Mg Of Methylprednisolone Acetate Research Articles

Ultrasonographic evaluation of anatomical variations, of the first dorsal compartment of wrist, and its correlation with de Quervain’s disease recurrence in Indian population: a hospital based longitudinal study

Background: de Quervain’s disease is a commonly encountered debilitating condition mostly treated conservatively. Cadaveric studies have revealed anatomical variations in the first dorsal compartment of the wrist; however, a causal association between the variants and recurrence of the disease has not been established. An ultrasonographic assessment of the first dorsal compartment of the wrist was done, to correlate the response to treatment, of the different anatomical variants. Methods: 106 wrists were included in the study after clinically confirming de Quervain’s disease. All were injected with 20mg of methylprednisolone acetate in the first dorsal compartment of the wrist and were followed up. Patients who were pain free for at least six months, as well as patients who did not respond or had a recurrence of disease within eight to twelve weeks, were all assessed with ultrasound. Results: 57.54% of the wrists were cured with one injection most of which revealed a tendon arrangement of one abductor pollicis longus (APL) and one extensor pollicis brevis (EPB) and two APL and one EPB without any septation. 32.07% of the wrists did not respond to this treatment and most of them comprised of septations and aberrant compartments with presence of supernumerary tendons. Conclusions: Ultrasonographic assessment of the first dorsal compartment of wrist, of all patients suffering from de Quervain’s tenosynovitis must be done to predict the outcome of conservative therapy and customize an optimal treatment modality for the individual anatomical variant.

Comparative evaluation of midline versus parasagittal interlaminar epidural steroid injection for management of symptomatic lumbar intervertebral disc herniation.

Epidural steroid injections (ESIs) with or without local anaesthetics have been used for the past several years for the treatment of back pain, especially for radicular symptoms. The aim of this prospective study was to compare the efficacy of midline with parasagittal approach for interlaminar ESI in the management of symptomatic lumbar intervertebral disc herniation. Sixty patients (aged 20-60 years) with pain pattern consistent with lumbar radiculopathy caused by lumbar intervertebral disc herniation and who did not respond to conservative treatment were included in the study. They were randomly divided in two groups of 30 each: group I (MILESI, n = 30) consisting of midline interlaminar ESI, and group II (PSILESI, n = 30) consisting of parasagittal interlaminar ESI. They were administered a combination of 80 mg of methylprednisolone acetate (40 mg/ml) and 6 ml of 0.25% bupivacaine (total volume of 8 ml). Pain, patient satisfaction, and the Oswestry Disability Index (ODI) were assessed at different time intervals before and after the procedure for up to six months. The improvement in pain score after ESI was statistically significant in both the groups at all intervals of time, with no significant difference between the two groups. The mean pain score was <3 from two weeks onwards after the injection. The pain score decreased by more than five points and it was around two points at the end of the six-month study period. Around 50% of patients in both groups had excellent satisfaction. Both techniques were effective in providing good analgesia. Pain relief and improvement in disability were clinically better with the parasagittal interlaminar approach.

Pulmonary response of severely asthmatic horses after intra-articular administration of methylprednisolone.

Intra-articular (IA) administration of corticosteroids is performed routinely in equine practice. The lung function of severe asthmatic horses has recently been shown to be improved by IA triamcinolone acetonide (TA). We therefore hypothesised that IA methylprednisolone acetate (MPA), another commonly used corticosteroids, would also decrease the airway obstruction in severe asthmatic horses. To compare the effects of intra-articular (IA) and intramuscular (IM) methylprednisolone acetate (MPA) administration on lung function and serum cortisol levels in horses with severe asthma. Randomised and controlled experiments on severe asthmatic research animals. Severe asthmatic horses in exacerbation were administered 200mg of MPA either intramuscularly (n=6) or via intra-articular injections in the tarsocrural joints (n=6; 100mg/joint). Serum cortisol concentration and pulmonary function was measured for 8days. A significant decrease in pulmonary resistance in the IA group (P=.003, mean diff 1.14) on day 1 in comparison with baseline was observed. A significant decrease from baseline was also observed on serum cortisol values in the IA group 6hours after injection (P=.001, mean diff 44.5), and at day 1 (P=.003, mean diff 45.1). Joint health was not evaluated in the current study and the physiological response of the severe asthmatic horses might deviate from that of the milder forms of asthma. MPA IA administration improves the lung function of severe asthmatic horses. However, this effect was mild and of a short duration.

