Local Steroid Injection Research Articles

Carpal Tunnel Syndrome Treatment Using Ultrasound-Guided Versus Landmark-Guided Corticosteroid Injection: A Randomized Prospective Trial

Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy occurring due to increased pressure in the carpal tunnel. Objectives: The study aimed to evaluate the degree of symptom improvement, safety, and the change in electrophysiological findings after ultrasound (US)-guided versus Landmark (LM)-guided local steroid injection for the treatment of CTS. Methods: This randomized clinical trial recruited 52 patients with moderate or moderate-to-severe CTS. The subjects were randomly assigned to US-guided or LM-guided corticosteroid injection groups and received 40 mg methylprednisolone. After four weeks and 12 weeks of treatment, the patients were evaluated using the Boston questionnaire and electrophysiological parameters were determined. Results: All variables, including symptom/functional scores and electrophysiological findings, improved significantly in both groups after four weeks (all P 0.05). Conclusions: The symptom severity, functional status, and all electrophysiological parameters improved significantly in both US-guided and LM-guided corticosteroid injection groups and generally, no statistically significant difference was observed between both methods.

Anterior cervical pain syndrome: Risk factors, variations in hyolaryngeal anatomy, and treatments.

Anterior cervical pain syndromes (ACPS) are a poorly understood entity associated with lateral neck discomfort when talking, chewing, or yawning, and with occasional excruciating pain and dysphagia. This investigation aims to describe patients with ACPS presenting symptoms and treatments. Retrospective chart review of all patients with ACPS presenting to a tertiary care laryngology practice in 1 year. All patients diagnosed with ACPS for 1 year were reviewed. Patient gender, age, body mass index (BMI), and pain triggers were documented. The hyolaryngeal complex was measured on computed tomography (CT) scans of the neck. Treatments were recorded. Nine patients were diagnosed with an ACPS in a 1-year period. Sixty-seven percent were female with an average age of 47.3 years ± 16.6. The average BMI of a patient with ACPS was 24.8 ± 3.69. The most common symptom was point tenderness at the lateral aspect of the hyoid or superior cornu of the thyroid cartilage (89%). Pain triggers included speaking (67%), head turn (56%), chewing (44%), yawning (56%), and swallowing (56%). On CT imaging, eight of nine patients had abnormalities of the hyoid bone or the superior cornu of the thyroid cartilage, correlating 100% with point tenderness location. Treatments include physical therapy (33%), steroid injection (44%), lidocaine injection (22%), and surgical intervention (56%). ACPS is a frustrating condition for patients and physicians. Evaluation of anterior cervical pain with point tenderness should include imaging measurement of the thyrohyoid complex. Effective treatments include local steroid injection and surgical resection of the abnormal structure. 4 Laryngoscope, 130:702-705, 2020.

Efficacy of Local Steroid Injections to Prevent Scar Contracture after Transoral Videolaryngoscopic Surgery

Efficacy of Local Steroid Injections to Prevent Scar Contracture after Transoral Videolaryngoscopic Surgery

Non-arthroplasty iliopsoas impingement in athletes: a narrative literature review.

Iliopsoas impingement occurs secondary to a tight iliopsoas tendon that causes impingement during movement. This review presents current aspects regarding the diagnosis of iliopsoas impingement and also exposes the readers to the possible anatomic and clinical variations together with the available treatment options. We conducted a narrative literature review with regard to non-arthroplasty iliopsoas impingement. Iliopsoas impingement is characterised by a distinct pattern of labral pathology, with anteriorly localised labral damage, that does not extend to the anterosuperior portion of the acetabulum. Anterior groin pain and intermittent catching, snapping or popping of the hip are common symptoms. Non-specific focal tenderness is often found over the iliopsoas tendon at the level of the anterior aspect of the joint. The 'C-sign' and Impingment test are usually positive. Dynamic ultrasonography is also useful for confirming the diagnosis. Initial management of painful iliopsoas impingement should be conservative. When patients continue to have pain, an ultrasound-guided injection can provide relief and predict the response to the surgical release. For patients who have recurrent pain after local injection of steroids, arthroscopic release has shown to achieve effective results. Although different treatment options for iliopsoas impingement are emerging, the current standard of therapy is conservative followed by an arthroscopic tenotomy if necessary. Young adult hip surgeons should always keep this differential in mind in a patient presenting with groin pain and mechanical symptoms.

Roles of Steroids in Preventing Esophageal Stricture after Endoscopic Resection.

