Single Corticosteroid Injection Research Articles

Effectiveness of a Single Corticosteroid Injection for Chronic Rotator Cuff Tendinosis

Department of Orthopedic Surgery, University of British Columbia, New Westminster, British Columbia, Canada Source of funding for the original study: No external funding. Correspondence about the original study: Sharon Griffin, CSS, Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario, N6A 3K7 Canada (e-mail: [email protected]).

Intralesional Corticosteroid Injection Versus Extracorporeal Shock Wave Therapy for Plantar Fasciopathy

To compare the efficacy of low-energy extracorporeal shock wave therapy (ESWT) and intralesional corticosteroid injection (CSI) for the treatment of plantar fasciopathy present for at least 6 weeks. A prospective, randomized, controlled, observer-blinded study over a period of 12 months. Primary care and hospital setting. A total of 132 patients were enrolled in the study, and 125 completed the study. Nineteen nonrandomized patients acted as a surrogate control group. All patients performed a standardized Achilles tendon and plantar fascia stretching program. The patients were randomly allocated to either treatment group A or B. Group A received a single CSI, while group B were referred for a course of low-dose ESWT comprising 3 treatments over a period of 3 weeks. Group C consisted of 19 nonrandomized patients who performed the standardized stretching program only. The worst daily pain recorded on a visual analogue scale (VAS), and the tenderness at the plantar fascia insertion as determined by an algometer. These measures were recorded immediately prior to the commencement of treatment and 3 months and 12 months posttreatment. With regard to VAS pain scores, values for the CSI (1.48; 0-7) were significantly lower than both ESWT (3.69; 0-8), and controls (3.58; 2-5) at 3 months. At 12 months, VAS scores for CSI (0.84; 0-7) and ESWT (0.84; 0-4) were both significantly lower than controls (2.42; 1-4). The tenderness values at 3 months were significantly higher for CSI (9.42; 7-11) than both ESWT (6.72; 4-11) and controls (7.63; 6-9). P < 0.05 was used throughout. Corticosteroid injection is more efficacious and multiple times more cost-effective than ESWT in the treatment of plantar fasciopathy that has been symptomatic for more than 6 weeks.

The Efficacy of Corticosteroids in Periradicular Infiltration for Chronic Radicular Pain

A randomized, double-blind controlled trial. To determine the treatment effect of corticosteroids in periradicular infiltration for chronic radicular pain. We also examined prognostic factors in relation to the outcome of the procedure. Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anesthetic and corticosteroids for radicular pain, secondary to lumbar disc herniation and spinal stenosis. There is currently no randomized trial to determine the efficacy of a single injection of corticosteroids for chronic radicular pain. Eligible patients with radicular pain who had unilateral symptoms who failed conservative management were randomized for a single injection with bupivacaine and methylprednisolone or bupivacaine only. Outcome measures included the Oswestry Disability Index, visual analogue score for back pain and leg pain, claudication walking distance, and the patient's subjective level of satisfaction of the outcome. We recruited 43 patients in the bupivacaine and methylprednisolone group and 43 patients in the bupivacaine only group. The follow-up rate is 100%. Five patients had early termination of the trial for discectomy and further root block. There is no statistically significant difference in the outcome measures between the groups at 3 months (change of the Oswestry Disability Index [P = 0.68], change in visual analogue score [back pain, P = 0.68; leg pain, P = 0.94], change in walking distance [P = 0.7]). Duration of symptoms has a statistically significant negative association with the change in Oswestry Disability Index (P = 0.03). Clinical improvement occurred in both groups of patients. Corticosteroids did not provide additional benefit.

Hay fever and a single intramuscular injection of corticosteroid: a systematic review