Study of efficacy of epidural methylprednisolone acetate and triamcinolone acetate for treatment of low back pain and radiculopathy

Background: Epidural steroids have been proven to be one of the most effective non-operative managements of back pain. The present study entailed evaluation of the efficacy of epidural methylprednisolone acetate and triamcinolone acetate for treatment of low back pain and radiculopathy.Methods: The two groups of 25 participants, formed on the basis of the injectable epidural steroid used {80mg of methylprednisolone acetate (group 1) or 40mg of triamcinolone acetate (group 2)}, were enrolled after following due selection criteria. After detailed history taking, examination and requisite investigations, 15 ml volume of the drug was injected epidurally with the patient lying in lateral position. The patients were followed-up at 3 weeks, 6 weeks and 3 months and pain assessment and percentage of pain relief was noted in comparison with the level of pain before epidural injection. Sleep quality, activity score, days in bed, analgesic requirement, complications and requirement of surgical intervention were all assessed at each follow-up.Results: The mean pain score was significantly less in group 1 after 6 weeks and 3 months period, with 60% in group 1 having “good” pain relief, while 69.56% amongst group 2 participants reported “fair” pain relief. Eighty four percent group 1 participants required 2 injections, while 64% participants in group 2 required 3 injections. There was overall improvement in the activity score, quality of sleep and decrease in bed rest and analgesic requirement.Conclusions: Epidural steroid therapy is highly efficacious and methylprednisolone acetate is more effective than triamcinolone acetate; with negligible complications.

Efficacy and Safety of Subacromial Corticosteroid Injection in Type 2 Diabetic Patients.

Purpose In type 2 diabetic patients affected by chronic shoulder pain, subacromial injection with corticosteroid could be an effective treatment. The aim of this study was to measure the risk-benefit ratio of this treatment. Methods Twenty patients with well-controlled diabetes were included in a prospective study. In a first preinjection phase, patients were asked to measure glycemia for 7 days, before breakfast and dinner, and then 2 hours after lunch and dinner. Baseline data including Constant Score (CS), Subjective Shoulder Value (SSV), and Numerical Rating Scale (NRS) for pain were collected. Patients were treated with subacromial injection with 40 mg of Methylprednisolone Acetate and 2 ml of Lidocaine. At discharge, patients were asked to remeasure glycemia for the following week. Results The overall pain improved and patients graded their shoulder as “greatly improved”. At 30-day follow-up, the SSV and the CS improved, considering pain but not ROM. The average daily glycemia was 136 mg/dl before injection, 161 mg/dl the day of the injection (p<0.001), and 170 mg/dl one day after injection (p<0.001). Glycemia was not statistically different 3 days after injection. Conclusion Subacromial injection is an effective short-term treatment in type 2 diabetic patients affected by shoulder pain, but a closed follow-up is recommended in all these patients. This trial is registered with NCT03652480. The Protocol ID is SHOULDERDM2013.

Comparison of the effects of ozone versus steroid injection, in treatment of patients with tennis elbow

Tennis elbow is a prevalent musculoskeletal disorder. In recent years ozone injection has been proposed as a treatment for many musculoskeletal disorders. The aim of this study was to compare the effect of ozone with the standard treatment of steroid injection in patients with tennis elbow, resistant to conservative treatments. This comparison is made according to VAS score, pressure pain threshold (PPT) and modified Mayo clinic performance index for elbow. In this study 64 patients with tennis elbow, which have had the symptoms for more than 3 months and were resistant to conservative treatments, were randomized to two groups. In steroid injection group 40 mg of methylprednisolone acetate and in zone injection group 4 mL of ozone with concentration of 15 mcg/mL was injected. Thirty-two patients in steroid and 29 patients in ozone injection group finished this study. Data were gathered before injection and 2 and 6 months after that by VAS score, modified Mayo clinic performance index for elbow and PPT (measured by the means of an algometer). Variables were compared between the two groups and also the changes in each group have been measured in reference to baseline data. In both groups VAS score, Mayo clinic performance index and PPT improved significantly in 2 and 6 month follow-up. Steroid injection was significantly better than ozone injection in improving 2 and 6 months pressure pain threshold and 6 months Mayo clinic performance index. Other data did not show significant difference between the two groups. Both steroid and ozone injection improved pain and function in patients with recalcitrant tennis elbow for at least 6 months. Steroid injection was superior to ozone injection in improving PPT in 2 and 6 month and Mayo clinic performance index score at 6 month follow-up.

