Percutaneous Steroid Injection Research Articles

Nationwide Multicenter Consensus on Practical Percutaneous Steroid Injection

Background and Objectives We evaluated the current status of percutaneous steroid injection (PSI) procedure for benign vocal fold lesions performed in Korea in order to achieve consensus about the indications, contraindications, anesthesia, complications, and the role of PSI.Subjects and Method An email-based questionnaire survey consisting of 11 questions was administered to 20 experienced laryngologists.Results The most commonly used indication was small vocal nodule (32.7%). The most common contraindication was vocal fold lesion with atrophy (46.9%). Triamcinolone injection under local anesthesia by cricothyroid was usually used in the PSI procedure. Following the procedure, vocal fold atrophy was the most prominent complication (39.1%). The role of PSI is still not well established; however, most laryngologists considered it to be an adjunctive treatment (61.9%).Conclusion The survey results provide an insight into the general consensus of opinion about PSI that guidelines for the indications, contraindications, anesthesia, and complications associated with this treatment option should be facilitated.

Comparison of Percutaneous A1 Pulley Release versus Steroid Injection in Terms of Mean Pain Score in Trigger Digits

Objective: To compare percutaneous A1 pulley release and steroid injection in terms of mean pain score in trigger digit. Study Design: Comparative cross- sectional study. Place and Duration of Study: Orthopedic Department Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2018. Methodology: Patients with trigger finger diagnosed clinically in Out Patient Department meeting inclusion and exclusion criteria were included in the study. Patients were randomly allocated to Group A & B by lottery method. Group A had percutaneous release of A1 pulley using a surgical blade 11, after preparation of the skin and injection of 1ml 2% plain Lidocaine. Group B had injection with corticosteroid. Both procedures were carried out in Out Patient Department under strict aseptic measures. Visual analogue score at start and end of the study was recorded. Results: A total of 185 patients were included in this study, 122(66%) were males and females were 63(34%). The mean age of patient was 37.80±11.80 years with range from 15-60 years. Mean score of Group A was 39.16±12.22 years and the mean age Group B was 38.93±10.98 years. 56(30.3%) patient had mild visual analogue score, 96 (51.9%) had moderate visual analogue, 33(17.8%) had severe visual analogue. Conclusion: Percutaneous release was found better option for the treatment of the trigger digit with a high success rate. Surgery should be reserved only for cases refractory to steroid injection technique.

Percutaneous steroid injection versus oral NSAIDs on treatment of symptomatic calcific rotator cuff tendinitis: a short-term retrospective clinical evaluation

Aim: Symptomatic calcific rotator cuff tendinopathies (CRCT) continue to be a significant health problem in the adult population because of intense pain and disability. Different clinical responses obtained with different treatment modalities show us the importance of determining the optimal method. The aim of this study is to compare short term pain and functional status improvements in adult patients diagnosed with CRCT and treated with oral non-steroid anti-inflammatory drugs (O-NSAID) or percutaneous steroid injections (PSI).
 Material and Method: A retrospective examination was made of the clinical results of adult patients diagnosed with CRCT and treated with one of the two treatment methods. Whole study group was formed of 40 patients (20 male, 20 female) with a mean age of 42.35 ± 8.28 (range, 23-57) years. The clinical responses of the patients in a period of 3 months were compared between the two treatment groups O-NSAID, PSI using the Visual Analogue Scale (VAS) and the Quick Disability of the Arm, Shoulder, and Hand Scale (Q-DASH). The angular upper limit values of the active range of motion (ROM) of the shoulder joint (anteflexion and abduction angle) of patients also were compared in the study. 
 Results: In the PSI treatment group, in the 3rd week and 3rd month clinical evaluations, significant better responses were obtained in both the VAS and Q-DASH scores of the patients compared to O-NSAID treatment group (p=0.000, p=0.001, respectively). And significant greater shoulder anteflexion and abduction ROM upper limits were determined in the PSI treament group compared to O-NSAID treatment group at the end of the 3rd month (p=0.000, p=0.000, respectively).
 Conclusion: The percutaneous steroid applications in treatment of CRCT can provide more pleasing short term results than O-NSAID treatments in terms of pain reduction and functional improvement.

Does complete regression of intraneural ganglion cysts occur without surgery?

