Intra-articular Steroid Injection Research Articles

Efficacy of Physical Therapy after Intra-Articular Steroid Injection in Patients with Adhesive Capsulitis of the Hip Joint

Efficacy of Physical Therapy after Intra-Articular Steroid Injection in Patients with Adhesive Capsulitis of the Hip Joint

Comparison of Intra-articular Knee Injection of Corticosteroid between Hemodialysis and Non-hemodialysis Patients.

Hemodialysis patients have various complications, and orthopedic diseases include carpal tunnel syndrome, spinal canal stenosis, spondylosis destruction, fractures, and osteoarthritis. As a treatment for knee osteoarthritis, intra-articular injections of hyaluronic acid and steroids are performed. In general, steroid injections have a strong short-term anti-inflammatory effect, but there is a risk of complications, such as infection. In addition to aging, dialysis patients are prone to weakened immune systems and susceptibility to infection. Therefore, more attention should be paid to the treatment of osteoarthritis in dialysis patients. This study aimed to compare the effects of steroid and complication of infection of dialysis and non-dialysis patients who underwent intra-articular steroid injection. A total of 20 dialysis patients (23 knees) and 20 non-dialysis patients (24 knees) with knee osteoarthritis who underwent steroid injections were investigated. All patients underwent radiographic diagnosis and were evaluated for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analog scale (VAS), range of motion (ROM), and side effects before, and at 3, and 6 months after injection. The mean body mass index (BMI) was 21.3 (±standard deviation (SD) 2.8) and 24.9 (±SD 2.6) in dialysis and non-dialysis patients, respectively, showing a significant difference. Both dialysis and non-dialysis patients showed statistically significant improvement in VAS and WOMAC scores after steroid injection. There were no significant differences between dialysis and non-dialysis patients in the gender differences and mean age. There were no infection complications in both groups. This study revealed the analgesic effect of steroids on knee osteoarthritis in dialysis and non-dialysis patients. On the other hand, there were no infection complications in either patient. These findings suggest that intra-articular steroid injection is safe for dialysis patients.

A comparison of two surgical methods in the treatment of shoulder adhesive capsulitis.

The purpose of the study was to compare the outcomes of arthroscopic capsular release surgery and manipulation of patients with resistant primary adhesive capsulitis (AC) under anesthesia. The study comprised forty-four patients who had surgery after being given a diagnosis of primary AC. Patients who had both passive and active glenohumeral and scapulothoracic movements equal to or less than 100° elevation and less than 50% of external rotation compared to the contralateral side were considered to have resistant adhesive capsulitis and were included in the study. Conservative treatments such as intra-articular steroid injections and physical therapy had failed to relieve the pain in these patients for at least six months. The patients who took part in the trial underwent manipulation under anesthesia (group 1) and arthroscopic capsular release (group 2) operations. The chosen surgical procedure was chosen at random and based on the surgeon's preferences. examining the patients' demographic information. After treatment, the patients were examined at three-month, six-month, and one-year intervals. Joint range of motion, visual analogue scale (VAS), and Constant-Murley shoulder scores were all recorded. Statistics were used to compare the outcomes of the two surgical techniques in this study both before and after the procedure. The study's participants' gender, side, extra procedure, and age factors did not show a statistically significant difference between groups 1 and 2 (p<0.05). According to the age, gender, side, additional process, and homogeneous distribution throughout the groups. No statistically significant difference was discovered between groups 1 and 2 in any of the measurements taken from study participants during the follow-up period: Pre-op visual pain scores (VPS), Post-op 3rd month VPS, Post-op 1st year VPS, Pre-op Constant score, Post-op 6th month Constant score, and Post-op 1st year Constant score (p<0.05). The change in VPS and Constant Score values over time did not show a statistically significant difference between the groups (p<0.05). A statistically significant difference between the groups was discovered in each of the Pre-op period and Post-op 6th month VPS assessments (p<0.05). Although there was no statistically significant difference between the two studied therapies, the surgical method was shown to be more beneficial in both groups the shorter the pre-op period was between the onset of the complaints and the operation.