Radiofrequency and Methylprednisolone in Treatment of Lower Back Pain Caused by Facet Joint Syndrome: Comparison of the Outcomes.

Introduction:In this trial we have discussed the outcomes of radiofrequency ablation and methylprednisolone treatment in cases diagnosed with facet syndrome; and effects of treatment modality on quality of life is evaluated by visual analogue scale and Oswestry Disability Index.Materials and Methods:This prospective, study was conducted with 100 patients with diagnosis of facet joint syndrome. Patients, benefited from diagnostic block, were separated into two groups, with 50 cases in each. In Group 1, 40 mg of methylprednisolone acetate were injected into each level. In Group 2, radiofrequency needle was used to apply RF to the facet joint.Results:Demographic characteristics of patients were similar (P > 0.05). VAS values of the patients in Group 1 were significantly lower than the values prior to treatment (P < 0.05). Similarly, VAS values of the patients in Group 2 were also significantly lower than the values prior to treatment (P < 0.05). When VAS scores of the patients in Group 2 at 3rd and 6th months were compared with scores of the patients in Group 1, significant differences were also observed (P < 0.01). ODI results of the patients in Group 1 were significantly lower than the values prior to treatment (P < 0.05). Additionally ODI scores of the patients in Group 1 on 9th and 12th months are recorded as significantly lower.Conclusion:We consider that the steroid injection should be used as the first choice of treatment before the RF methods to be used in patients with back pain, caused by facet articulation pathology, if there are no contraindications.

Hypothalamic Pituitary Adrenocortical Axis Suppression following a Single Epidural Injection of Methylprednisolone Acetate

Background: Epidural injections (EIs) are the most commonly performed minimally invasive intervention in managing chronic low back pain (CLBP). There is inconsistency in data to accurately predict the degree of hypothalamic-piuitary-adrenal (HPA) axis suppression in patients receiving exogenous steroid therapy, especially in the form of epidural steroid injections (ESIs). Objective: We aim to quantify the degree and duration of HPA axis suppression after a single ESI of 80 mg methyl prednisolone acetate in patients with CLBP. Study Design: A single open-label prospective study. Setting: An operating room of a tertiary care hospital. Methods: Patients with CLBP and unilateral radicular pain were included in this study. An ESI of 80 mg of methylprednisolone acetate was administered in each patient. Blood samples for cortisol and adrenocorticotropic hormone (ACTH) were collected before the ESI and on days 7, 14, and 28 after the ESI. The patients’ pain levels were graded on the numeric rating scale (NRS) at baseline and on days 7, 14, 28, and 60 after the ESI in the pain clinic. Results: A total of 30 patients were enrolled in this study. The median with interquartile range (IQR) serum cortisol level at baseline and on days 7, 14, and 28 after intervention were found to be 329.55 (208.49 – 399.48) nmol/L, 72.99 (52.95 – 119.82) nmol/L, 194.45 (73.88 – 292.52) nmol/L, and 302.56 (257.68 – 357.43) nmol/L, respectively. A significant discrease in the serum cortisol levels was observed on days 7 (P &lt; 0.001) and 14 (P &lt; 0.001). Twenty-six (87%), 13 (43%), and 2 (7%) patients had serum cortisol levels below normal (&lt;170 nmol/L) on days 7, 14, and 28, respectively. HPA axis suppression was observed in all of the patients for a median (IQR) period of 14 days (range: 11–17 days). Limitations: This study was an unblinded observational study. The effect of a single ESI was studied and the sample collection of day 21 serum cortisol and ACTH were passed over. Conclusions: HPA axis function was suppressed after the ESI until day 14 and returned to the normal range by postoperative week 4. Key words: Epidural injections, steroids, HPA, suppression, cortisol, ACTH

The effect of local injection of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis among patients with greater trochanteric pain syndrome.