The dynamic nature of intraneural ganglion cysts, including spontaneous expansion and regression, has been described. However, whether these cysts can regress completely in the absence of surgical management has important therapeutic implications. Therefore, we aim to review the literature for cyst regression without surgical intervention. We reviewed our database of 970 intraneural ganglion cysts in the literature to search for evidence of complete regression based on strict radiologic confirmation, either spontaneously, or after percutaneous cyst aspiration or steroid injection. We did not find any examples of complete regression without surgical treatment that met inclusion criteria. Spontaneous regression was reported in four cases; however, only two cases had follow-up imaging, both of which demonstrated residual cysts. Nineteen cases of percutaneous intervention were found in the literature, 13 of which reported clinical improvement following aspiration/steroid injection; however, only seven cases had available imaging. Only two cases reported complete resolution of cyst on MR imaging at follow-up, but reinterpretation found residual intraneural cyst in both cases. We believe that pathology (structural abnormalities and/or increased joint fluid) always exists at the joint origin of intraneural ganglion cysts which persist even with regression of the cyst. The persistence of a capsular abnormality or defect can lead to recurrence of the cyst in the future, and while imaging may show dramatic decreases in cyst size, truly focused assessment of images will show a tiny focus of persistent intraneural cyst at the joint origin. Thus, expectant management or percutaneous intervention may lead to regression, but not complete resolution, of intraneural ganglion cysts.

Short-and long-term results of ultrasound-guided fine-needle aspiration and steroid injection in the treatment of ganglion cysts

Objective: To determine the efficacy and safety of percutaneous aspiration and steroid injection treatment for ganglion cysts and retrospectively evaluate the size change in ganglion cysts during follow-up.
 Material and Method: All patients who underwent percutaneous aspiration and steroid injection treatment for ganglion cysts between January 2019 and February 2020 were included in the study. Demographic characteristics and clinical signs and findings of the patients were obtained from electronic patient records. Treatment response was classified as “excellent,” “good,” and “poor” at one month and one year according to ultrasound measurement.
 Results: Ganglion cyst aspiration and steroid injection were successfully performed in 37 (86.0%) of 43 cases. A total of 28 cases with short- and long-term follow-ups were included in the final analysis. All the cases had cosmetic complaints before the treatment, and seven had pain and four had limited range of motion. Early treatment response was excellent in 7 (25.0%) patients, good in 14 (50.0%), and poor in 7 (50.0%). Late treatment response was excellent in 18 (64.3%) patients, good in 3 (10.7%), and poor in 7 (25.0%). After the procedure, mild pain lasting less than two days developed in the cyst area in half of the patients. Skin color change was observed in two cases in the first-month follow-up.
 Conclusion: Ultrasound-guided fine-needle aspiration and steroid injection with the right technique is an alternative cost-effective method to surgery that can be successfully applied in the treatment of ganglion cysts with low side effects and relatively good results.

Randomized Controlled Trial on Combined Percutaneous Release and Steroid Injection Versus Percutaneous Release Alone for Trigger Finger in Adults

Introduction. Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection.
 Objective. To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone
 Methods. We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications.
 Results. Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work.
 Conclusion. The addition of corticosteroid injections to percutaneous release of trigger finger significantly improves TAM and pain VAS scores.

Comparison of functional outcome between local steroid injection and percutaneous release of trigger finger

The best modality for management of correctable triggering of fingers has remained controversial. This study focuses on the outcome of 2 minimally invasive techniques, the percutaneous release of A1 pulley and the local Corticosteroid injection. Aim of this Prospective study is to compare the functional outcome in terms of pain, remnant and recurrent triggering over a period of 6 months, in patients of trigger finger, treated with percutaneous release and steroid injection. For this study, 100 patients of grade 2 and 3 triggering of fingers underwent percutaneous release or steroid injection (50 each) randomly, and they were assessed repeatedly over a follow up period of 6 months. The analysis was done using a Green’s grading, Roles-Maudsley score and VAS Score. Results were analysed with graphical representation. Percutaneous release gave an excellent relief from triggering with no recurrence, and 98% success rate. Steroid injection had only 56% success rate with 22% recurrence at the end of 6 months (higher with grade 3). The roles Maudsley score was almost equal at the end of 6 months, with 98% patients having good and excellent results in both groups. Pain relief was immediate after the steroid injection but there was a relapse in a few patients by the end of 6 months (14% developed VAS Score 4 and higher). It took 1 month for pain to get relieved in the percutaneous group, but the relief was well sustained (96% had absolute relief in percutaneous group vs 66% in steroid group). The percutaneous release should be the preferred modality in all grade 2 and 3 trigger fingers with adequate analgesia for the 1st week post- procedure.