Patient Satisfaction with Pisiform Excision for Pisotriquetral Instability or Arthritis: A Prospective Review.

Background Pisotriquetral pain and instability is an elusive cause of ulnar-sided wrist pain. Initial treatment of chronic pisotriquetral pathology should involve a trial of nonoperative therapy such as neutral wrist splint, anti-inflammatories, and intra-articular steroid injections. The mainstay of surgical management of pisotriquetral pain is pisiform excision. Purpose This prospective study seeks to understand patient satisfaction after pisiform excision in patients with isolated pisotriquetral pathology. Patients and Methods A consecutive series of nine cases of pisiform excision was performed by the senior surgeon. The primary outcome measure was determined a priori to be the Patient-Rated Wrist Evaluation (PRWE) score. Wrist range of motion, grip strength, and QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) scores were also collected preoperatively and at 3 and 12 months postoperatively as secondary outcome measures. Results There was a very rapid improvement in the PRWE by 3 months, which was maintained at 12 months. The QuickDASH score was slower to improve, with a significant improvement by 12 months. There was no change in grip strength or wrist range of motion at any time point. Conclusion Pisiform excision results in a very rapid improvement of symptoms and should be considered in cases of pisotriquetral instability or arthritis that fail conservative management. Level of Evidence Level IV, case series.

FROZEN SHOULDER: DOES HYDRODILATATION WITH STEROID HAS ADDED ADVANTAGE OVER INTRA-ARTICULAR STEROID INJECTION

Objective: In our study, we will compare the efficacy of intra-articular steroid injection with hydrodilatation (with steroid) with regards to Shoulder Pain and Disability Index (SPADI), visual analog scale (VAS), and range of motion (ROM) in patients of adhesive capsulitis. Methods: The study is a prospective study carried out on 36 patients in Department of Orthopaedics, Government Medical College, Jammu, from August 2021 to July 2022. The patients were evaluated in terms of SPADI, VAS, and ROM (flexion, abduction, and external rotation) at 0-, 6-, 12-, and 24-week interval. Results: Hydro-dilatation has better results in comparison to intra-articular steroid injection. The patients with hydrodilatation fared with better scores in terms of SPADI as well as VAS with significant p-value (≤0.05). In addition, the patients also had better ROM in the former group. Conclusion: Hydrodilatation with corticosteroid provides better relief in terms of pain as well as ROM for frozen shoulder when compared to intra-articular CSI. The predictability of results with hydrodilatation is excellent and hence it is a better modality of treatment compared to intra-articular CSI.

Quality Improvement of a Hip Injection Service.

Background Osteoarthritis is a substantive burden on the population and National Health Service (NHS) in the United Kingdom. A recent systematic review suggests that intra-articular steroid injections are an efficacious conservative treatment modality. The NHS Constitution states that "patients should wait no longer than 18 weeks from GP referral to treatment."An NHS hospital trust failed to meet this standard in a quarter of patients waiting for an intra-articular steroid injection of the hip. Strategies were considered to improve the time from referral to treatment (RTT). The aim of this quality improvement project was to improve the efficiency and capacity of the injection list. Materials and methods Patients who underwent an injection on a list between January and April 2019 were identified. Data were retrospectively collected and included the sites of injection and waiting times. Proformas for documentation and discharge summaries were introduced. Time taken for each appointment pre- and post-intervention were compared with the aim to increase the number of patients per list. Results Thirty-six (26%) of 138 patients experienced delays beyond 18 weeks from RTT. The mean (standard deviation [SD]) number of weekswaiting for an injection from the time of referral was 14 (6). The mean (SD) time for each appointment was 12 minutes 36 seconds (7 minutes 36 seconds) pre-intervention and 8 minutes 36 seconds (3 minutes 12 seconds) post-intervention. Discussion and conclusion Our standardized proformas led to an improvement in efficiencyby reducing the time taken for documentationand capacityby subsequently increasing the number of patients per list.