Greater trochanteric pain syndrome (GTPS) is a common clinical entity for which the most effective treatment is local corticosteroid injection (LCI). There are no studies on the effect of LCI among patients with GTPS on the hypothalamic-pituitary-adrenal axis. The present study recruited nonselected patients diagnosed with GTPS. After consenting, participants received low dose (1μg) of adrenocorticotropin hormone (ACTH) stimulation test at 09:00. Immediately following the test, participants received a LCI of 80mg of methylprednisolone acetate at the greater trochanteric region. The ACTH stimulation test was repeated 1, 2, 4, and 6weeks following the LCI. Cortisol samples were obtained at just prior to (basal) and 30min (post-stimulation) following every ACTH stimulation test. Serum cortisol levels of <500μmol/l obtained 30min following the ACTH stimulation test were considered evidence of secondary adrenal insufficiency. The study enrolled 22 patients, 21 of whom completed participation. There were 19 female participants (~90%), and mean age of all the participants was 55.2±8.6years. Four participants showed evidence of secondary adrenal insufficiency, which was observed only at weeks 1 and 2 following the LCI. Mean serum cortisol level among these four participants 30min following the ACTH stimulation test was 354μmol/l, with a range of 268-430μmol/l. LCI of 80mg of methylprednisolone acetate in the greater trochanteric area among patients with GTPS was associated with transient secondary adrenal insufficiency in ~20% of the patients, mainly 1week following the injection.

The impact of intra-articular methylprednisolone acetate injection on fructosamine levels in diabetic patients with osteoarthritis of the knee, a case-control study.

Fructosamine is a glycated protein that reflects blood glucose control over the last 2-3weeks. There are no studies that address the impact of intra-articular injection (IAI) of methylprednisolone acetate (MPA) on fructosamine levels among patients with type-2 diabetes and osteoarthritis of the knee (OAK). Non-selected patients attending the rheumatology or orthopedic clinic with type-2 diabetes and painful OAK, who failed non-steroidal anti-inflammatory drugs (NSAIDS) and physical therapy, were asked to participate in our study. After consent blood tests were drown for fructosamine, hemoglobin A1c (HbA1c) level, complete blood count, lipid profile, serum albumin, serum protein, c-reactive protein, and erythrocyte sedimentation rate. Demographic and different clinical parameters were also documented. Immediately after that, patients had IAI of 80mg of MPA at the knee joint (group 1). Two to three weeks later, the same blood tests were repeated (except for HbA1c). Age- and sex-matched group of patients with type-2 diabetes and painful OAK attending the same clinics, but who were managed by NSAIDS were asked to participate as a control group (group 2) and had the same evaluation at enrollment and 2-3weeks later, after consent. Eighteen patients from either group completed the study. Mean fructosamine level in group 1 patients was 263.7 ± 31.8mg% prior to the IAI vs. 274.6 ± 39.3mg% (p = 0.035), 2-3weeks later, while mean fructosamine level in the control group (group 2) at enrollments was 274.2 ± 31.2mg% vs. 269 ± 30.2mg%, p = 0.509, 2-3weeks later. There was no significant change in any other parameter tested at enrollment in either group, compared to those obtained 2-3weeks afterwards. Body mass index was on the edge of significance as a predictor for a significant change in fructosamine level in group 1 patients. IAI of 80mg of MPA in patients with type-2 diabetes and OAK had resulted in a significant, though mild increase in fructosamine levels 2-3weeks later.