Background and Purposes Endoscopic resection has been worldwide recognized as a treatment strategy for early esophageal lesions. The occurrence of esophageal stricture after endoscopic resection will reduce the quality of life of patients. This study will evaluate the efficacy and safety of steroids in the prevention of esophageal stricture after endoscopic resection and the influence of different steroid administration methods. Methods In the relevant literature database, literature from 2008 to 2018 is retrieved by using preset keywords, the search results are carefully screened, and the conclusion of the literature is synthesized to form arguments and draw conclusions. Results 73 articles met our requirements. Oral steroid administration, not prophylactic endoscopic balloon dilation alone, was effective in preventing esophagostenosis after esophagoscopic treatment and reducing the number of repeated endoscopic balloon dilations even after extensive endoscopic resection. Local steroid injection is useful and economy for preventing esophageal stricture, even though it may raise the risk of perforation during dilations. A wider range of circumferential mucosal defects is an independent predictor for stricture formation for patents given preventive steroid injections after endoscopic submucosal dissection. For complete circular mucosal defect, the further researches are essential to investigate the role of local steroid injection. The effect of other methods such as steroid gel, intravenous infusion of steroid, and novel steroid filling methods require more confirmation. Conclusions Therefore, steroids play an irreplaceable role in preventing esophageal stricture after endoscopic resection. Oral and local injections of steroids are the two most acceptable methods and more prospective studies are needed to compare the effectiveness and safety of these two methods.

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts.

Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2-3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self-expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post-ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high-risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over-the-scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three-quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.

Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome.

Surface irregularities of the greater trochanter have been described as a potential radiographic sign of greater trochanteric pain syndrome (GTPS). We report a diagnostic accuracy study to evaluate the clinical usefulness of trochanteric surface irregularities on plain radiographs in the diagnosis of GTPS. We retrospectively identified the anteroposterior pelvic radiographs of a consecutive group of 38 patients (representing a 27.5% series prevalence) diagnosed with GTPS (mean age 69.5 years ± 16.1 [standard deviation], 27 females, 11 males) based on clinical symptoms and a positive response to a local anaesthetic and steroid injection. A control group consisted of 100 patients (mean age 73 years ± 17.1 [standard deviation], 67 females, 33 males) with either hip osteoarthritis listed for hip arthroplasty (n = 50), or with an intracapsular neck of femur fracture (n = 50) both presenting between January and July 2017. Radiographs were cropped to blind observers to the presence of hip osteoarthritis or intracapsular fracture but included the trochanteric region. The radiograph sequence was randomised and separately presented to 3 orthopaedic surgeons to evaluate the presence of trochanteric surface irregularities. The inter-observer correlation coefficient agreement was acceptable at 0.75 (95% CI, 0.60-0.84). Trochanteric surface irregularities including frank spurs protruding ⩾2 mm were associated with a 24.7% positive predictive value, 64.0% sensitivity, 25.7% specificity, 74.3% false-positive rate, 36.0% false-negative rate, and a 65.3% negative predictive value for clinical GTPS. Surface irregularities of the greater trochanter are not reliable radiographic indicators for the diagnosis of greater trochanteric pain syndrome.

LOCAL ANESTHETIC SPREAD TO THE CONTRALATERAL TRIGEMINAL GANGLION

Chronic neuropathic pain syndromes can severely affect a person’s quality of life. Trigeminal neuralgia is among these syndromes and involves the mandibular branch of the fifth cranial trigeminal nerve. Patients typically present with facial pain described as electrical and shock-like in nature, exacerbated by movements of the jaw such as talking and chewing. Many patients are unable to achieve adequate relief with medical management and therefore require interventions such as injections of local anesthetics, steroids, or glycerol. One method of injection uses ultrasound guidance for local anesthetic injection in the pterygopalatine fossa affecting the trigeminal ganglion. A 64-year-old woman with a history of trigeminal neuralgia presented for a trigeminal nerve block on her right side via ultrasound guidance. Following the injection, she experienced the desired effect of numbness on her right side in the distribution of the trigeminal nerve. In addition, the patient reported feeling the same effects on her left side despite no injection being done on that side. We describe a unique case in which local anesthetics spread through the pterygopalatine fossa and across the midline, affecting the contralateral trigeminal ganglion. Patients should be monitored for hemodynamic changes following this injection. Key words: Trigeminal neuralgia, trigeminal nerve block, pterygopalatine fossa, regional block, trigeminal ganglion

Prevention of esophageal stricture after endoscopic resection.