In severe hay fever, some patients are strongly affected despite the use of first-line therapy and are therefore treated with an intramuscular injection of systemic corticosteroid (i.m. SCS) in some countries. The aim of this paper was to explore the efficacy and side effects of a single i.m. SCS injection in hay fever in adults. PubMed, EMBASE, Cochrane Library. Systematic review. Criteria for inclusion: hay fever or seasonal allergic rhinitis, adults, injectable steroids, clinical trials, English language. None of the clinical trials were excluded, since an important aim of the review was to identify any possible side-effects. clinical effects, and clinical and physiological side-effects. 18 clinical trials met the inclusion criteria: nine double-blind RCTs (five placebo-controlled and four comparative RCTs), two single-blinded RCTs, and seven open trials. All studies were conducted before 1988. The efficacy of a single intramuscular injection of SCS was statistically significant in all five placebo-controlled trials and demonstrated considerable clinical benefit, lasting approximately from within the first day to four weeks. In the only two studies comparing i.m. SCS to nasal steroids a superior effect with i.m. SCS was demonstrated. The side-effects were few, both clinically and physiologically, with retained ability to respond to stress with hypothalamic-pituitary-adrenal activation. The studies in this review were sound and their findings consistent: i.m. SCS therapy was shown to be efficient and safe for the treatment of hayfever in adults. This review shows no support for any concerns regarding serious tissue atrophy or other serious side-effects, any long-lasting suppression of plasma-cortisol, or any influence on stress reaction, following a single intramuscular injection of SCS.

Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting

Purpose There have been few prospective studies evaluating the results of nonsurgical treatment of a well-defined patient cohort with symptomatic basal joint osteoarthritis of the thumb. This prospective study uses a validated outcome instrument to examine the effectiveness of a single steroid injection and 3 weeks of splinting in patients with osteoarthritis in Eaton stages 1 to 4 with a minimum of 18 months of follow-up evaluation. Methods Thirty consecutive patients (30 thumbs) were studied prospectively to evaluate the efficacy of a single injection of corticosteroid into the trapeziometacarpal joint, followed by immobilization in a thumb spica splint for 3 weeks. All patients answered an outcome-based questionnaire (Disabilities of the Arm, Shoulder, and Hand) and were examined before injection, 6 weeks after injection, and at final follow-up examination (minimum, 18 months). Eaton radiographic stage was recorded by 3 independent observers. Results At 6 weeks 13 patients had improvement in pain intensity and 17 patients reported no symptomatic improvement. Twelve of those with relief at 6 weeks continued to have relief at long term follow-up evaluation (mean, 25 months). Of patients with long-term relief average grip strength of the affected thumb was 95% of contralateral side, whereas those without relief had grip strength values that were 60% of contralateral side. For those patients without relief at 6 weeks there was no improvement seen at later follow-up evaluation. Five patients with Eaton stage 1 disease had an average of 23 months of relief with nonsurgical treatment. In stage 2 and stage 3 disease 7 thumbs improved at 6 weeks after injection and 6 thumbs had long-term relief. In stage 4 disease, 6 thumbs had neither short-term nor long-term relief with the injection. Disease side, handedness, and smoking did not affect outcomes. At final follow-up evaluation 12 thumbs had had surgical treatment. Conclusions Steroid injection with splinting for the treatment of basal joint arthritis of the thumb provided reliable long-term relief in thumbs with Eaton stage 1 disease but provided long-term relief in only 7 of 17 thumbs with Eaton stage 2 and stage 3 basal joint arthritis.

Functional distal interphalangeal joint splinting for trigger finger in laborers: a review and cadaver investigation.

This two-part study evaluates the efficacy of functional distal interphalangeal joint (DIP) splinting for the treatment of trigger finger. Thirty-one fingers from 21 meat packing plant workers were treated with DIP splinting. A single corticosteroid injection was offered if triggering was stage 4 or greater. All workers returned to work immediately. Eighty-one percent of the digits were treated successfully (mean follow-up: 1 year). Treatment failure correlated with duration of symptoms and stage of triggering but did not correlate with age, race, sex, disease in multiple digits, or prior treatment. For the second part of the study, the effect of DIP splinting on flexor digitorum profundus (FDP) tendon excursion was studied in 16 fingers from 4 fresh cadavers. Excursion decreased 4.8 mm for the Stax splint and 4.2 mm for the dorsal Alumafoam splint. We conclude that DIP splinting provides a reliable and functional means of treating work-related trigger finger without lost time from work. Our cadaver investigation supports our theory that DIP splinting significantly decreases FDP excursion.

Effects of pulse methylprednisolone on bone and marrow tissues: corticosteroid-induced osteonecrosis in rabbits.

