Local Corticosteroid Injection Research Articles

Factors Causing Prolonged Postoperative Symptoms Despite Absence of Complications After A1 Pulley Release for Trigger Finger

This study aimed to investigate the incidence and prognostic factors for prolonged postoperative symptoms after open A1 pulley release in patients with trigger finger, despite absence of any complications. We reviewed 109 patients (78 single-finger involvement, 31 multiple-finger involvement) who underwent open A1 pulley release for trigger finger from 2010 to 2016, with 8 weeks or longer postsurgical follow-up and without postoperative complications. The group had 16 men and 93 women, with mean age of 56 years (range, 21-81 years), and average follow-up period of 24.8 weeks (range, 8.0-127.4 weeks). Prolonged postoperative symptoms were defined as symptoms persisting for longer than 8 weeks after surgery. Factors analyzed for delay in recovery included duration of preoperative symptoms; number of preoperative local corticosteroid injections; preoperative flexion contracture of proximal interphalangeal (PIP) joint; multiplicity of trigger finger lesions; occupation; presence of type 2 diabetes mellitus, other hand disorders like carpal tunnel syndrome, de Quervain disease, or Dupuytren contracture; and fraying or partial tear of the flexor tendon. Twenty-six fingers (19.3%) showed prolonged postoperative symptoms, with mean time until complete relief being 14.0 ± 6.4 weeks (range, 9-34 weeks). Risk factors associated with prolonged postoperative symptoms included duration of preoperative symptoms, preoperative flexion contracture of the PIP joint, and fraying or partial tear of the flexor tendon. Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients. In addition, they should explain to patients with a positive history of these factors and in whom flexor tendon injury is found during surgery about the possibility of prolonged postoperative symptoms. Prognostic IV.

Hydroxyapatite Crystal Deposition Disease of the Shoulder: A Review of Cases and Literature

AbstractHydroxyapatite crystal deposition diseases (HADDs) are characterized by deposition of insoluble crystals within the joints and periarticular soft tissues, initiating inflammatory destructive reaction. Calcium hydroxyapatite (CHA) is the most common type of calcium in human bone and is also the most common pathologic calcification found in the body. There are three phases of the disease: silent, mechanical, and adhesive phases. The shoulder is the most common site of HADD. CHA crystals are non-birefringent in polarized light. Radiographic characteristics include homogenous, amorphous densities without trabeculations that are variable in size, ovoid, triangular, or linear. The first imaging modalities to identify calcific tendinitis (CT) were X-ray and ultrasound, as calcium deposits are readily identifiable on both. Treatment is chiefly conservative, including nonsteroidal anti-inflammatory drugs (NSAIDs), local heat application, and physiotherapy. Local corticosteroid injections may also be of benefit. When intra-articular, CHA crystals can cause joint destruction such as “ Milwaukee shoulder.” In the acute symptomatic phase of HADD, called acute calcific periarthritis, soft tissue and osseous edema can be present and needs to be differentiated from infection, tumor, and trauma.

Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease.

Background:Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established.Hypothesis:Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease.Study Design:Cohort study; Level of evidence, 3.Methods:Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy.Results:Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up (P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes (P = .009) and patients younger than 50 years (P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up (P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up (P = .049).Conclusion:Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.

Anterior Cutaneous Nerve Entrapment Syndrome in Children: A Prospective Observational Study.

Anterior cutaneous nerve entrapment syndrome (ACNES) is often an overlooked cause of abdominal pain. Data for pediatric patients, especially with regard to the treatment modalities are scarce. The aim of this study was to present a treatment modality of ACNES with combined local subfascial anesthetic and corticosteroid injection in a prospectively collected cohort of pediatric patients. This was a prospective observational long-term study that included pediatric patients who were diagnosed with ACNES in a tertiary care pediatric center and who were followed-up for at least 12 months (median: 1.7 y; range: 1 to 2.7 y). All children were treated by ultrasound-guided subfascial injection of 40 mg 1% lidocaine and 4 mg dexamethasone into the rectus abdominis muscle in the place of the most severe pain (trigger point infiltration). The study included 38 children (28, 73.7% female; median age: 15 y). The majority of patients had pain in the lower right abdominal quadrant and were diagnosed in a median of 6 (range: 0.5 to 50) months after symptoms started. Overall, 24 (63%) patients achieved sustained symptom-free remission after a median of 1 (mean: 1.6; range: 1 to 5) trigger point infiltration during the first treatment session. Five (13%) children were surgically treated because of a lack of long-term response. Children who were surgically treated required a higher number of block applications during the first session of treatment, compared with children who were successfully treated conservatively. ACNES in children can be successfully treated by a combined local subfascial anesthetic and corticosteroid trigger point infiltration.