Stricture formation after esophageal endoscopic resection has a negative impact on patients' quality of life because it causes dysphagia and requires multiple endoscopic dilations. Various methods by which to prevent stricture have recently been developed and reported. Among these methods, local steroid injection is the most commonly used and is currently considered the standard method for noncircumferential resection. However, local steroid injection has a limited effect on circumferential resection. Thus, oral steroid administration is used for such cases because it may have a stronger effect than local injection. Steroid treatment, both by local injection and oral administration, is effective and low-cost; however, it may cause fragility of the esophageal wall, resulting in adverse events such as perforation during balloon dilatation. Many innovative approaches have been developed, such as tissue-shielding methods with polyglycolic acid, tissue engineering approaches with autologous oral mucosal epithelial cell sheet transplantation, and stent insertion. These methods may be promising, but they are limited by a scarcity of data. Further investigations are needed to confirm the efficacy of these methods.

Treatment Strategy for Frozen Shoulder.

Frozen shoulder (FS) is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. The pathophysiology of FS is relatively well understood as a pathological process of synovial inflammation followed by capsular fibrosis, but the cause of FS is still unknown. Treatment modalities for FS include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release. Conservative management leads to improvement in most cases. Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management. However, there is no consensus as to the most efficacious treatments for this condition. In this review article, we provide an overview of current treatment methods for FS.

Comparison of Surgical Decompression and Local Steroid Injection in the treatment of Carpal Tunnel Syndrome

Comparison of Surgical Decompression and Local Steroid Injection in the treatment of Carpal Tunnel Syndrome

Preliminary study reveals the efficiency of platelet rich plasma injection over physiotherapy for chronic plantar fasciitis treatment

Background: Plantar Fasciitis (PF) is considered as one of the most prominent causes of heel pain in adults. Regenerative medicine has been developed as one of the therapeutic strategies for treatment of chronic tendinopathy using Platelet-Rich Plasma (PRP). So, the present study was intended to solve the controversial role of PRP injection as anti-inflammatory or as regenerative therapy for treatment of chronic tendinopathy. Aim of the work: To evaluate the effect of Platelet Rich Plasma (PRP) injections under Musculoskeletal Ultrasonography (MSUS) guidance in the management of patient's chronic plantar fasciitis in comparison to physiotherapy. Methods: The present study involved twenty plantar fasciitis patients with 3 months failed of traditional treatment. One of them received local steroid injection during follow up, so excluded from the study. The studied patients were classified into two main groups as follows: PRP group (10 patients) and physiotherapy group (9 patients). All patients were evaluated using the American Orthopedic Foot Association Society (AOFAS) score and MSUS was done before and 4 weeks after treatment. Results: The AOFAS increased significantly among the PRP group by 36% increase versus 13% in the physiotherapy group after treatment. Tendon echogenicity was significantly changed in 70% of cases after PRP injection (p-value

Outcome of Keloid's Treatment in a Tertiary Care Hospital

Introduction: Keloids are characterized by their continued growth following trauma, extension into normal tissue and their high recurrence rate following excision. Keloids are common following ear piercing or flame burns. These lesions are highly conspicuous and cosmetically unappealing. Multiple methods including surgery, radiotherapy, antimitotic agents, silicone sheet, pressure clipsand cryotherapy have been advocated. The risk of recurrence and the need to prevent distortion of following resection is a challenge to the surgeon.
 Material and Methods: A total of 46 patients with keloid were treated at the plastic surgery department of the Nepalgunj Medical College between January 2013 to March 2017. The patients were divided in two groups. Group A consisted of 24patients with keloid in their ear where complete excision of keloid was done with tension free repair and was supplemented withintralesion triamcinolone injection at the time of operation and thereafter as and when needed. Group B consisted of 22 patients. Out of these 15 patients had keloid over the anterior chest wall and rest 07 had keloid over the deltoid region. These cases receivedintralesional triamcinolone only, a total of 5 such injections at month interval as a tension free repair after excision was notconsidered feasible.
 Results & Conclusion: Patients in Group A underwent surgical excision and intra and post operative intralesionalsteroids and patients in Group B received 4 weekly intraregional injection of triamcinolone injection 40 mg. Out of 24 keloid in Group A two developed post-excision recurrence during a mean follow-up period of 24 months. However they regressed with subsequent local injection of steroid. The group B consisting of scar over the deltoid region and anterior chest wall were not found suitable for excision as a tension free repair (a must to prevent recurrence) was not considered possible. Complete Excision of keloids with tension free suture and local steroid injection is a simple & favored technique for the management of keloid, it preserves contour &skin quality and has a low recurrence rate. Unfortunately all cases are not suitable for total surgical excision. In such cases, steroid locally has to given locally at monthly intervals. The keloids regresses, but atrophy and depigmentation at the site of injection are the complications.