The Effect of Vocal Fold Steroid Injection via Cricothyroid Membrane in Patients with Vocal Polyp

Background and Objectives Vocal polyps are generally caused by phonotrauma such as vocal overuse, and the first line treatment is known as laryngeal microsurgery. The aim of the study is to evaluate the applicability and effectiveness of percutaneous steroid injection via cricothyroid membrane in patients with vocal polyp and to evaluate its advantages and limitations of the technique.Subjects and Method We included in this study 70 patients with vocal polyp managed by vocal fold steroid injection via the cricothyroid membrane from Jan 2008 to July 2018. We compared their medical records of laryngoscopy, stroboscopy, and multi-dimensional voice program analysis at pre and post treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30).Results Of the patients, 54.3 percent showed morphological improvement. In acoustic analysis, the pre-treatment mean values of jitter, shimmer, and NHR were 2.20±2.23, 5.09±3.24, 0.15±0.04, respectively. The post-treatment values were 1.54±1.28, 5.00±4.40, 0.13±0.04, respectively, and only jitter was statistically significant. For subjective symptom improvement, 32 (45.8%) patients showed better score on the post-treatment of VHI-30 compared to pretreatment. Ten patients experienced mild complications such as vocal fold atrophy and scar; however, no critical complications such as internal bleeding or dyspnea were reported.Conclusion According to our study, steroid injection is a safe and effective procedure for patients with vocal polyp. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery.

The Efficacy of Percutaneous Steroid Injection via Cricothyroid Membrane for Reinke’s Edema

Background and Objectives Reinke’s edema is a benign vocal fold disease caused by an edematous laryngeal superficial layer of lamina propria. The first line treatment is cessation of smoking and laryngeal microsurgery. The aim of the study is to evaluate the feasibility and efficacy of percutaneous steroid injection via cricothyroid membrane in patients with Reinke’s edema. Materials and Method From Jan 2010 to July 2018, 33 Patients with Reinke’s edema managed by vocal fold steroid injection via the cricothyroid membrane were included in this study. We compared medical records of laryngoscopy, stroboscopy and Multi-Dimensional Voice Program analysis at pre-treatment and post-treatment. Subjective voice improvement was evaluated using Voice Handicap Index-30 (VHI-30). Results 75.7% of the patients showed partial response and 6.06% showed complete response. 93.94% were present smokers and only 4 patients ceased smoking after the treatment. In acoustic analysis, the pre-treatment mean value of jitter, shimmer, and noise to harmonic ratio was 2.30±3.21, 9.34±10.37, 1.11±2.90 each. The post-treatment value was 2.20±1.89, 6.96±5.30, 0.20±0.09 respectively and none of the parameters were statistically significant. For subjective symptom improvement, 25 (75.8%) patients showed a better score on post-treatment VHI-30 compared to pre-treatment. Conclusion According to our study, steroid injection is a relatively safe and effective procedure for patients with Reinke’s edema. A vocal fold steroid injection via the cricothyroid membrane can be an alternative treatment option for those who are not able to undergo conventional laryngeal microscopic surgery, however cessation of smoking is necessary for effective treatment. Key words: Vocal cords ㆍ Reinke’s edema ㆍ Percutaneous ㆍ Steroid injection ㆍ Treatment 핵심용어: 성대 ㆍ ë ˆì¸ì¼€ì”¨ ë¶€ì¢ ã† ê²½í”¼ì  ㆍ ìŠ¤í Œë¡œì´ë“œ ì£¼ìž ìˆ ã† 치료

Comparative study between percutaneous release and local steroid injection in trigger finger

Trigger finger is the commonest form of tendinopathy. In this study the comparison is done with two effective methods of management which is by giving steroid injection and percutaneous release.in this study two group were created of 40 patients in each group. Both the procedure was done in OPD day care basis. Patients were followed up to 6 months in gap of 1,3,6,12,24 weeks. The outcome was measured by VAS score and recurrence.