Comparison of 90-day complication rates and readmissions of primary total elbow arthroplasty in elective and traumatic cases: a single center experience.

The purpose of this study is to compare the 90day complication rates of primary Total Elbow Arthroplasty (TEA) performed for arthritis (primary-OA; rheumatoid arthritis-RA) versus those performed for distal humerus fractures (DHF). Patients who underwent a TEA from 2015 to 2021 were identified from our institutional database and placed into cohorts based on surgical indications (TEA-OA, TEA-RA and TEA-DHF). Chart review was conducted to analyze the prevalence of complications, emergency department (ED) visits, readmissions, and secondary procedures in the first 90day post-operative period. Complications included but were not limited to wound complications, hematoma, infection (superficial or deep), nerve palsy, periprosthetic fracture/failure and others. 49 patients who underwent TEA were included in this study: (DHF = 19, OA = 14, RA = 16). Six complications occurred within the first 90days of surgery. There were two periprosthetic joint infections (PJI) in the OA group, requiring irrigation and debridement (I & D) within the first 90days of surgery. There were three post-operative ulnar nerve palsies and one PJI requiring I & D in the TEA-RA group. Compared to the TEA-DHF and TEA-OA groups, the RA group had higher rates of all-cause complications (p = 0.03) and nerve palsy (p = 0.03). There were no significant differences between groups in readmissions (p = 0.27) or secondary interventions (p = 0.27). The 90-day complication/readmission rates of TEA preformed for DHFs is lower than those preformed for OA and RA. These differences could be related to the underlying chronic inflammatory etiology and side effect of treatments (intraarticular steroid injection, and biologics) received by patients with arthritis. Retrospective Cohort Study, level IV.

Non-technical factors for recurrence of sacroiliac joint pain after intra-articular steroid injection: a cohort study

Background &amp; Objective: The effectiveness of intra-articular corticosteroid injection therapy is still debatable, despite numerous studies which demonstrated the benefits of steroid injections. Injection failure can be caused by a variety of technical factors, some of which have been identified in studies, including the accuracy with the injection location is performed and the pattern of corticosteroid distribution. We investigated the non-technical factors that influence the effectiveness of intra-articular corticosteroid injection at the sacroiliac joint (SIJ) in the past.&#x0D; Methodology: It was a prospective cohort study to determine non-technical factors associated with recurrence in patients with SIJ pain who had received multidisciplinary treatment for their ailment. A total of 55 patients met the inclusion and exclusion criteria for the study who were followed up. Patients who had SIJ injections before 9 months and, who had no improvement on the pain scale, or there was a worsening of the pain, or the patient returned with SIJ pain complaints on the same side, were included in the trial. The results were analyzed using logistic regression to determine the likelihood of recurrence.&#x0D; Results: A total of 55 participants was enrolled in the study, with a higher proportion of females (n = 33; 60 %) than males (n = 22; 40 %). Thirty-one patients were returning patients (56.36 %) out of 55 patients. According to the results of the bivariate analysis, age was associated with recurrent SIJ pain. According to the results of the T-test, the mean age of the recurrent patients was 49.32 ± 16.68 y, whereas the mean age of the non-recurrent patients was 56.7 ± 12.76 y. The results of the multivariate analysis revealed that age, NSAID consumption, and unilateral SIJ pain, all had protective values in the context of recurrence of the sacroiliac joint pain.&#x0D; Conclusions: The use of non-steroidal anti-inflammatory drugs (NSAIDs) and the involvement of a single SI joint are protective factors against the recurrence of SI joint pain.&#x0D; Abbreviations: COST: European Cooperation in Science and Technology; NSAIDs: Non-steroidal anti-inflammatory drugs; SIJ: Sacroiliac joint;&#x0D; Key words: Anti-inflammatory agent; Non-technical risk factors; Intra-articular; Age; Recurrent sacroiliac joint pain&#x0D; Citation: Siahaan YMT, Pangestu AR. Sungono V. Non-technical factors for recurrence of sacroiliac joint pain after intra-articular steroid injection: a cohort study. Anaesth. pain intensive care 2022;26(5):773-777. &#x0D; DOI: 10.35975/apic.v26i6.2049

Do intra-articular steroid injections affect blood glucose levels in diabetic patients?