A study of treatment of lateral epicondylitis with corticosteroid injection

Background: Lateral epicondylitis (LE) of the elbow is a frequently encountered condition in general practice. The aim of the study was to assess efficacy of local corticosteroid injection in treatment of lateral epicondylitis. Materials & methods: In this study, we included 60 patients treated with local steroid injections in lateral Epicondylitis and regular follow up was done. Pain intensity and functional outcomes were measured using Visual Analogue Scale (VAS). Patients with lateral epicondylitis of at least 6 weeks' duration were included whereas patients with bilateral involvement, Infection, tumours of upper extremity, Pregnancy and Uncontrolled Diabetes were excluded. Regular follow up was taken at 2, 8 & 24 weeks. Results: in this study, 60 patients were included out of which 18 were male and 42 were female patients with 30-50 years was major age group affected. Corticosteroid injections revealed improvement in pain and functional status in first 4 weeks and further improvement up to 6 weeks which then remained constant up to 6 months without any complications. Recurrence of symptoms was noticed in 16 patients at 10-12 weeks post injection. Conclusion: Corticosteroid injections have a short-term beneficial effect combined with rehabilitation.

Ultrasound-guided vs. landmark-guided local corticosteroid injection for carpal tunnel syndrome: A systematic review and meta-analysis

To review the randomized controlled trials (RCTs) and assess the comparative effectiveness of ultrasound-guided versus landmark-guided local corticosteroid injections in patients with carpal tunnel syndrome (CTS). RCTs from Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE (Ovid), and Web of Science (from inception to 1 February 2017) were included. Two authors independently screened abstracts and full texts. The Outcomes of interest were symptom severity scale (SSS) and functional status scale (FSS) scores of Boston Carpal Tunnel Questionnaire as well as four electro-diagnostic parameters including compound muscle action potential, sensory nerve action potential, distal motor latency, and distal sensory latency. Overall, 569 abstracts were retrieved and checked for eligibility and finally 3 RCTs were included (181 injected hands). Pooled analysis showed that ultrasound-guided injection was more effective in SSS improvement (mean difference [MD] = −0.46, 95% confidence interval [CI] = −0.59 to −0.32, P < 0.00001); whereas, no significant difference was observed between the two methods in terms of FSS (MD= −0.25, 95% CI = −0.56 to 0.05, P = 0.10). There were also no statistically significant differences in improvements of CMAP (MD = 1.54, 95% CI = 0.01 to 3.07, P = 0.05), SNAP (MD = −0.02, 95% CI = −6.27 to 6.23, P = 1.00), DML (MD = 0.05, 95% CI = −0.30 to 0.39, P = 0.80) or DSL (MD = 0.00, 95% CI = −0.65 to 0.65, P = 1.00). Ultrasound-guided injection was more effective than landmark-guided injection in symptom severity improvement in patients with CTS; however, no significant differences were observed in functional status or electro-diagnostic improvements between the two methods.

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

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

Local administration of corticosteroids in treatment of carpal tunnel syndrome

Carpal tunnel syndrome is the most frequent entrapment neuropathy. We performed a literature review of application of local corticosteroid injections. The main aim of the review is to outline the issues concerning indications for the treatment, efficiency and safety of the procedure, and the effect’s duration. Different techniques and different types of corticosteroids, outcomes of the local injections in comparsion with surgical treatment are discussed.

Local Injection of Autologous Platelet Rich Plasma and Corticosteroid in Treatment of Plantar Fasciitis in Female Patients