To investigate the effects of pulse methylprednisolone acetate on bone and bone marrow tissues and to clarify the causal factors of corticosteroid-induced osteonecrosis (ON) by using an experimental animal model. Male adult Japanese white rabbits were injected once with 20 mg/kg of methylprednisolone into the right gluteus medius muscle. Seven rabbits were killed at 4 weeks, 4 at 6 weeks, 4 at 8 weeks, and 6 at 10 weeks. Both histopathologic and hematologic studies were performed every week. By 4 weeks after the steroid injection, 43% of the rabbits studied had developed multifocal ON lesions in the femur and/or humerus. In 1 rabbit, a thrombus was detected in an arteriole adjacent to the necrotic area at 4 weeks. After 6 weeks, there was also progressive histologic evidence of revascularization, with granulation tissue, and osteoblastic repair, with appositional bone formation. Hyperlipemia, fatty liver, and intraosseous fat embolism were observed in conjunction with thrombocytopenia and hypofibrinogenemia. A single injection of high-dose corticosteroids was found to be capable of inducing thrombocytopenia, hypofibrinogenemia, and hyperlipemia with multifocal ON in several bones.

Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection.

Patients who received a single corticosteroid injection for treatment of third webspace plantar interdigital neuroma were studied retrospectively. Forty-three patients (51 feet) were available for followup study (followup mean, 4 years; range, 2 to 6 years). Mean age of patients was 53 years. Pain initially was relieved in 36 patients (41 feet [80%]). Twenty-four feet (47%) ultimately required surgical excision, while most of the remaining 27 feet (53%), which had not been treated surgically, were the source of residual symptoms in patients. A single corticosteroid injection cannot be recommended as a cure for symptoms of third webspace neuroma, but it can be offered as a temporizing measure or as nonoperative treatment. A single corticosteroid injection does not preclude a successful surgical result.

Effects of local injection of corticosteroids on the healing of ligaments. A follow-up report.

One hundred and one skeletally mature New Zealand White rabbits were used to study the long-term effects of a single injection of corticosteroid on the biomechanical, histological, and biochemical properties of ligament-healing. Two steroid doses were studied, as previously described. The injections were made into a fascial pocket immediately after transection of the ligament. The animals were killed forty-two and eighty-four days after the injury. In our previous investigation, in which we examined the early (inflammatory and proliferative) phases of ligament-healing, the specimens that had been injected with a dose of steroids equivalent to that given to humans demonstrated significantly inferior biomechanical properties and histological organization relative to controls that had not received an injection. In the current study, we examined the later (remodeling and maturation) phases of ligament-healing and found that the tensile strength (the ultimate stress) of the specimens that had been injected with the steroids returned to a value that was equal to that of the controls that had not received an injection; however, the peak load of the specimens that had been injected with steroids remained inferior to that of the controls. This was accompanied by a lag in the histological maturation.

Reduction of cortisol levels after single intra-articular and intramuscular steroid injection

This study was undertaken to determine the influence of single intra-articular or intra muscular injections of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis. Twenty-one patients with rheumatic disease who had never been treated with systemic glucocorticoids and had not received local injections of these agents for the preceding 2 months, were given 40 mg of methylprednisolone acetate. Group I (11 patients) received one intra-articular injection into the knee, and Group II (10 patients) received the same dose intramuscularly. In Group I, serum cortisol levels were significantly decreased 24 hours after injection (228.2 +/- 8.7 nmol/L versus 193 +/- 16.3 nmol/L; P < 0.05). Serum cortisol levels were decreased in 9 of the 11 patients, by an average of 21.5%. Two patients' levels were below 138 nmol/L, which is considered to be the lower limit of normal range. Serum cortisol levels were below normal range in 3 patients 72 hours after intra-articular steroid injection. In Group II, serum cortisol levels were significantly decreased at 72 hours after injection (239.6 +/- 10.3 nmol/L versus 175.6 +/- 21.4 nmol/L; P < 0.01). Three patients' levels were below normal. By 72 hours postinjection, serum cortisol concentrations in 9 of 10 patients were decreased by an average of 31% compared to preinjection values. The present study suggests that decreased adrenocortical secretion, as reflected in depressed cortisol levels, can result from a single, low-dose, intra-articular or intramuscular injection of depot corticosteroids.