Simple Bone Cyst Treated with Percutaneous Steroid Injection

Objectives: Through this study, we want to explore the effectiveness of methylprednisolone injections to treat simple bone cyst (SBC).Methods: We collected the data of all patients with SBC who were treated with percutaneous steroid injection (PSI). The study was conducted in Cipto Mangunkusumo Hospital and we used a computerized search of operative reports to identify all SBC patients who were treated by PSI 3 times between 2013 and 2016.Results: A total of 10 patients were reported in these serial cases, 8 males and 2 females. The average age of these subjects is 7.8 years old. Musculoskeletal Tumor Society functional score determine good result after 3rd injection of steroid. Bone healing evaluation using Chang Criteria showed a good healing proccess.Conclusion: Steroid injection therapy for SBC yielded a good functional result. It gets solid union relatively quickly, simple operation procedure, widely available, with less side effect. Therefore, this procedure could be a choice for treatment of SBCs patient. Further study needs to be conducted with more sample size.

The successful treatment of Bamboo node of the vocal fold by percutaneous steroid injection

The successful treatment of Bamboo node of the vocal fold by percutaneous steroid injection

Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid.

To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. Treatment success based on imaging was categorized as substantial (51-100%), partial (1-50%), or none (0%) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7female, 2male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93months (mean 16 ± 29months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75%) had complete symptomatic relief and 2 patients (25%) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50%). There was a partial imaging response in 2 patients (25%) and no imaging response in 2 out of 8 patients (25%), and all 4 of these patients had local recurrence. There were no complications. Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence.

Treatment of Simple Bone Cysts by the Effect of Cortisone Injection Technique

Introduction: Simple bone cysts (SBC) are benign bone defects that are defined as minimally expansile lucent lesions consisting of a cavity filled with fluid and lined with a fibrocellular membrane. The long-used and the most popular of these treatment modalities is the cortisone injection technique. Treatment options include observation, percutaneous steroid injection, and surgery. This study investigates the results of patients who were treated by steroid injections. Materials and Methods: Total number of fifty patients diagnosed with solitary bone cyst. The study included patients with pathological fractures who did not accept any treatment and patients who steroid injection was performed. The diagnosis of simple cyst was confirmed with clinical and radiological findings. IBM SPSS Statistics 21 manufactured by IBM USA was used for entire calculations. Result: The mean age in first group was 10 ± 4.3 and second group was 9.6 ± 3.2. the cyst area measured in plain radiographs was an average of 63.7 ±9.3 (cm3) in group one and 69.3 ±8.9 (cm3) in second group. Eleven of the lesions were active and 13 were inactive in group one. Twelve lesions were active and eight were inactive in Second group. The involved bone between two groups found statistically significant (P=0.004), and the significancy also found between pathological fractures of two groups (P=0.003). Conclusion: Steroid has no primary curative role in the treatment of bone cysts, but that other factors occurring during steroid injection or natural course of the cyst itself (pathological macro and/or micro fractures developing during the treatment process, procedures causing a decrease in intracystic pressure during injection) may play a supportive role in the healing process.

Ischiofemoral impingement syndrome: another cause of extraspinal sciatica

A 76-year-old woman was admitted to our hospital with complaints of right buttock pain and sciatica. Magnetic resonance imaging was performed. The magnetic resonance imaging showed right ischiofemoral narrowing, edema, and increased signal intensity within the quadratus femoris muscle (Fig. 1). The initial visual analogue scale was 8–9. Computerized tomography-guided percutaneous steroid and local anesthetic injection was performed. Then non-steroidal antiinflammatory drug treatment and exercise program was initiated. After 12 weeks of treatment, pain of the right hip was decreased gradually to visual analogue scale 2–3. Ischiofemoral space is the smallest distance between the ischial tuberosity and lesser trochanter of the femuron axial T1weighted images. Ischiofemoral impingement is characterized by abnormalities of quadratus femoris muscle and narrowing of the space between the lesser trochanter of the femur and the ischial bone (1). It is usually seen in women and is a rare cause of sciatica. The common causes are history of surgery, fracture or arthrosis, hamstrings tendinopathy, or congenital.

Ultrasound use in the pediatric airway: the time has come.

Advancements in ultrasonography and increasing familiarity with its use in the operating room (vascular access and regional neural blockade) suggest its feasibility as an adjunct in pediatric airway evaluation and intervention. We report 3 cases demonstrating the usefulness of ultrasound techniques in this setting. We show key elements of airway anatomy, noninvasive observation of vocal cord motion, and percutaneous periglottic steroid injection via the cricothyroid membrane in 3 different patients. This report reveals the possible usefulness of ultrasound imaging in clinical anesthesia care, specifically airway management, in children.