Short-term efficacy to conventional blind injection versus ultrasound-guided injection of local corticosteroids in tenosynovitis in patients with inflammatory chronic arthritis: A randomized comparative study

ObjectiveTo compare the short-term efficacy of conventional blind injection (CBI) versus ultrasound-guided injection (USGI) of corticosteroids (CS) injection in tenosynovitis in patients with chronic arthritis and to investigate if the USGI is a less painful procedure and if there are differences in the changes of US findings during the post injection follow-up. MethodsPatients presenting tenosynovitis requiring CS injection were involved. After clinical and US evaluation, patients were randomized to receive CBI or USGI. Efficacy of procedure was assessed by the improvement in both Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), including procedure-VAS global-VAS and local-VAS, after 1 and 4 weeks post-procedure. Power Doppler (PD) and greyscale (GS) US findings were also object of the follow-up. CBI or USGI under an aseptic technique were performed according the local guidelines using 20mg of methylprednisolone acetate. ResultsA total of 114 patients were randomized to receive CBI (54 patients) or USGI (60 patients) procedure. No significant difference was observed in terms of gender, age and pain duration among CBI and USGI groups at baseline. USGI proved to be significantly less painful than CBI (P=0.0001). AUC analysis showed that during the follow up visits, the USGI procedure had significantly better response in HAQ, local-VAS and global-VAS (P=0.0001, P=0.012 and P=0.0001 respectively) compared to CBI. During the follow up period, a significant greater reduction in the PD scores was found in the USGI group compared to the CBI group (P=0.0002), whereas no statistical differences were found in the GS findings between the groups (P=0.5627). ConclusionOur study demonstrates superiority of USGI over CBI for CS injections in painful tenosynovitis, having better short-term outcomes measured by functional, clinical and US scores. These data support the use of USGI for tenosynovits in typical inpatient and/or outpatient in rheumatological practices.

Effect of single dose intramuscular methylprednisolone injection into the masseter muscle on the surgical extraction of impacted lower third molars: a randomized controlled trial.

Lower impacted third molar surgical extraction usually causes post-surgical sequelae like pain, trismus and swelling as a result of postoperative inflammatory response. The aim of this study was to evaluate and compare the efficacy of single dose 40-mg (1 cc) of methylprednisolone acetate, injected into the masseter muscle, preoperatively one hour before the surgery or post-operatively, immediately following the surgical removal of impacted lower third molars, in controlling most common postoperative sequelae, i.e. trismus, pain and swelling of facial soft tissue. A randomized control study was done of 60 patients. Each patient was categorized in two groups, group I and group II, according to the time of receiving methylprednisolone acetate. Group I was injected 40 mg of methylprednisolone acetate into the masseter muscle via the intrabuccal approach, one hour before the surgery. Group II was injected 40 mg of methylprednisolone acetate into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound. The washout period was one month after the first operation. Evaluation were made of postoperative pain, trismus and swelling. The numeric pain scale (NPS) was used for pain assessment. When the patients were administered methylprednisolone acetate preoperatively, showed superior results in terms of oral aperture, pain and all the facial swelling parameters, with statistically significant differences versus the postoperatively administered methylprednisolone acetate (p < 0.05). A single dose of 40 mg (1 cc) methylprednisolone acetate injected into the masseter muscle preoperatively is more effective in reducing pain, trismus and swelling, when compared to that administered postoperatively.

Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial

The outcome of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of acute plantar fasciitis has been debated. The purpose of the present study was to evaluate and compare the therapeutic effects of CSI and ESWT in patients with acute (<6-week duration) symptomatic plantar fasciitis. Of the 116 eligible patients, 68 were randomized to 2 equal groups of 34 patients, each undergoing either ESWT or CSI. The ESWT method included 2000 impulses with energy of 0.15 mJ/mm2 and a total energy flux density of 900 mJ/mm2 for 3 consecutive sessions at 1-week intervals. In the CSI group, 40 mg of methyl prednisolone acetate plus 1 mL of lidocaine 2% was injected into the maximal tenderness point at the inframedial calcaneal tuberosity. The success and recurrence rates and pain intensity measured using the visual analog scale, were recorded and compared at the 3-month follow-up visit. The pain intensity had reduced significantly in all patients undergoing either technique. However, the value and trend of pain reduction in the CSI group was significantly greater than those in the ESWT group (p < .0001). In the ESWT and CSI groups, 19 (55.9%) and 5 (14.7%) patients experienced treatment failure, respectively. Age, gender, body mass index, and recurrence rate were similar between the 2 groups (p > .05). Both ESWT and CSI can be used as the primary and/or initial treatment option for treating patients with acute plantar fasciitis; however, the CSI technique had better therapeutic outcomes.