Postnatal lung function in preterm lambs: Effects of a single exposure to betamethasome and thyroid hormones

OBJECTIVE: We determined the effect of a single direct fetal injection of corticosteroid and thyroid hormones on postnatal pulmonary function in preterm lambs. STUDY DESIGN: Initially fetal sheep (126 days' gestation) randomly received saline solution, betamethasone (Celestone Soluspan, 0.5 mg/kg), betamethasone plus triiodothyronine (5 μg/kg), or betamethason plus thyroxine (15 μg/kg) as a single injection. Forty-eight hours later (128 days' gestation) the tetuses were delivered and ventilated for 50 minutes. In a second protocol fetuses were delivered at 128 days' gestation, after only 24 hours of hormone exposure. RESULTS: Betamethasone treatment improved compliance nearly twofold after 24 or 48 hours of exposure. Efficiency of ventilation also improved after steroid therapy; this effect was augmented 48 hours after thyroxine exposure (but not triiodothyronine). No thyroxine effect was noted after 24 hours of exposure. Maximal lung volume increased by 80% after steroid treatment and doubled in response to combination betamethasone and thyroxine therapy. Alveolar pool sizes of saturated phosphatidylcholine and surfactant protein A were comparable for all groups exposed for 48 hours. CONCLUSION: A single fetal exposure to betamethasone improves postnatal pulmonary function after 24 or 48 hours. Addition of thyroxine (but not triiodothyronine) augments this effect at 48 hours.

Névralgie cervico-brachiale chronique traitée par injection péridurale cervicale de corticoïdes. Résultats à long terme

• Objective : To assess long-term results of a single cervical epidural corticosteroid injection (CECI) in patients suffering from chronic cervicobrachial neuralgia (CCBN). • Study design : Open prospective study. • Patients : A CECI was performed in 29 patients suffering for more than 12 months from a non-compressive and non-surgical CCBN with permanent pain for at least three months non relieved by an adequately conducted medical treatment. • Methods : The cervical epidural space was injected (C7-T1, 18 G needle) with an increasing volume (maximum 10 mL) of isotonic saline solution to exacerbate patient's cervicobrachial pain. The patients then received an equivalent volume of 0.5 % lidocaine plus triamcinolone acetonide (10 mg·mL −1). The pain decrease was estimated on a visual analogic scale (VAS), in comparison to intensity of pain rated at 100 mm before CECI. • Results : The mean volume injected into the epidural space was 6 ± 2 mL. It increased pain in 26 out of 29 patients. After 3 months, a success rate of 83 % was obtained, with a pain rate of 12 mm on VAS. Concerning mid- and long-term results, pain relief remained stable for at least 24 months (mean follow-up : 48 ± 18 months). Simultaneously, the need for analgesics decreased significantly. • Conclusion : A single CECI in patients suffering from non-compressive and non-surgical CCBN results in long-lasting pain relief.

Healing characteristics of a type I collagenous structure treated with corticosteroids.

One hundred twenty-eight skeletally mature New Zealand White rabbits were used to study the effect of a single corticosteroid injection on the biomechanical, biochemical, and histologic aspects of ligamentous healing. Two steroid dosages were used. The amount of the low-dose steroid was calculated by determining the corticosteroid concentration at which fibroblastic synthesis of collagen was inhibited in vitro. A human equivalent dose of betamethasone was used as the high-dose steroid injection. These two steroid doses and a saline control were injected around a transected medial collateral ligament. At 10 days all groups showed significantly inferior biomechanical properties relative to noninjected controls. By 3 weeks the human equivalent steroid dose group continued to demonstrate significantly inferior properties. Histologic and biochemical analyses confirmed the biomechanical results. The clinical relevance of the study was that the delivery of a human equivalent steroid dose into an acutely injured ligament significantly impairs the healing process relative to a noninjected ligament at 10 days and at 3 weeks after injury. This implies that a corticosteroid-treated injured ligament may not be able to withstand the mechanical loads of early vigorous rehabilitation.

Oral vs Repository Corticosteroid Therapy in Acute Asthma

Acutely ill asthmatic patients treated in the usual fashion in an emergency room setting and discharged within six hours were studied to determine whether therapy with a single injection of a repository corticosteroid (methylprednisolone sodium acetate) could be as effective as a tapering course of oral corticosteroids in decreasing asthma symptomatology and relapse within seven days. Seventeen patients (18 episodes of asthma) formed the study population. Eight episodes occurred in patients who received depot methylprednisolone (group 1) and ten episodes in patients who received oral corticosteroid treatment (group 2). All patients in both groups improved following emergency room treatment. Relapse occurred in two of ten patients in group 2 and none in group 1. Symptoms attributable to asthma recurred in significantly more patients in group 2 than in group 1 (9 vs 0, p less than .01). Side effects from therapy with corticosteroids were rare. This study indicates that intramuscular repository corticosteroids are at least as effective as oral corticosteroids in the management of the acute asthmatic outpatient, with a distinct advantage with regard to patient compliance.

