group and 220 in HA group.  The injection site, injection volume, number of injections, interval, and follow up were varied between these studies. All of the patients are undergoing treatment with ultrasound-guided intraarticular injections of PRP. The outcomes tabulated were Visual Analog Scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score which showed improvements from the baseline. All of the studies showed improvement of the score from the baseline. Although, there were improvements, it can be concluded that there was not enough evidence to promote the utilization of intra-articular PRP injections as a treatment for hip osteoarthritis. Since international guidelines only recommend intra-articular steroid injections for managing hip OA, it would be advantageous to conduct additional studies comparing PRP to steroids to assess the effectiveness of PRP injections in treating hip OA.

A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia versus intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial

BackgroundFrozen shoulder (FS) is a common condition that can cause severe pain and limited range of motion in the shoulder joint. While intra-articular steroid injection has been shown to be an effective treatment for FS, manipulation under anesthesia (MUA) is an alternative treatment that has gained popularity in recent years. However, there is a lack of evidence regarding the effectiveness of MUA on FS patients with concomitant rotator cuff injury or tear. Though a few studies have shown that MUA is not associated with rotator cuff tears, and will not exacerbate the injury, more high-quality studies with bigger sample sizes are needed. Therefore, the aim of this multi-center, single-blinded, randomized, parallel-group, superiority study is to compare the efficacy of MUA versus intra-articular steroid injection in the treatment of FS patients with a diagnosis of rotator cuff injury or tear by MRI.MethodsA parallel, single-blinded, multi-center randomized controlled trial of 320 patients will be conducted at three hospitals of China. Eligible patients with frozen shoulder and rotator cuff injury or tear diagnosed by MRI will be randomly assigned to, in equal proportions, the manipulation under anesthesia group and the intra-articular steroid injection group via a central randomization system, undergoing a corresponding operation on day one and a sequent physical exercise for 14 days. The primary outcome is the comprehensive efficacy evaluation (total effective rate) and the change of Constant-Murley Score. Outcome assessors and data analysts will be blinded, and participants will be asked not to reveal their allocation to assessors.DiscussionThis study aims to explore the superiority of manipulation under anesthesia in reducing pain and improving shoulder function in frozen shoulder patients accompanied with rotator cuff injury. To provide a scientific basis for the dissemination and application of manipulation under anesthesia, and a better knowledge for the role of MUA in the treatment of frozen shoulder accompanied with rotator cuff injury.Trial registrationChictr.org.cn ChiCTR2200067122. Registered on 27 December 2022. ChiCTR is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) network and includes all items from the WHO Trial Registration data set in Trial registration.

Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache.

Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered. To determine the success rates of arthrodesis of the lateral atlanto-axial joint for relieving neck pain and disability. Practice audit. Private practice of senior author. Prospective series of 23 consecutive patients. Outcomes were measured using a numerical rating scale for neck pain, and the Neck Disability Index for disability. Success rates were calculated for various degrees of improvement of neck pain at long-term follow-up (8-40 months), and for achieving various combinations of improvement of both neck pain and disability. Complete relief of pain was achieved in 40% of patients, with a further 40% achieving at least 50% relief. At long-term follow-up, 30% of patients had no neck pain and no disability, and a further 25% had only minimal pain, minimal disability, or both. The present study did not corroborate earlier studies that claimed outstanding outcomes for arthrodesis of the LAAJ, but its outcomes are consonant with more recent studies that provided transparent outcome data. These studies provide Pain Physicians with empirical data on success rates and outcomes, upon which they can base their consideration of referral for arthrodesis.

Under what conditions is the intra-articular steroid injection superior to nonsteroidal anti-inflammatory drugs for treating sacroiliac joint pain?

The purpose of this prospective study was to determine the conditions under which intra-articular injection therapy may be superior to nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with sacroiliac joint pain in the outpatient setting at our hospital. Patients with sacroiliac pain were divided into two groups: NSAID and the sacroiliac injection group. The NSAID group received 25 mg of indometacin orally once a day and 750 mg of naproxen orally once a day. In the sacroiliac injection group, 5 mg of betamethasone were injected into the sacroiliac joint. The patients' history of lumbar surgery, whether they had sacroiliitis, and the duration of pain were recorded. The patients' VAS (Visual analogue scale) scores at week 1 and month 1 were evaluated. VAS scores were decreased after the first week and first month in the sacroiliac injection group compared to the NSAID group (p<0.001). Sacroiliac steroid injection was found to be superior to NSAIDs in reducing VAS scores in patients with sacroiliitis, a history of lumbar surgery, and pain lasting more than 30 days (p<0.001). In patients without sacroiliitis, without a history of lumbar surgery, and with less than 30 days of pain, no difference was observed between the groups in reducing VAS scores at the end of the first month. In patients with sacroiliac joint pain, sacroiliac joint injection is superior to NSAIDs in pain relief in patients with pain for more than 30 days, those with MRI-diagnosed sacroiliitis, and those who have undergone lumbar surgery.

Efficacy of cryoneurolysis versus intra-articular steroid in sacroiliac joint pain: A retrospective, case-control study.