Do intra-articular steroid injections affect blood glucose levels in diabetic patients?

Genicular nerve block in juvenile idiopathic arthritis: a randomized clinical trial

ObjectivesThis study aimed at evaluating the effect of genicular nerve block (GNB) in juvenile idiopathic arthritis (JIA) patients with persistent unilateral knee arthritis on pain, inflammatory parameters, function, and range of motion.MethodsA total of 104 JIA patients were diagnosed according to the International League Against Rheumatism (ILAR) criteria with persistent unilateral knee arthritis. They were allocated randomly into 2 groups: group 1 treated with GNB, while group 2 was treated with intra-articular triamcinolone (TA) only. Visual analogue scale (VAS) on pain, sonography of large joints in rheumatology (SOLAR) scoring system, and Lysholm scores were assessed at 0-, 2-, and 12-week intervals. Swelling and tenderness were clinically evaluated semi-quantitatively (0-3) at the same time intervals.ResultsVAS pain, tenderness, swelling, and SOLAR grey scale (GS) and power Doppler (PD) scores were significantly reduced after 2 weeks in both groups (p < 0.05). This was greater in the GNB group regarding VAS and tenderness, while SOLAR and swelling were stronger reduced in TA group. After 12 weeks, all outcome measures showed lower values in the GNB group compared to TA, and this was significant regarding VAS pain. Moreover, Lysholm functional score was significantly increased in both groups at both intervals; and higher values were seen in the TA group compared to GNB after 2 weeks.ConclusionGNB was able to control pain and improve function and inflammation of the knee joint in JIA patients. Though steroid attained better results after 2 weeks, GNB achieved an equivalent longer-term improvement after 12 weeks.Trial registration identifying numberNCT04687930.Key Points• Persistent knee arthritis treatment in JIA is always challenging.• GNB was approved for treatment of pain in knee osteoarthritis.• GNB in the present study succeeded to control active knee arthritis and this effect was comparable to intra-articular steroid injection.

Treating post-menopausal women with symptomatic hand osteoarthritis with hormone replacement therapy.

Hand osteoarthritis is a common, painful, and functionally limiting condition that commonly affects post-menopausal women. There is a gap in our understanding of the underlying pathobiology of hand osteoarthritis. Conventional treatment for painful joints that arise from hand osteoarthritis includes non-surgical options, such as systemic analgesics, intra-articular steroid injections, and splinting. Surgical options are available when non-surgical interventions are not effective and vary depending on the type of joint in the finger, thumb, or wrist that is symptomatic.

Functional outcome of treatment of frozen shoulder using Hydrodilatation along with intraarticular steroid and saline injection

Introduction: Defined as idiopathic shoulder pain of at least one month duration accompanied by increasing limitations of active and passive glenohumeral movements in all the directions in the patients who have no identifiable general illness and whose radiological findings are entirely normalMaterial and Methods: This study was conducted in the department of orthopaedics, RMMCH (Government Cuddalore Medical College) from August 2020 to November 2022 in the selected candidates in the age group between 35 to 65 years. Clinical outcomes were measured with Shoulder Pain and Disability Index (SPADI).Result: SPADI score recorded at 1 and 6 months follow up gives a clear picture that all stages of frozen shoulder had good clinical outcome and early stages of frozen shoulder had excellent results.Conclusion: Intervention with corticosteroid injection with saline distension is better than any of corticosteroid, saline distension or physiotherapy alone.In the long run it was found that outcome is improved by intervention using Hydrodilatation with saline and steroid followed by physiotherapy. Hydrodilatation along with steroid provides early, medium and long term improvements in range of movements.