Simultaneous Bilateral Knee Injection of Methylprednisolone Acetate and the Hypothalamic-Pituitary Adrenal Axis

ObjectiveThe objective of this study was to evaluate the effect of simultaneous bilateral intra-articular injection (IAI) of methylprednisolone acetate (MPA) on the hypothalamic-pituitary-adrenal axis in patients with knee osteoarthritis.MethodsNonselected patients...

Role of suprascapular nerve block in chronic shoulder pain: A comparative study of 60 cases

Background: Suprascapular nerve block using anatomical landmark has been shown to be a safe and effective treatment for chronic shoulder pain from rheumatoid and degenerative arthritis. This can be performed as an outpatient procedure that reduces pain and disability. Aims and Objectives: To access efficacy of suprascapular nerve block in chronic shoulder pain. To compare results between placebo and use of methyl prednisolone with bupivacaine for nerve block . Materials and Methods: 60 patients with chronic shoulder pain were taken up for the trial. In the study group, all patients received the block through the anatomical landmark approach, with a single sitting suprascapular nerve block. On randomized basis, 30 patients were given 10 ml of 0.5% bupivacaine and 40 mg of methyl prednisolone acetate (depo medrol) to block the suprascapular nerve. Another 30 patients were injected with 11 ml of 0.9% saline. Patients were followed up on 2 nd day, 7 th day, and 21 st day and 3 months for the status of relief of pain and improvement of movement of joint. Results: Evaluation of the efficacy of the block was achieved by comparing verbal pain scores and improvement in range of movements at 2, 7, 21 days and 3 months after the injection. Significant pain relief is defined as improvement of more than 70% on verbal and visual analog pain scale scores. Results were consistent with VAS score of pain. Maximum improvement was noted in the bupivacaine+methyl prednisolone mixed group. Conclusion: The result of this study shows a clear benefit of methyl prednisolone + bupivacaine for suprascapular nerve block in cases of chronic shoulder pain. There was statistically and clinically significant reduction in pain and improvement in range of movements.

Corticosteroid Injection With or Without Thumb Spica Cast for de Quervain Tenosynovitis

To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for de Quervain tendinitis. In this prospective trial, 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI+ TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, Shoulder and Hand and visual analog scale scores. The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, Shoulder and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI+ TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI+ TSC had a significantly higher treatment success rate. The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. Therapeutic II.

Impact of outpatient clinic ultrasound imaging in the diagnosis and treatment for shoulder impingement: a randomized prospective study

The use of musculoskeletal ultrasonography (MSUS) in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size. This randomized prospective study assessed whether clinic-based MSUS can significantly improve diagnostic accuracy in shoulder pain and whether MSUS-guided shoulder injection results in improved long-term outcomes. One hundred consecutive patients with 125 painful shoulders were recruited. Patients were randomized to receive either sonographic assessment with consequent palpation-guided injection (Group 1, n = 66) or sonographic assessment with a MSUS-guided injection of 40 mg of methylprednisolone acetate (Group 2, n = 59). A blinded rheumatologist (ADF) performed clinical assessments at baseline, 6 and 12 weeks including shoulder function tests (SFTs) (Hawkins-Kennedy test, supraspinatus tendon tenderness), physician global assessment (PGA) and patient visual analogue scores (VAS) for pain (0-10). Eighty patients with 90 symptomatic shoulders completed 12-week follow-up. Twenty patients, 11 (20 shoulders) from the palpation-guided group and 9 (15 shoulders) from the MSUS-guided group, were excluded at 6 weeks either due to requirement for repeat injection or due to surgical referral. Mean age for patients was 57.7 years, and 65 % patients were female; mean shoulder pain duration was 18 weeks (range 14-22 weeks). SFTs, patient VAS and PGA scores for pain improved significantly from baseline in both groups with significantly greater improvements in the MSUS-guided group (44 shoulders) compared to the palpation-guided group (46 shoulders) in all parameters at 6 (p < 0.01) and 12 weeks (p < 0.05). The use of MSUS in guiding subdeltoid injection has been shown to improve outcome up to 6 weeks in a few small studies. A recent meta-analysis identified the need for further studies with longer-term outcome and larger sample size.