Intra-articular steroids provide significant pain relief in sacroiliac joint pain (SIJP), but their action is short-lived. Cryoneurolysis is reported to produce prolonged pain relief in various pain conditions. However, its efficacy has not been evaluated in patients with SIJP. Thus, we compared the efficacy of cryoneurolysis with steroid injections in adult patients with SIJP. This retrospective healthcare records review-based study involved 83 patients with SIJP. Patients were divided into two groups: cases (sacroiliac joint [SIJ] cryoneurolysis, n = 39) and controls (SIJ steroid injection, n = 44). An 11-point numeric pain rating scale (NPRS) was used to assess the pain severity at baseline and immediately, 1, 3 and 6 months post-intervention. A reduction of ≥50% in NPRS score immediately following SIJ cryoneurolysis and steroid injection was considered a successful outcome. The difference between the treatment groups was assessed with a Chi-square test, and P < 0.05 was considered statistically significant. Both cases and controls showed significantly decreased NPRS scores from baseline to immediately, 1 month, 3 months and 6 months postintervention (P < 0.001). However, compared to controls, cases had significantly lower NPRS scores at all time points (all P < 0.001). Moreover, a significantly greater proportion of cases had ≥50% decrease in NPRS score from baseline, that is, 1 month (97.44% vs. 75%, P = 0.004), 3 months (100% vs. 47.73%, P < 0.001) and 6 months (69.23% vs. 27.27%, P < 0.001). Although both cryoneurolysis and intra-articular steroid injections provide significant pain relief immediately, 1, 3 and 6 months postintervention, cryoneurolysis resulted in significantly greater pain relief.

Developing flare-responsive intra-articular steroid injections

Developing flare-responsive intra-articular steroid injections

Superficial Vein Thrombosis After Intra-articular Particulate Steroid Injection for Knee Osteoarthritis.

Intra-articular steroid injections for knee osteoarthritis are a routine procedure in musculoskeletal clinics. While their role in osteoarthritis care is debatable, they serve as an important therapeutic option to relieve osteoarthritis-associated pain. Potential risks are self-limited (increased pain flare, local skin irritation, flushing, insomnia) or severe (septic arthritis, intravascular medication placement, and the deleterious effect on cartilage and bone). In our experience, more serious adverse events are rare. In this case, we present a complication secondary to intra-articular steroid administration that has not previously been reported in the literature: superficial vein thrombosis. This will raise awareness among clinicians, improve the informed consent process, and provide an approach for the management of subsequent injections.

Chronic shoulder injury related to vaccine administration following coronavirus disease 2019 vaccination: a case report

BackgroundShoulder injury related to vaccine administration, defined as shoulder pain and limited range of motion occurring after administration in the upper arm, has been previously reported. The symptom resolved completely after treatment with oral nonsteroidal anti-inflammatory drugs or an intraarticular steroid injection, however there have been few reports of long-term symptoms following coronavirus disease 2019 vaccination. This case report describes a healthy, middle-aged, healthcare worker who developed post-vaccination subacromial–subdeltoid bursitis that lasted for more than 6 months after Pfizer–BioNTech coronavirus disease 2019 vaccination.Case presentationA 55-year-old Japanese woman with no significant medical history was vaccinated in the standard site, with the needle direction perpendicular to the skin. Within a few hours after the second vaccination, severe shoulder pain and limited range of motion appeared. Although shoulder range of motion improved, her shoulder pain did not improved for several months, and she consulted an orthopedic doctor 5 months later. Radiographs of her left shoulder did not provide helpful diagnostic information. High intensity in the subacromial–subdeltoid space was seen on short TI inversion recovery of magnetic resonance imaging, showing subacromial–subdeltoid bursitis. She was diagnosed with a shoulder injury related to vaccine administration. The patient was started on an oral anti-inflammatory drug, and the left subacromial space was injected with 2.5 mg of betamethasone with 3 ml of 1% lidocaine without epinephrine every 2 weeks. One month after starting this treatment, since her shoulder pain had not improved, the oral anti-inflammatory drug was switched to tramadol hydrochloride acetaminophen. However, 3 months after switching medication, the shoulder pain continued, and she worked so as to have minimal impact on her shoulder.ConclusionA case of subacromial–subdeltoid bursitis following a second dose of the Pfizer–BioNTech coronavirus disease 2019 vaccine that lasted many months is reported. Injection technique is a modifiable risk factor, the adverse effects of which could potentially be mitigated with appropriate and relevant training of healthcare providers. To prevent this type of case, the appropriate landmark, needle length, and direction should be confirmed.

Incidence, Common Pathogens, and Risk Factors for Infection after Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review.

We sought to assess the current literature to present a comprehensive summary of the incidence, common pathogens, and risk factors for infection after anterior cruciate ligament (ACL) reconstruction. PubMed, CINAHL, EMBASE, and Scopus databases were searched for relevant studies reporting on infection after ACL reconstruction. Two reviewers independently screened the extracted studies for adherence to inclusion and exclusion criteria. Studies were selected if they reported on the incidence of infection, pathogens cultured from infected knees, or risk factors for infection after primary ACL reconstruction. Exclusion criteria consisted of studies with fewer than 100 patients or studies that included revision ACL reconstruction. Fifty studies met the inclusion and exclusion criteria, reporting on a total of 316,214 ACL reconstructions. Included studies evaluated between 123 and 104,255 patients. The overall incidence of infection was 0.60% (0.15-2.44%). The most common pathogens were Staphylococcus aureus, S. epidermidis, and coagulase-negative Staphylococci. Five studies reported that the use of hamstring autograft was a statistically significant risk factor for infection after ACL reconstruction, thus making hamstring autograft the most commonly reported risk factor. Other reported risk factors included male sex, use of immuno-suppressive medications or intraarticular steroid injections, prior knee surgery, and diabetes. Systematic review of the literature revealed that infection after ACL reconstruction remains an infrequent event with an incidence of 0.60% (0.15-2.44%). Furthermore, the most common pathogens are from the Staphylococcus genus of bacteria, comprising 84% of all culture-positive infections. Multiple risk factors have been reported for ACL reconstruction; however, statistical significance varied across studies. Together, these findings may help guide physicians in the prevention and treatment of infection after ACL reconstruction.