Selective Suprascapular and Axillary nerve (SSAX) block – A diaphragm sparing regional anesthetic technique for shoulder surgeries

Interscalene block, the gold standard for shoulder surgeries is inevitably associated with phrenic nerve palsy, even at low volumes. The major innervation of the shoulder joint is by suprascapular nerve and axillary nerve. Suprascapular nerve block has been used commonly for postoperative analgesia in shoulder surgeries done under GA. Combining axillary block with suprascapular nerve block was found to provide superior analgesia when compared to suprascapular block alone. Selective Suprascapular and Axillary nerve (SSAX) block provides effective analgesia in shoulder surgeries without causing diaphragm palsy, but has limited published literature. We performed ultrasound guided suprascapular block in the supraspinous fossa (posterior approach) using 10 ml of 0.25% Ropivacaine and axillary block in the quadrangular space using 6ml of 0.25% Ropivacaine before administration of general anaesthesia (GA) in 4 cases. Among four cases, 2 were closed shoulder manipulation with intra-articular steroid injection for periarthritis, 1 was closed reduction and K-wire fixation for chronic shoulder subluxation and the 4th was Latarjet procedure for recurrent shoulder dislocation. All patients received paracetamol 1g at the end of the procedure and every 6 h postoperatively. No patient experienced pain during recovery and the analgesia lasted for a mean duration of 347.5 minutes. Tramadol was required for rescue analgesia in only one patient (Latarjet surgery). We found that SSAX block provided effective analgesia in all patients, but needs randomized controlled trials with larger sample size comparing with interscalene block.

Comparison of the Efficacy of Platelet-Rich Plasma (PRP) and Local Corticosteroid Injection in Periarthritis Shoulder: A Prospective, Randomized, Open, Blinded End-Point (PROBE) Study.

BackgroundPeriarthritis or frozen shoulder, also called adhesive capsulitis, is characterized by stiffness and pain along with gradual loss of active and passive movement in the glenohumeral joint. More than 2-5% of the population suffers from periarthritis with a higher incidence in the age group of 40-60 years. The various treatment modalities used for its management include simple physiotherapy, short-wave therapy, ultrasonic therapy, transcutaneous electrical nerve stimulation, hydrotherapy, analgesics, intra-articular injections, manipulation under general anesthesia (MUA), and surgical management. The application of intra-articular steroid injection has been a common and efficacious option in rapidly diminishing shoulder pain and disability. Some recent studies reported a better outcome using platelet-rich plasma (PRP) injections in frozen shoulder cases. Hence, this randomized controlled trial was conducted to compare the efficacy of intra-articular injections of PRP and triamcinolone in patients of shoulder periarthritis in a population from the eastern region of IndiaMethodologyA total of 60 patients with periarthritis shoulder were allocated into two groups after randomization. Group A received 2 mL autologous PRP, and Group B received 2 mL of triamcinolone (40 mg/mL) intra-articular injection. Patients were followed up on the 4th week, 12th week, and 24th week. The assessment of pain and function using the visual analog scale (VAS) score and the Disabilities of Arm, Shoulder, and Hand (DASH) score, respectively, was done at each follow-up. The primary analyses of both primary and secondary outcomes were conducted in the intention-to-treat (ITT) population. SPSS version 24 (IBM Corp., Armonk, NY, USA) was used for data analysis.ResultsThe mean VAS score in the PRP and triamcinolone groups was 14.33 ± 3.79 and 31.63 ± 7.62, respectively (p = 0.0001) after 24 weeks. The mean DASH score in the PRP and triamcinolone groups was 18.08 ± 8.08 and 31.76 ± 3.63, respectively (p = 0.0001), which shows significant improvement in both pain and disability scores in the PRP group after 24 weeks.ConclusionsThe triamcinolone group showed better short-term outcomes whereas PRP showed better long-term outcomes in reducing pain and disability scores in terms of VAS and DASH scores.