The Clinical Outcomes of Local Steroid Injection Plus Conservative Management and Conservative Management Alone in Chronic Low Back Pain Due to Myofascial Pain Syndrome

The Clinical Outcomes of Local Steroid Injection Plus Conservative Management and Conservative Management Alone in Chronic Low Back Pain Due to Myofascial Pain Syndrome

Comparative study between platelet-rich plasma injection and steroid injection in mild\u2013moderate shoulder osteoarthritis and their relation to quality of life

ContextOsteoarthritis (OA) is a degenerative joint disorder that causes joint pain and stiffness. Platelet-rich plasma (PRP) is considered a recent effective line of management of OA.AimsTo compare the effect of local injection of PRP versus steroid in shoulder OA and their relation to quality of life.Patients and methodsThis study included 50 patients with mild–moderate OA shoulder diagnosed according to Samilson and Prieto grading system of shoulder OA and were recruited from the outpatient clinic of physical medicine, and rehabilitation, Faculty of Medicine, Menoufia University Hospital, in the period between 2017 and 2018. The study included both sexes. Group I included 25 patients who were injected intra-articularly with PRP in the affected shoulder, and group II included 25 patients who were injected with triamcinolone acetate. They were evaluated by Western Ontario Osteoarthritis Shoulder index and visual analogue scale before and after injection.Statistical analysisA descriptive and analytic study by SPSS, version 16, on IBM compatible computer was done.ResultsThere was a highly statistical significant difference between preinjection and postinjection parameters regarding Western Ontario Osteoarthritis Shoulder score and visual analogue scale in both groups, with more improvement in the PRP group.ConclusionIntra-articular injections with PRP and steroids are effective less-invasive lines of shoulder OA treatment, with superiority to PRP owing to more persistence of its effects.

Retrospective case review of combined local mepivacaine and steroid injections into vaginal trigger points for the management of moderate-to-severe perineal pain after childbirth.

After an obstetric trauma, a non-negligible number of postpartum women complain of perineal pain and dyspareunia. These symptoms clearly diminish their quality of life. Many treatment options have been suggested, such as oral analgesia, local anaesthetic, or steroid injections… Regretfully, none of these have yet demonstrated their efficacy with the validated trials. The objective of this review is to retrospectively evaluate the response to vaginal infiltrations into the trigger points (where the vaginal/perineal examination sets off the maximum intensity of pain) combining local anaesthetic and corticosteroids. Our goal is to detect women who complain of sexual disfunction and perineal pain 2 and 6months after childbirth. All reviewed cases correspond to vaginal deliveries made between June 2016 and April 2017. Trigger points were detected through a vaginal examination. Patients with moderate-to-severe perineal pain were determined using a visual analogue score (VAS 0-10). We suggested a treatment of vaginal infiltration specifically into the trigger points. Patients underwent local injections with a combination of mepivacaine hydrochloride 2% (8ml) and betamethasone acetate (2ml). Twenty-seven women were treated with vaginal injections directly into the trigger points. Seven of them [7/27 (25.92%)] were treated 2months after delivery and experienced complete recovery of their perineal pain 4months after the treatment. Those who first chose conservative treatment [20/27 (74.08%)] were also assessed 6months after giving birth. This group continued to suffer the same symptoms and they then subsequently underwent vaginal injections. As well as the first group, these women experienced complete recovery of their perineal pain after treatment. No side effects have been registered so far. Women treated with vaginal injection into the trigger points improved in a fast and effective way. It seems to be a well-tolerated and safe option for women with moderate-to-severe pain.

Surgical Treatment of Scarring Alopecia Associated with Acne Keloidalis Nuchae

Acne keloidalis nuchae (AKN) is a relatively rare chronic inflammatory condition that leads to alopecia on the occipital scalp. Multiple large keloids and alopecia associated with long-lasting folliculitis impair the psychosocial functioning of patients. We report successful treatment of alopecia associated with AKN. When a 23-year-old male was referred to us, a large area of alopecia and multiple keloids associated with AKN were found. Following total excision of the lesion, the defect was reconstructed with two rotation flaps elevated bilaterally. Most patients with AKN undergo conservative treatments including oral antibiotics and local steroid injections. As surgical treatments, excision followed by skin grafting or second-intention healing has been reported. However, all of the previously-reported treatments have left alopecia on the occipital region. Although long scars might be left in the scalp, local flap reconstruction would be an option for the treatment of large areas of alopecia associated with AKN.

