Single Intra-articular Corticosteroid Injection Research Articles

The Disease-Modifying Effects of a Single Intra-Articular Corticosteroid Injection during the Freezing Phase of Frozen Shoulder in an Animal Model.

Although frequently prescribed for frozen shoulder, it is not known if corticosteroid injections improve the course of frozen shoulder. This study aimed to assess the disease-modifying effects of an intra-articular corticosteroid administration at the freezing phase of frozen shoulder. Twenty-four Sprague-Dawley rats were divided into four groups. Their unilateral shoulders were immobilized for the first 3 days in all groups, followed by an intra-articular corticosteroid injection in Group A, an injection and the cessation of immobilization in Group B, no further intervention in Group C, and the cessation of immobilization in Group D. All rats were sacrificed in Week 3 of study, at which point the passive shoulder abduction angles were measured and the axillary recess tissues were retrieved for histological and Western blot analyses. The passive shoulder abduction angles at the time of sacrifice were 138° ± 8° (Group A), 146° ± 5° (Group B), 95° ± 11° (Group C), 132° ± 8° (Group D), and 158° ± 2° (Control). The histological assessments and Western blots showed greater fibrosis and inflammation in the groups that did not receive the corticosteroid injection (Groups C and D) compared to the corticosteroid-injected groups (Groups A and B). These findings demonstrate the anti-inflammatory and disease-modifying effects of corticosteroid injections during the freezing phase of frozen shoulder in an animal model.

Ultrasonography Changes Following Single Intra-articular Corticosteroid Injection in Knee Osteoarthritis- A Randomized Controlled Trial

Ultrasonography Changes Following Single Intra-articular Corticosteroid Injection in Knee Osteoarthritis- A Randomized Controlled Trial

Evaluation and Outcome of IA Hyaluronic Inj. vs. Corticosteroid Therapy for OA Knee: Tertiary Level Hospital in Bangladesh

Background: There are many types of arthritis, but osteoarthritis (OA) is one of the most frequent. IA injections of corticosteroids into the knee joint may improve pain and impairment by relieving joint inflammation. Purpose: To evaluate the effectiveness and safety of hylastan, a novel viscosupplements, with a single intra-articular corticosteroid injection in the treatment of knee osteoarthritis pain (OA). Because of its large molecular weight, the sodium hyaluronate in Hylastan is more likely to stay in the joint for an extended period of time than other viscosupplements. Methods: Multicentered based randomized quasi-experimental comparative study was performed in Shah Mokhdum Medical College, Rajshahi, Bangladesh, from January 2019 to December 2021. Enrolled patients aged ≥40 years. Patients were randomized 1:1:1 to one of three arms: 2 X 4 mL hylastan (n = 129; arthrocentesis then IA hylastan Day 0, same treatment Week 2); 1 X 4 mL hylastan (n = 130; arthrocentesis then IA hylastan Day 0, arthrocentesis only Week 2); steroid (n = 132; arthrocentesis then IA methylprednisolone acetate 40 mg Day 0, arthrocentesis only Week 2). The primary clinical outcome measure was changed from baseline in WOMAC A pain score overall postbaseline visits to Week 26. Results: Statistically significant pain reduction was observed in all three arms, with similar mean (95 % CI) changes in WOMAC A: 2 X 4 mL hylastan -0.9 (-1.0, -0.7); 1 X 4 mL hylastan -0.8 (-0.9, -0.7); steroid -0.9 (-1.0, -0.8); all p < 0.0001 versus baseline. Changes in secondary outcomes were similar in all three arms. Target knee adverse events were comparable for all treatments. Conclusions: An acceptable safety profile and effective pain relief were found with both IA hylastan injection regimens. The hypothesis of better pain relief with IA hylastan was not met compared to IA corticosteroid. The effectiveness and safety of hylastan compared to other viscosupplements require more investigation. Level of evidence Therapeutic study, Level I.