Outpatient Treatment of Low Back Pain and Sciatica by a Single Extradural Corticosteroid Injection

Outpatient Treatment of Low Back Pain and Sciatica by a Single Extradural Corticosteroid Injection

Linear Hypopigmentation After Intra-articular Corticosteroid Injection

To the Editor.— Goldman et al, 1 in the October 1981Archives, reported a case of linear leukoderma without atrophy after intra-articular injection of a concentrated corticosteroid suspension. We report an additional case with subsequent spontaneous repigmentation that was not observed by the previous authors. Report of a Case.— A 51-year-old woman had had persistent pain around the region of the second and third metatarsophalangeal joints of her left foot. She was told that this was related to malalignment of her toes caused by a bunion. In May 1982, she had received a single corticosteroid injection presumably into the left second metatarsophalangeal joint with subsequent relief of pain. The suspension used was 40 mg/mL of triamcinolone (Aristocort) acetonide; the total amount injected was 1 mL. During the next month, the patient noted hypopigmentation of the skin around the site of injection without evidence of inflammation or atrophy. The hypopigmentation spread

Ultrasonic assessment of cutaneous atrophy caused by intradermal corticosteroids.

A noninvasive technique of pulsed ultrasound was used to determine the long-term changes in skin thickness resulting from intradermal injections of triamcinolone acetonide (TA). Injections of 0.1 ml of either saline or a suspension containing 5 mg/ml or 10 mg/ml of TA were made at selected sites on the forearms of two human volunteers. The corticosteroid-treated sites showed a maximal decrease of 30% to 40% of the original skin thickness at 4 to 8 weeks after a single injection. A transient thinning was observed at control sites injected with saline. A greater degree of thinning was seen at the site injected with 10 mg/ml of TA as compared to the site injected with 5 mg/ml of TA. The thinning at the corticosteroid injection sites persisted at least 18 weeks after the single corticosteroid injection but had approached normal thickness values by 44 weeks following treatment. Pulsed ultrasound may be useful as a noninvasive technique for monitoring the effects of intradermally injected corticosteroids on human skin thickness and may also be useful in assessing intrinsic atrophogenic potentials of different corticosteroid molecules in human skin and the duration of action of various injectable formulations of a corticosteroid.

Trochanteric bursitis--a frequent cause of 'hip' pain in rheumatoid arthritis.

One hundred consecutive patients with rheumatoid arthritis (RA) were examined for the presence of trochanteric bursitis. This condition was found in 15. Ten patients responded to a single local injection of corticosteroid and the remaining 5 to a second injection. Trochanteric bursitis is an underdiagnosed, easily remediable cause of pain in RA. Specific examination for in presence should be a routine in all patients with RA, especially those with hip pain.

Tenography in de quervain's disease

This paper describes our diagnostic method, which enables an early and immediate differentiation between those patients who could benefit from a single or several local corticosteroid injections, and those who will probably require surgery. The authors have no intention of advocating a preferred treatment, but try to predict the outcome of the various modes of therapy.

Lipoxygenation of arachidonic acid as a source of polymorphonuclear leukocyte chemotactic factors in synovial fluid and tissue in rheumatoid arthritis and spondyloarthritis.

The predominant lipoxygenase products of arachidonic acid were extracted and purified from synovial fluid and sonicates of synovial tissue of patients with rheumatoid arthritis (RA), spondyloarthritis (SA), or a noninflammatory arthropathy (NIA). The concentration of 5(S),12(R)-dihydroxy-6,8,10-(trans/trans/cis)-14-cis-eicosatetraenoic acid (leukotriene B4) in synovial fluid was elevated significantly in patients with RA and a positive latex test for rheumatoid factor (P < 0.05, n = 14) and in patients with SA (P < 0.05, n = 10), compared with that of subjects with NIA (n = 9). The content of 5(S)-hydroxy-6,8,11,14-eicosatetraenoic acid (5-HETE), but not of leukotriene B4, was elevated significantly in synovial tissue of seven patients with RA in comparison with that of four subjects with NIA (P < 0.05). A single intra-articular injection of corticosteroid significantly lowered the synovial fluid level of leukotriene B4 in six patients with RA. These data suggest an involvement of the potent chemotactic factors 5-HETE and leukotriene B4 in human inflammatory disease.