Effectiveness of Local Tenoxicam Versus Corticosteroid Injection for Plantar Fasciitis Treatment

Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (P>.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.

Intra-articular methylprednisolone acetate injection at the knee joint and the hypothalamic–pituitary–adrenal axis: a randomized controlled study

The objective of this study was to evaluate the effect of intra-articular corticosteroid injection (IACI) of methylprednisolone acetate (MPA) on the hypothalamic-pituitary-adrenal (HPA) axis in patients with osteoarthritis of the knee. Patients with symptomatic osteoarthritis of the knee who failed to respond to nonsteroidal anti-inflammatory medications and physical therapy were randomized between group 1 and group 2. Group 1 patients had an IACI of 80mg of MPA at the knee joint and group 2 patients had an intra-articular injection (IAI) of 6ml (60mg) of sodium hyaluronate (control group). Immediately prior to the IAI and on weeks 1, 2, 3, 4, and 8 following IAI, patients from both groups underwent a low-dose (1μg) adrenocorticotropin hormone (ACTH) stimulation test. Demographic, clinical, laboratory, and radiologic variables were documented in all patients. Both criteria of <7μg/dl increase in the serum cortisol level and absolute levels of <18μg/dl 30min following the ACTH stimulation test were used to define secondary adrenal insufficiency (SAI). Twenty patients were randomized in each group. In group 1, 25% of patients had SAI vs. none in group 2 (p = 0.0471). The earliest SAI was observed at week 2, and latest SAI was observed at week 4. SAI was observed at one time point, two consecutive time points, or two separate time points in the same patient. There was no correlation between SAI and any of the demographic, clinical, or laboratory variables. An IACI of 80mg MPA at the knee joint induced a transient SAI in 25% of the patients, an effect that was observed between week 2 and week 4 following the IACI.

The effect of epidural methylprednisolone acetate injection on the hypothalamic-pituitary-adrenal axis

Study ObjectiveTo evaluate the effect of an epidural corticosteroid injection of 80 mg and 40 mg of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis and on back pain. DesignRandomized, single-blinded prospective study. SettingOperating room of a university-affiliated hospital. Patients42 patients with low back pain due to radiculopathy. InterventionsGroup 1 received an epidural corticosteroid injection of 80 mg of methylprednisolone acetate, and Group 2 received an epidural corticosteroid injection of 40 mg of methylprednisolone acetate. All study patients underwent a stimulation test of one μg of adrenocorticotropin hormone (ACTH), and their pain levels were graded just prior to and following the epidural corticosteroid injection on weeks one, 3, and 4. MeasurementsSerum cortisol of the ACTH stimulation tests and back pain levels were rated using a visual analog scale (VAS). Serum cortisol levels lower than 18 ng/mL 30 minutes following the ACTH stimulation test were considered to be secondary adrenal insufficiency. Main Results21 patients were enrolled in each group. The rate of secondary adrenal insufficiency in Group 1 was ~86%, ~ 22%, and ~17% of patients versus ~53% (P = 0.024), 15% (P = 0.874), and ~12% (P = 0.715) of Group 2 patients at weeks one, 3, and 4, respectively. About 62%, 56%, and 39% of Group 1 patients had a favorable clinical response as opposed to ~47% (P = 0362), 35% (P = 0.21), and ~6% (P = 0.049) of Group 2 patients at weeks one, 3, and 4, respectively. ConclusionsEpidural corticosteroid injection of methylprednisolone acetate in both groups was associated with very high rates of secondary adrenal insufficiency, but significantly more so in Group 1 at week one. This suppression was transient, with recovery of the gland in most patients noted over the ensuing weeks. An epidural corticosteroid injection of 80 mg had higher rates of favorable clinical response than a 40 mg injection, but significantly more so at week 4 only. This favorable response waned over a few weeks in both groups.