Intra-articular Along with Subacromial Corticosteroid Injection in Diabetic Patients With Adhesive Capsulitis

Background: To compare intra-articular plus subacromial corticosteroid injection with a single intra-articular injection in diabetics with adhesive capsulitis. Materials and Methods: A total of fifty-four diabetic patients were randomized into corticosteroid injection in both intra-articular and subacromial sites (group A) and one intra-articular injection (group B). Pain by a visual analog scale (VAS), shoulder range of motion, and functional state by the American Shoulder and Elbow Score was assessed before injection, and at follow-up months. Results: The pain VAS scores of group A were considerably lower than group B at the first-month follow-up visit (P=0.01). The range of motion in forward-elevation and internal rotation at three-month follow-up visits was significantly higher in group A than in group B (P=0.035, P=0.04, respectively). No notable differences in the range of motion in forward-elevation, internal rotation, and external rotation between groups at the final follow-up visit were seen. Though a significant difference in the ASES between groups at the third-month follow-up visit (P=0.03), the ASES score at the final sixth-month follow-up was similar in both groups (P=0.7). Conclusion: In diabetic adhesive capsulitis of the shoulder, subacromial combined with intra-articular steroid injections has superior subjective outcomes compared to single intra-articular corticosteroid injection.

Adhesive Capsulitis: Demographics and Predictive Factors for Success Following Steroid Injections and Surgical Intervention

PurposeExamine demographic factors of all patients treated for adhesive capsulitis by a single surgeon, report the treatments and outcomes of these patients, and determine the effectiveness of various treatments, including corticosteroid injections and operative intervention in relation to risk factors for adhesive capsulitis.MethodsAll patients treated for adhesive capsulitis by a single surgeon between 2008 to 2014 with minimum 2 years' follow-up were identified via charts and operative reports and were eligible for inclusion. Demographic information including sex and medical comorbidities was documented. Preintervention and postintervention shoulder range of motion was recorded. Specific treatment information (number of corticosteroid injections, etc) was collected. Treatment outcomes were then compared as an aggregate and among varying comorbidities.ResultsOverall, 1377 patients were treated for adhesive capsulitis (946 women vs 431 men [P = .001]). For patients with adhesive capsulitis: a higher percentage of men than women had diabetes (24.8% vs 17.3% [P = .001]); nondiabetic patients had better forward flexion at initial presentation than patients with diabetes (114° vs 108° [P = .015]); more patients with diabetes required capsular release than nondiabetic patients (13% vs 7.3% [P = .003]); more nondiabetic patients resolved adhesive capsulitis without corticosteroid or surgical intervention than patients with diabetes (83.6% vs 61.7% [P = .001]); more nondiabetic patients resolved adhesive capsulitis after single corticosteroid injection than did patients with diabetes (95.9% vs 86.7% [P = .001]). Multiple intraarticular corticosteroid injections provided no added benefit over a single injection in resolving adhesive capsulitis in patients with diabetes and nondiabetic patients.ConclusionIn shoulder adhesive capsulitis, women and patients with diabetes are more commonly affected, patients with diabetes respond less favorably to physical therapy in isolation and physical therapy plus corticosteroid injections than nondiabetic patients. No benefit from multiple intraarticular corticosteroid injections was seen compared with a single intraarticular corticosteroid injection in patients with diabetes and nondiabetic patients. Patients with diabetes and nondiabetic patients have functional improvement after capsular release and manipulation if conservative treatment for adhesive capsulitis fails.Level of EvidenceIII, case control.

Is there a short-term benefit from an intra-articular steroid injection in female patients with adhesive capsulitis of the shoulder treated with physiotherapy?

