Intra-articular Steroid Injection Research Articles

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.

Rapidly destructive osteoarthritis of the hip following intra-articular steroid injections: A case report

Rapidly destructive osteoarthritis of the hip following intra-articular steroid injections: A case report

Rare Indication of Atlantoaxial Fusion-failed Conservative Management of Primary Atlantoaxial Osteoarthritis

Introduction: Osteoarthritis of the atlantoaxial joint is a significant cause of occipitocervical pain, which is often missed and has an increasing prevalence with age. The patients typically present with occipitocervical pain and restricted and painful neck rotations. Despite the primary reliance on conservative management for this pathology, surgical intervention becomes crucial for those not responding to standard conservative treatment. The presented case series highlights the rarity of the requirement of surgical intervention in the management of Atlantoaxial osteoarthritis (AAOA) and the clinical outcomes of surgical management in AAOA. Case Report: This paper presents a case series of four patients who were managed surgically with atlantoaxial fusion, from a database of 108 patients with AAOA. The case series includes three males and one female with a mean age of presentation being 67.5 years. All four patients presented with occipitocervical pain, and painful neck movements and were diagnosed with AAOA on the anteroposterior open mouth view radiographs showing changes of osteoarthritis such as bone erosions, sclerosis, osteophytes. The patients were managed conservatively with non-steroidal anti-inflammatory drugs, intra-articular steroid injections, and cervical collar immobilization. Those not responding to conservative management and with incapacitating pain were managed surgically with atlantoaxial fusion procedures. Conclusion: In a group of patients with a painful and debilitating degenerative AAOA only a small proportion of cases require surgical intervention. In this cohort, only 3.70 % of patients required surgery, highlighting the rarity of surgical intervention required in the management of AAOA. Nevertheless, when conducted, atlantoaxial fusion has proved to be efficacious with a low rate of serious complications and the patient self-rated outcome in terms of post-operative visual analog scale score and neck disability index scores indicating a high degree of satisfaction with the procedures. Keywords: Atlantoaxial, osteoarthritis, fusion, transarticular screws.

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.

Multi-drug resistant Mycobacterium abscessus septic arthritis following an intra-articular steroid injection; a case report

Background: Mycobacterium abscessus (M. abscessus), a rapidly growing Mycobacterium (RGM) is an emergent cause of soft issue and musculoskeletal infections. Treatment is often complicated by commonly occurring intrinsic and acquired resistance to not only the classical anti-tuberculous agents but also to most currently available antibiotics. Case Presentation: We present a case of left thumb carpometacarpal (CMC) joint septic arthritis in a 66-year-old American Caucasian woman following an intra-articular steroid injection for osteoarthritis treatment. She did not improve on conventional empirical cellulitis treatment prompting culture and sensitivity assays. Mycobacterium abscessus Deoxyribonucleic acid was detected by real-time polymerase chain reaction (PCR) with additional cultures growing the same organism within a week. Samples were sent to the New York State Department of Health for a full culture and sensitivity profile which demonstrated extensive resistance to antibacterial agents including conventional anti-tuberculous agents. Conclusion: This case not only highlights the importance of having a high degree of suspicion for M. abscessus in joint and soft tissue infections not improving to commonly used empirical therapies even in low prevalent areas. It also underlines the importance of performing cultures and sensitivity given antibiotic combinations for most RGM infections should be sensitivity guided.

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.

The Use of Peripheral Nerve Block and Intra-articular Steroid Injection for Pain Management in an Adolescent with Hutchinson-Gilford Progeria Syndrome: A Case Report.

Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic disorder causing accelerated aging and age-related pathologies. Weighing benefits and risks on doing surgical versus conservative pain management require multidisciplinary planning and consideration in HGPS patients. This presents a case of a 15-year-old patient with HGPS with severe pain from bilateral hip dislocation managed with peripheral nerve block and steroid injection. This afforded her immediate pain relief allowing her to undergo physical rehabilitation comfortably.

Analysis of patients with adhesive capsulitis treated at the Kosovska Mitrovica Clinical Hospital Center over a two-year period

Introduction/Objective. Adhesive capsulitis (AC) is a condition characterized by pain and significant reduction in active and passive movements in the glenohumeral joint, especially in external rotation. It is one of the most common and challenging clinical disorders encountered by orthopedic surgeons. AC is predominantly an idiopathic condition and has an increased prevalence in women and patients with diabetes mellitus and hypothyroidism. The etiology and pathogenesis are not entirely clear. Treatment options include conservative and surgical approaches, but the results remain controversial. Methods. The study included patients treated for primary (idiopathic) AC from June 2021 to June 2023 at the Kosovska Mitrovica Clinical Hospital Center. A total of 172 patients were treated. All were managed non-operatively with physical therapy and local intra-articular steroid injections. The patients were followed up on an outpatient basis monthly, then at six months, one year, and two years. Results. All patients were divided into two groups. The first group (87 patients) underwent physical procedures, while the second group (85 patients) received intra-articular corticosteroid injections. Patients that were treated with physical therapy were not administered injections of steroids, while the group of patients treated with corticosteroids were not given physical therapy. Patients were selected through randomization. Conclusion. Steroid injections may be beneficial in the early stages of the disease, especially in the first 6-8 weeks, but long-term results did not show any significant difference between the two groups of patients.