Treatment of Recurrent Vocal Cord Granuloma with Percutaneous Steroid Injection

Treatment of Recurrent Vocal Cord Granuloma with Percutaneous Steroid Injection Vocal cord granulomas are areas of chronic inflammation, usually located near the vocal process, caused by a variety of conditions such as intubation, gastroesophageal reflux disease, and vocal abuse. They are often difficult to eradicate. Treatments range from conservative management using anti-reflux medications, inhaled steroids, and voice therapy, to more invasive measures such as surgical excision, botulinum toxin injection, and steroid injection. Surgical treatment often leads to a high rate of recurrence. Botulinum toxin injections have shown promise in preliminary studies, but are not appropriate for all patients due to potential adverse effects. Percutaneous steroid injection offers a safe, minimally invasive, yet effective method of treating and preventing recurrence of both primary and recurrent vocal cord granulomas. This paper reports successful treatment of a recurrent vocal cord granuloma using percutaneous steroid injection in a patient who failed both medical management and multiple surgical excisions. Complete resolution was seen two months after the second steroid injection. The patient has remained disease free one year from the final treatment, maintained only on daily proton pump inhibitor therapy. This case demonstrates there are multiple options available to treat this disease, and more prospective research is needed to establish a consistent treatment algorithm for all subsets of patients.

Efficacy of percutaneous vocal fold injections for benign laryngeal lesions: Prospective multicenter study

Conclusion: Percutaneous steroid injection (PSI) may be a useful alternative modality for treatment of benign vocal fold lesions. Objectives: When patients refuse general anesthesia or voice therapy for benign vocal fold diseases (Reinke's edema, vocal polyp, nodule, and scarring), there are no other options available. We conducted an analysis of the effects of PSI as an alternative treatment for benign vocal fold diseases. Methods: From October 2008 to March 2010, 130 patients with benign vocal fold disease who refused general anesthesia or showed no response to voice therapy underwent PSI. From this group, the present study included 115 patients who completed the evaluation before PSI and at the first and third month after PSI and also an additional 25 patients who completed evaluation at the sixth month after PSI. Results: Among 115 patients in the study, 40 cases (34.8%) showed complete remission and 57 cases (49.6%) showed partial remission. As a result, overall improvement rates were 84.4%. Almost all objective and subjective parameters showed statistical improvement at the first and third month after PSI (p < 0.05). Jitter and all subjective parameters maintained statistical improvement until the sixth month. No severe complications, such as fold atrophy, were observed.

Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial

This study compared the results of percutaneous A1 pulley release and steroid injection in 105 trigger digits in 95 patients. The patients were randomly assigned to either surgery (43 patients, 46 digits) or steroid injection (52 patients, 59 digits). The results were assessed at 1 and 6 months and the measurements included rate of recurrence (primary outcome measure), pain on movement, active range of movement of the affected digit and grip strength. No recurrences were seen at 1 month. At the 1 month assessment, patients after steroid injection achieved greater active range of movement of the fingers (270° vs 264°) and stronger grip (99% vs 85%) than those treated by percutaneous release. At the 6 month assessment six recurrences (11%) occurred in the steroid injection group and none in the percutaneous release group (P = 0.005). Patients after percutaneous release had less pain on movement of the involved digit (VAS 0.4 vs 1.3), but still had lower AROM of the fingers (265° vs 270° after steroid injection). We conclude that percutaneous A1 pulley release is more effective medium-term therapy for trigger digit than steroid injection, because of lower risk of recurrence.

Calcific Tendinitis: A Pictorial Review

Calcific tendinitis is caused by the pathologic deposition of calcium hydroxyapatite crystals in tendons and is a common cause of joint pain. The disease typically affects the shoulder and hip, with characteristic imaging findings; however, any joint can be involved. Occasionally, calcific tendinitis can mimic aggressive disorders, such as infection and neoplasm, especially on magnetic resonance imaging. Radiologists should be familiar with the imaging findings to distinguish calcific tendinitis from more aggressive processes. Image-guided percutaneous needle aspiration and steroid injection of calcific tendinitis are useful techniques performed by the radiologist for the treatment of symptomatic cases. Familiarity with these procedures and their imaging appearance is an important aspect in the management of this common disease.