Superolateral knee injection with a patellar tilt for osteoarthritis pain.

In this Watch & Learn video, Daniel Stulberg, MD, FAAFP, demonstrates a superolateral knee injection with a patellar tilt. This injection, with a sodium hyaluronate product, is intended for patients who have osteoarthritis pain and no current effusion. The technique would be the same for an intra-articular knee steroid injection.

Effectiveness and Safety of CT-Guided Facet Joint Cyst Rupture for Radicular Pain as First Choice Therapy: A Retrospective Analysis.

To evaluate effectiveness and safety of computed tomography (CT)-guided cyst rupture with intraarticular contrast-enhanced injection of steroid and local anesthetic as first choice therapy in patients with facet joint cyst-induced radicular pain. Retrospective data set analysis. University hospital. One hundred and twenty-one patients suffering from radicular pain attributable to facet joint cysts were included. The rate of patients without following surgery was assessed and defined as surrogate to measure effectiveness. Patients' characteristics, procedure-associated complications, technical aspects, and imaging findings on magnetic resonance imaging (MRI) were analyzed. A subgroup of 65 patients (54%) underwent telephone interview to assess pain relief and clinical outcome measured by Numeric Rating Scale and Oswestry Disability Index. Analyses between the groups with and without surgery were performed by Fisher exact test and two-sample unpaired t-test, respectively. The effectiveness of CT-guided cyst rupture was found to be 66.1%. Procedure-induced pain yielded in premature abort in two cases (1.7%). The detection of epidural contrast agent was statistically significantly associated with no need for surgery (P = .010). The cyst level was associated with the status of following surgery (P = .026), that is, cysts at lower lumbar spine were easier to rupture than cysts at other locations (cervical, thoracic, or upper lumbar spine). No further significant association was found. CT-guided cyst rupture as the first-choice therapy in patients with cyst-induced radicular pain was safe and effective. Successful cyst rupture was associated with no need for surgery. Cysts at lower lumbar spine revealed the highest success rate.

A comparison of the outcomes following intra-articular steroid injection alone or arthrocentesis alone in the management of internal derangement of the temporomandibular joint.

One of the main causes of chronic facial pain is temporomandibular disorders (TMDs) which may turn out to be a major cause for disability. The two types of treatment strategies may be undertaken to counter temporomandibular joint (TMJ) disorders, namely conservative management and surgical intervention. Surgical management can be classified into invasive open methods and minimally invasive procedures such as arthrocentesis, intra-articular steroid injection, and arthroscopy. The aim of this study is to compare the efficacy of Kenacort (Triamcinolone) as an intra-articular corticosteroid injection and arthrocentesis for lysis and lavage, for the treatment of the temporomandibular joint disorders. Twenty patients with internal derangement of temporomandibular joint (IDTMJ) not responding to conservative management and meeting the inclusion criteria randomly underwent either intra-articular steroid injection or arthrocentesis and the results of the two procedures were evaluated and compared. Unpaired t-test, repeated-measures ANOVA. A value of P < 0.05 is considered to be statistically significant. Both procedures turned out to be successful in reducing pain and improving mouth opening, both in a short-term and a long-term use. Upon comparison in our series of patients, arthrocentesis was noted to be a better treatment modality in the long term for the management of IDTMJ.

Prevalence of rapidly progressive osteoarthritis of the hip following intra-articular steroid injections.