Background: Chronic plantar fasciitis is the commonest cause of foot complaints in India. The incidence of plantar fasciitis peaks in people between the ages of 40 to 60 years with no bias towards either sex. Numerous methods have been advocated for treating plantar fasciitis, including rest, non-steroidal anti-inflammatory medication, night splints, foot orthosis, stretching protocols and extracorporeal shock wave therapy. The aim of this study to compared the functional outcome of Local Steroid and PRP in Plantar Fasciitis. Methods: A prospective randomized control trial done on 63 patients with complaint of plantar fasciitis coming to SMS Medical College & Hospitals, Jaipur, who were attain the inclusion criteria in the study. Patient coming to OPD were randomly allocated C.R. number. Patients with Odd C.R. number were given PRP and those with even number were given Steroids. Patients were followed at 12 weeks and 24 weeks after the injection to look for the effect of PRP and corticosteroid. Then the results were obtained on mean VAS score and AOFAS score in both the groups. Results: The present study showed that the mean age was 40 years in group I and 39 years in group II. Maximum females were housewife (41.26%) in both groups. The difference of mean in between groups, VAS score & AOFAS was insignificant in first visit (P=0.8642 & P=0.3400) and statistical significant after 12 weeks (P<0.0001*** each) and 24 weeks (P<0.0001***each). Conclusions: We believe that PRP injection is safe and can be an excellent alternative to corticosteroid injection in plantar fasciitis, not responsive to conservative means. The findings of this preliminary study can be very relevant in clinical practice.

Tratamento minimamente invasivo para a dor lombar refratária realizado por epiduroscopia

Propósito: Avaliar a resposta obtida com tratamento direcionado por epiduroscopia e associado à aplicação local de corticosteróides e ozônio (O2-O3) nos pacientes com dor lombar e radiculopatia não responsiva a outras terapias não invasivas. Material e Métodos: Estudo retrospectivo com 32 pacientes que não obtiveram resultado satisfatório, com no mínimo 6 semanas de tratamento com antiinflamatórios, analgésicos, fisioterapia e infiltração epidural e facetariade corticóides, e submetidos ao procedimento pela técnica de epiduroscopia. O estudo compreende o período de 1 ano (julho 2006 a junho 2007), com acompanhamento mínimo de dois anos. Resultado: Os pacientes foram avaliados pela Escala Analógico Visual (VAS) antes e após o procedimento,quando obtiveram uma melhora de 80% com relação a dor prévia. O acompanhamento com três, seis, doze e vinte e quatro meses demonstrou uma melhora mantida na média de 60%. O Índice de Incapacidade de Oswestry mostrou modificação significativa nos estados pré e pós-procedimento, com70% dos pacientes classificados no Grupo um (1) com Disfunção Mínima no terceiro mês após o uso da técnica. Nenhuma complicação séria foi relatada ou relacionada com o procedimento utilizado. Conclusões: A aplicação local de corticosteróides e ozônio (O2-O3) direcionados por epiduroscopia éum procedimento seguro e minimamente invasivo, com bons resultados clínicos no controle da dor lombar refratária, oferecendo aos pacientes uma janela de alívio maior que as alternativas existentes no momento, o que permite melhor controlar outros fatores; como o emocional, o socioeconômico eo ambiental que se associam negativamente no controle da dor crônica.

Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial

BackgroundRecent studies have reported that radial extracorporeal shock wave therapy (rESWT) reduces pain and improves function in patients with mild to moderately severe carpal tunnel syndrome (CTS) compared to a placebo. However, most of those studies used multi-session rESWT combined with wrist support and evaluation of efficacy was limited to a maximum of 14 weeks.MethodsThe prospective randomized controlled trial compared efficacy in relieving pain and improving clinical function between single-dose rESWT and local corticosteroid injection (LCsI) over the mid-term (24 weeks). Twenty-five patients with mild to moderately severe CTS were randomized to receive either single-dose rESWT (n = 13) or LCsI (n = 12). Primary outcomes were evaluated using the Boston self-assessment questionnaire (BQ), while secondary outcomes used the Visual analogue scale (VAS) and electrodiagnostic parameters. Evaluations at baseline and at 1, 4, 12 and 24 weeks after treatment were performed.ResultsThere was significantly greater improvement in symptom severity scores, functional scores and Boston questionnaire scores at weeks 12 to 24 in the rESWT group compared to the LCsI group. When compared to the baseline, there was significant reduction of VAS and functional score in the rESWT group at weeks 12 and 24. The LCsI group had no statistically significant differences in VAS reduction and functional score of the same period.ConclusionsTreatment of CTS using single-dose rESWT has a carry-over effect lasting up to 24 weeks suggesting that single-dose rESWT is appropriate for treatment of mild to moderate CTS and provides longer-lasting benefits than LCsI.Trial registration(TCTR20150709001). Registered 9 July 2015

The efficacy of local corticosteroid injection in the treatment of trigger finger