Streptococcus pyogenes bacteremia and toxic shock syndrome related to Strongyloides stercoralis hyperinfection: a case report

BackgroundWe describe a patient with Strongyloides stercoralis hyperinfection associated with Streptococcus pyogenes and with streptococcal toxic shock syndrome. To the best of our knowledge this association has not been previously described.Case presentationA 78 year-old Israeli man, who was born in Iraq but lived in Israel for 66 years, presented with multi-organ failure including acute kidney and hepatic injury, coagulopathy, and lactic acidosis. He had a medical history including aortic valve replacement, diabetes mellitus, spinal stenosis, and low back pain treated with repeated local steroid injections. Blood cultures were positive for Streptococcus pyogenes and antibiotic treatment was switched to penicillin G, clindamycin, and intravenous immunoglobulins. Repeated physical examinations failed to identify the source of the bacteremia. On day 12 of hospitalization the serology results for Strongyloides stercoralis sent on admission, because of chronic eosinophilia, came back positive. A microscopic stool examination and stool polymerase chain reaction were positive for Strongyloides stercoralis. Ivermectin therapy was commenced and continued for a total of 4 weeks. He was discharged for rehabilitation after 25 days.He had no exposure to endemic countries or to immigrants. During many years he had multiple gastrointestinal symptoms, respiratory symptoms, cutaneous symptoms, chronic eosinophilia, and high immunoglobulin E levels. He underwent several operative procedures and numerous hospitalizations and medical encounters with different experts but a parasitic infection was not considered. His asymptomatic daughter was also found to be serologically positive.ConclusionsStrongyloides stercoralis hyperinfection associated with Streptococcus pyogenes bacteremia and toxic shock is described for the first time. The case also highlights the importance of history taking and reviewing past laboratory results, the utility of serological tests for Strongyloides stercoralis, and the importance of screening asymptomatic family members of an infected patient. Strongyloides stercoralis hyperinfection must be considered in the differential diagnosis of any patient with Streptococcus pyogenes bacteremia or toxic shock of no clear source as well as in symptomatic patients with chronic or intermittent eosinophilia, even without any epidemiological risk factors.

Ocular manifestations of cytomegalovirus in immunocompetent hosts.

This review highlights recent studies that have increasingly implicated cytomegalovirus (CMV) as a significant cause of keratouveitis and retinitis in immunocompetent hosts. Molecular testing has identified that CMV infection is frequently present in cases of Posner-Schlossman and Fuchs, keratouveitis syndromes previously presumed to be idiopathic conditions. Ocular hypertension and endothelial cell loss are important complications of CMV keratouveitis and are likely mediated by viral invasion of the trabecular meshwork and corneal endothelium. Topical ganciclovir is a well tolerated, effective, and economical therapy. CMV retinitis is possible in the absence of HIV/AIDS. CMV has long been considered an innocuous infection in the general population, though recent studies have found otherwise. Intraocular reactivation, replication, and invasion of the trabecular meshwork and endothelium lead to recurrent bouts of ocular hypertension and endothelial cell loss, the complications of which may be tempered with initiation of antivirals. Topical ganciclovir is a promising therapy that needs investigation. CMV retinitis, an entity previously believed isolated to the severely immunosuppressed population, has been reported on numerous occasions in presumably immunocompetent individuals, particularly following local steroid injections. Further studies may elucidate the pathogenesis of CMV in immunocompetent populations.

Comparitive study between stretching exercises and cortico steroid injection in treatment of patients with plantarfasciitis

Introduction: Plantar fasciitis is the commonnest cause of heel pain. Its cause is uncertain so as there is a lot of treatment methods for it. Our study compares the outcome of two common treatment modaliy known as local infiltration of steroid injection and plantar fascia stretching exercises with each other regard to decrease pain intensity and improvement in function. Materials and methods: 80 patients with complain of heel pain clinicaly diagnosed as plantar fasciitis are included in the study. Other causes of heel pain are ruled out in them. One group with local steroid injection while the other group was treated with plantar fascia stretching exercises. They are re evaluated regard to function and pain scores after 2 and 10 weeks, Results: Two groups were similar regard to sex, age, height, weight and body mass index .Significant decrease in pain and improvement in function was reported in steroid group but, after the 10th week, two groups reported the same results in those manners. Discussion: It seems that because after 10 weeks of treatment with both therapeutic methods, the results were comparable , it is better to use the less complicated and less invasive method (stretching), but in cases which prompt pain relief and better function is desired, local steroid injection may be better.