Numerous studies have indicated that intra-articular steroid injections to the hip are beneficial for short-term pain relief. However, recent studies have drawn concerns of rapidly progressive osteoarthritis of the hip (RPOH) following intra-articular steroid injections. The prevalence of RPOH following intra-articular steroid injections varies widely in the literature. To identify the prevalence of RPOH following intra-articular steroid injections, and to compare baseline characteristics between patients with and without RPOH. Case series. Tertiary academic hospital. A total of 924 patients (median [interquartile range; IQR] age: 59 [45-70] years; 579 female) who received an intra-articular hip steroid/anesthetic injection from January 2016 to March 2018 and had available pre- and post-injection imaging (prior to surgical intervention) were included in the study. Baseline and injection-related data-including demographics, age, body mass index, medical history, laterality, and steroid type-were collected from electronic medical records. Post-injection RPOH was determined via imaging review by a physiatry fellow, followed by an attending physiatrist and a musculoskeletal radiologist to confirm findings. The majority of patients received unilateral injections into the hip, and the most common steroids used were triamcinolone and methylprednisolone. Review of pre- and post-injection imaging revealed 26 cases of RPOH, for an overall prevalence of 2.8% (95% confidence interval [CI] 1.9%-4.1%). Compared to those without RPOH, patients with RPOH were significantly older (median age [IQR]: 64 [60-73] vs. 59 [44-70] years, p=.003) and had a shorter duration of symptoms prior to their injections (median [IQR]: 3 vs. 12 [6-36] months, p < .001). Adjusted regression analyses showed that age was associated with greater odds of RPOH (odds ratio [OR], 95% CI: 1.04, 1.01 to 1.07; p=.003). The prevalence of RPOH following intra-articular steroid injections into the hip was lower than previously reported but still clinically relevant. This should be considered when counseling patients prior to intra-articular hip steroid injections.

Research priority setting for paediatric rheumatology in the UK.

The evidence base that underlies the management of children and young people with paediatric rheumatic diseases is deficient. In this field, there are many crucial unanswered questions. The UK Paediatric Rheumatology Clinical Studies Group, supported by UK National Institute for Health Research Clinical Research Network: children and Versus Arthritis, elicited ideas for research priorities from paediatric rheumatologists, trainees, allied health-care professionals, nurse specialists, patients, parents of patients, carers, and charities. These ideas were collected through online surveys and face-to-face meetings. A modified Delphi process was used, which included online research priority ranking surveys and a consensus workshop. A longlist of 55 disease-specific research priorities and 37 general research priorities were voted on in the first survey. A list of 11 top general research priorities was produced. The top ten disease-specific research priorities were discussed in depth at a Delphi workshop to determine their final ranking. This Health Policy paper will help to guide clinicians, academics, and funding bodies to prioritise research in paediatric rheumatic diseases, specifically in areas of unmet patient needs.

Comparison of efficacy of intra articular steroid injection versus manipulation under anesthesia (MUA) in idiopathic frozen Shoulder.

Objective: To compare efficacy of intra-articular steroid (IAS) injection with manipulation under anesthesia (MUA) in idiopathic FS. Study Design: Randomized Control Trail. Setting: Department of Orthopedic, Independent University Hospital, (IMC) Faisalabad. Period: 1st January 2021 to 30th June 2021. Material &amp; Methods: Diagnosis of FS was based upon detailed history and proper physical. Group A (n=50) included intra-articular injection patients and Group B (n=50) was patients receiving MUA. Pain was measured by VAS and disability was measured by Disability Index (SPADI) scale. Results: Mean age of sample was 37 ± 10.52 in group A and 39.14± 9.48 in group B. Age of patients ranges from 35 to 50 years. Female patients were greater in both the groups. Most of the patients have duration of disease for more than 1 month. The ratio of patients with right side disease was more than 50% in both the groups as compared to left side. In group A. there was a significant decrease in mean pain from 3.45 ± 1.12 to 2.16 ± 0.8 In group B, mean pain score decreased from 3.65 ± 0.88 to 2.35 ± 0.68 1. Overall group A was more effective as compared to group B but the results were not significant statistically. Conclusion: The intra-articular injection method was superior to MUA because it was easier, safer, and less expensive, and it produced early results.