Background and Objectives: Trigger finger is a condition that causes triggering, snapping or locking on flexion of the involved digit. Treatment modalities are conservative (Non-steroidal anti-inflammatory drugs, splints or corticosteroid injections) or operative (percutaneous or open release of A1 pulley- the first annular pulley of the fibro-osseous sheath of the fingers situated at the level of the metacarpophalengeal joint). The aim of this study is to evaluate the efficacy of corticosteroid injection for trigger finger in adults.Material and Methods: Fifty patients with 54 trigger digits were treated by one or two injections of methylprednisolone acetate with 1% lignocaine. Patients were followed-up for a period of 6 months.Results: Symptoms and signs resolved in 79.63% of the injected digits. Local adverse reactions to steroid injection- pain at the injection site and steroid flare were self-limiting. There was no tendon rupture or post-injection infection.Conclusion: The study concludes that steroid injection is an effective first line treatment for trigger finger in most patients.Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(2): 13-18

Regenerative efficacy of therapeutic quality platelet-rich plasma injections versus phonophoresis with kinesiotaping for the treatment of chronic plantar fasciitis: A prospective randomized pilot study.

BACKGROUND:Plantar fasciitis (PF) a common chronic musculoskeletal pain routinely diagnosed and treated in rehabilitation practices. When conservative management fails in this degenerative disease, local injections of corticosteroids, platelet rich plasma (PRP), botulinum toxin, extracorporeal shockwave therapy, surgical release are used. In our prospective randomized pilot study we compared the regenerative efficacy of Platelet Rich Plasma vs Kinesiotaping with phonophoresis who were resistant to conservative management of PF.MATERIALS AND METHODS:Sixty-four chronic plantar fasciitis patients nonresponding to conservative management were evaluated for two interventions.36 patients received ultrasound guided 2.5 ml autologous platelet rich plasma (PRP) injection and 28 participant received phonophoresis and total10 Kinesiotaping on alternate days. 54 participants 33 in PRP intervention group and 21 in KT group were analyzed, by Numerical Rating Scale (NRS), plantar fascia thickness (ultrasound guided) and disability and activity limitation measured by foot function index in every two weeks up to 6 months.RESULTS:Post intervention assessment at 2 weeks revealed improvement in pain relief was better in Kinesiotaping group (NRS-4.619) as compared to PRP group (NRS- 6.061). But evaluation at 12 and 24 weeks showed statistically significant improvement in NRS and Foot function index in PRP group than in Kinesiotaping. Similarly, at the end of 24-week improvement in foot function index (FFI) was more in PRP group (P<0.0001). At end of 12 and 24 weeks there was significant reduction in plantar fascia thickness in PRP group (p<0.0001) as compared to KT group (p<0.05).CONCLUSION:Our study concluded that therapeutic quality autologous PRP injection (1x106 platelets/μl) has regenerative effect with long and better efficacy in pain management of chronic recalcitrant plantar fasciitis than Phonophoresis and Kinesiotaping.

Comparative Study of the Results of Local Injection of Autologous Whole Blood and Corticosteroid in Tennis Elbow

Comparative Study of the Results of Local Injection of Autologous Whole Blood and Corticosteroid in Tennis Elbow

HOW DO BOARD-CERTIFIED HAND SURGEONS MANAGE CARPAL TUNNEL SYNDROME? A NATIONAL SURVEY.

ABSTRACTObjective:To evaluate tendencies in the planning, diagnosis, and treatment of carpal tunnel syndrome (CTS) by Brazilian hand surgery specialists. Methods:This cross-sectional study was performed at the 36th Brazilian Hand Surgery Congress. We prepared a questionnaire about preferences in the management of CTS, and board-certified hand surgeons that attended the congress were asked to fill out the questionnaires. A total of 174 questionnaires were analyzed. Results:Electromyography examination is used by most surgeons. Night splinting is the most commonly used conservative treatment option. Half of the surgeons utilized prophylactic antibiotics. Most of the interviewees conduct inpatient surgery in the operating room and prefer intravenous regional anesthesia. Most of surgeons use the standard open technique associated with proximal release of the antebrachial fascia and do not perform neurolysis. Compressive dressings are most commonly used for 7 days. Conclusion:The approach to CTS among Brazilian hand surgeons with regard to pre-, intra-, and post-operatory conduct is consistent with the international literature. However, there is a need to reflect and conduct new studies on non-surgical treatment involving local corticosteroid injection, use of prophylactic antibiotics, hospital admission, and type of anesthesia in order to provide more cost-effective approach to surgical treatment for CTS. Level of Evidence V; Expert opinion.