A Review on Drugs Used in the Management of Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the most widespread rheumatic disease and main cause of disability in children. The disorder includes various classified forms depending on the affected joints’ location and number, as well as the presence or absence of various inflammatory markers. The specific cause is not known but is believed to involve a combination of genetic, humoral, and environmental factors. The aims of treating JIA are to reduce inflammation, reach remission, alleviate pain, sustain function, and do so with minimal side effects. Nonsteroidal anti-inflammatory drugs are still beneficial in mild cases, while intra-articular steroid injections remain the most common treatment for patients with oligoarticular juvenile idiopathic arthritis. Disease-modifying drugs like methotrexate and leflunomide have shown to be effective and safe, but in numerous patients, the disease continues to be active even with this therapy. These patients are given more specific medical care like tumour necrosis factor -alpha (TNF-α) inhibitors, interleukin-1 inhibitors, interleukin-6 inhibitors, selective costimulation modulators, and selective B-cell blockade. Treatment comes with risks, as several medications necessitate monitoring and patient education to manage potential complications. If left untreated, the disease can progress and become chronic, leading to significant illness and potentially having a devastating impact on the child’s quality of life. Despite the advancements in modern therapies improving patient outcomes, a significant portion of individuals still do not respond to treatment. This underscores the necessity for a deeper comprehension of disease development and recovery in order to properly categorize patients for appropriate treatment options.

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.

Efficacy of three different techniques in the fluoroscopy-guided intra-articular steroid injection of the hip: a randomized controlled trial

Fluoroscopy-guided injection via the anterior (A), anterolateral (AL), or proximal anterolateral (PAL) approaches are the common hip injection techniques without comparing the efficacy of the three techniques. The prospective randomized controlled trial was conducted from August 2020 to March 2022. Included patients with intra-articular hip disorders indicated an intra-articular steroid injection. Excluded significant spine pathology with radiculopathy or significant neurological deficits, previous hip surgery of the injection side, suspected tumor or infection origins, steroid or contrast media allergy, and body mass index > 35 kg/m2. The primary outcome was the injection attempt defining one attempt and multiple attempts. 90 patients were recruited and allocated to 30 per group. There were no differences between A, AL, and PAL respectively regarding the success in one attempt rate (80%, 80%, 90%; p = 0.533), VAS during local anesthetic injection (4.33 ± 1.99, 3.70 ± 2.34, 4.27 ± 2.49; p = 0.500), VAS during intra-articular injection (4.27 ± 1.87, 4.70 ± 2.37, 4.13 ± 2.37; p = 0.587), radiation doses (0.558 ± 0.313, 0.526 ± 0.485, 0.492 ± 0.275 mGy; p = 0.788), radiation time (0.043 ± 0.017, 0.039 ± 0.021, 0.041 ± 0.015 seconds; p = 0.723), and complications. The post-injection mHHS was improved in all three approaches without significant differences.

Analysis of patients with adhesive capsulitis after COVID-19 vaccination: An observational study.

This study aimed to increase the awareness of clinicians about shoulder injury related to vaccine administration (SIRVA) by analyzing 21 patients with adhesive capsulitis that developed after COVID-19 (coronavirus disease 2019) vaccination. In this observational study, 21 patients (11 males, 10 females; mean age: 60.7±7.3 years; range, 45 to 70 years) with incipient shoulder pain and limitation diagnosed with adhesive capsulitis due to SIRVA were evaluated between June 2021 and December 2022. Demographic and clinical data of the patients were recorded. Pain was evaluated with the Visual Analog Scale (VAS). The passive range of motion (ROM) of the affected shoulder was measured by a goniometer. The applied treatment methods (medical treatment, physical therapy, intraarticular steroid injection, hydrodilatation, and suprascapular nerve block) were recorded. The patients were called in for control two months later. Visual Analog Scale scores and passive shoulder ROMs were reevaluated. Symptoms started after the second dose in nine (42.9%) patients. The mean time between vaccination and onset of complaints was 8.0±6.4 days. Sinovac vaccine was administered to eight patients, BioNTech vaccine was administered to five patients, and Sinovac+BioNTech vaccine was administered to eight patients. Baseline to control ROM angle changes were 128.8±30.4º to 155.0±20.6° for flexion, 117.1±37.8° to 147.1±26.4° for abduction, 45.9±17.8° to 61.9±12.6° for internal rotation, and 43.4±21.9° to 56.3±18.3° for external rotation, respectively. The mean VAS scores were 7.0±1.2 (5-9) at baseline and 2.7±1.0 (1-5) at the control. There was a statistically significant difference between the baseline and control (two months after treatment) in terms of VAS scores and ROM angles (p<0.001). Clinicians should be aware of adhesive capsulitis following vaccine administration since a significant improvement can be obtained by proper treatment for SIRVA.

S1933 Intra-Articular Steroid Injection as the Etiology of Acute Pancreatitis

S1933 Intra-Articular Steroid Injection as the Etiology of Acute Pancreatitis