Diagnosis and Management of Sacroiliac Joint Dysfunction.

➤ Symptoms that suggest that the sacroiliac joint (SIJ), as opposed to pathology of the lumbar spine or hip, may be a source of pain include pain with position changes, such as standing from a seated position or sitting on a hard surface. Radiation to the groin or Fortin area also suggest sacroiliac joint as a source.➤ A constellation of findings, including pain referral patterns, provocative maneuvers, and response to injections, should be utilized when assessing SIJ pathology.➤ While its effectiveness remains unsubstantiated, manipulation of the SIJ is noninvasive and warrants consideration as an initial treatment modality.➤ The diagnostic validity of local anesthetic and/or corticosteroid injections is difficult to assess as the criteria for a positive response are not uniform in the literature, and evidence to support intra-articular injections for therapeutic purposes is weak.➤ SIJ fusion appears to be emerging as an acceptable treatment for patients with recalcitrant SIJ dysfunction; however, only a few long-term outcome studies have been done.➤ New minimally invasive fusion techniques appear to decrease the morbidity of open procedures with at least comparable outcomes.

Carpal tunnel syndrome: is the local corticosteroid injection electrophysiologically effective?

Background: Carpal Tunnel Syndrome (CTS), compressive lesion of the median nerve at the wrist, is the most world widely prevalent entrapment neuropathy. There are current therapeutic tools available, including conservative measures (e.g. manual splints, local corticosteroids injections or systemic corticosteroid therapy, etc) and surgical intervention on carpal transverse ligament. Current scientific data regarding improvement related to conservative measures are still conflicted, despite several studies support clinical improvement on pain scales, more objective data regarding electrophysiologic parameter still lack on literature.

Comparative Study of 30 Cases of Local Injection of Autologous Blood and Corticosteroids in Treatment of Plantar Fascitis

Comparative Study of 30 Cases of Local Injection of Autologous Blood and Corticosteroids in Treatment of Plantar Fascitis

Progression from Injection to Surgery for Trigger Finger: A Statistical Analysis.

The purpose of this study was to identify predictive factors of poor response to intra-flexoral sheath corticosteroid injection, as well as to identify factors associated with patients' decisions to undergo surgical treatment. Data from 112 patients who received steroid injection treatment for trigger finger were reviewed retrospectively. Logistic regression was used to assess the prognostic value of factors assumed to affect prognosis (age, sex, underlying disease, history of illness, presence of carpal tunnel syndrome, multiple digit involvement, and pre- and post-operative disability scores). Multiple digits were affected in 42 patients. Associated and underlying conditions were carpal tunnel syndrome (n = 36), hypertension (n = 23), hyperlipidemia (n = 14), and history of malignant tumor (n = 10). Logistic regression analysis showed that multiple digit involvement and Froimson clinical severity score were factors significantly associated with surgical treatment after intra-flexoral sheath corticosteroid injection treatment. These two factors were also found to be associated with the patients' decisions to undergo surgical treatment. Although local corticosteroid injection is useful in most cases, providers need to counsel patients with multiple digit involvement and/or severe cases about the possibility of requiring additional surgical treatment.

Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review.

Context:Diabetes mellitus (DM) has become an epidemic in the United States and is associated with increased risk of multiple comorbidities, including painful musculoskeletal conditions. A common treatment for many of these painful musculoskeletal conditions is local soft tissue and intra-articular corticosteroid injection (CSI). These local injections have the potential to cause elevated blood glucose levels (BGLs) and cause complications in patients with DM. Therefore, it was the objective of this investigation to review the currently available evidence that directly addresses the effects of local CSIs used for painful musculoskeletal conditions on BGL in patients with DM.Evidence Acquisition:PubMed, Google Scholar, EMBASE, CINAHL, and Cochrane Review databases were searched with a combination of the terms corticosteroid, glucocorticoid, steroid, injection, musculoskeletal, and diabetes. Search limits included the English language. Bibliographic references from these articles were also examined to identify pertinent literature.Study Design:Clinical review.Level of Evidence:Level 3.Results:Ten studies that met the inclusion criteria were reviewed. All these studies showed significant but transient increases in postinjection BGL after a single local CSI in patients with DM. There were no adverse reactions or complications reported.Conclusion:Single, local soft tissue and intra-articular musculoskeletal CSIs are most likely safe in patients with well-controlled DM.