The purpose of this retrospective study was to investigate the possible short-term benefit of a single intra-articular corticosteroid injection in those patients treated with physiotherapy when compared to a group of patients undergoing physiotherapy only (PT only). A retrospective chart review was conducted to identify eligible patients treated over a 4-year period. All female patients between 40 years and 60 years with a confirmed clinical diagnosis of idiopathic adhesive capsulitis who completed a prescribed physiotherapy program were considered eligible. Sixty-three patients fulfilled the inclusion criteria, but 22 were excluded because of missing data in the medical record. The remaining 41 patients comprise the study cohort; an experienced musculoskeletal physiotherapist assessed these patients both at initial presentation and at 12 weeks. Twenty patients with a mean age of 55.1 years underwent PT only and 21 patients with a mean age of 52.4 years received a single intra-articular dose of 40 mg methylprednisolone followed by physiotherapy. Outcome measures included the visual analogue scale (VAS) and measurement of range of motion. At final assessment (12 weeks), significant between-group differences were identified for the 'PT only' group for flexion ( p = 0.01) and abduction ( p = 0.008). When comparing the mean change from the initial assessment, a significant between-group difference was observed for abduction ( p = 0.03). The results of this study suggest that the intra-articular injection of a single dose of cortisone has no significant short-term benefit in female patients with idiopathic adhesive capsulitis managed with physiotherapy.

Clinical efficacy of hydrodistention with joint manipulation under interscalene block compared with intra-articular corticosteroid injection for frozen shoulder: a prospective randomized controlled study

Hydrodistention is known to be an effective method of treatment for frozen shoulder. However, hydrodistention is accompanied by severe pain during the procedure. An interscalene block may relieve the severe pain associated with the procedure of hydrodistention. This study compared the clinical efficacy of hydrodistention with joint manipulation under an interscalene block with that of intra-articular corticosteroid injection. This prospective randomized controlled study included 121 patients presenting with frozen shoulder. Patients were randomized into 2 groups; those in group A (60 patients) were treated by hydrodistention with joint manipulation under an interscalene block, and those in group B (61 patients) were managed with intra-articular corticosteroid injection. Pain intensity and patient satisfaction were assessed by the visual analog scale. Functional outcomes were assessed by the Constant score and the range of shoulder motion. Group A demonstrated better patient satisfaction and earlier restoration of range of motion than group B at 6 weeks (P ≤ .001). At 12 weeks, the pain score was lower and the Constant score was better in group A than in group B. However, at 12 months after treatment, pain score (P = .717), patient satisfaction (P = .832), range of motion (P > .05), and Constant score (P = .480) were similar in the 2 groups. Hydrodistention combined with joint manipulation under an interscalene block provided earlier pain relief and restoration of shoulder range of motion and function compared with single intra-articular corticosteroid injection in patients with primary frozen shoulder.

Corticosteroid Injections Accelerate Pain Relief and Recovery of Function Compared With Oral NSAIDs in Patients With Adhesive Capsulitis

Background: Intra-articular corticosteroid injection is a common therapy for adhesive capsulitis, but there is a lack of prospective randomized controlled studies analyzing the efficacy of single injections applied blindly to accelerate improvement in pain and function. Hypothesis: In patients with adhesive capsulitis, a single intra-articular corticosteroid injection without image control applied before the beginning of a physical therapy program will accelerate pain relief and recovery of function compared with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 74 patients with primary adhesive capsulitis in the freezing stage were randomized to receive either intra-articular injections with betamethasone or oral NSAIDs. Clinical outcome was documented at baseline and after 2, 4, 8, and 12 weeks and comprised a visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the abbreviated Constant-Murley score, and the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score for function. Passive range of motion was measured with a goniometer. Results: Patients treated with corticosteroid injections achieved faster pain relief compared with control patients during the first 8 weeks after treatment (P < .001). However, no significant difference in pain was observed among the groups at final follow-up. Likewise, shoulder function and motion improved significantly in both groups at all follow-up points. Shoulder function scores and most motion parameters improved faster in the injection group up to week 8 (P < .001). Again, no significant differences in function or motion were seen at final follow-up. Conclusion: In patients with adhesive capsulitis, a single corticosteroid injection applied without image control provides faster pain relief and earlier improvement of shoulder function and motion compared with oral NSAIDs.

Evaluation of the benefit of corticosteroid injection prior to exercise therapy in patients with knee osteoarthritis: A randomized trial

Purpose: Combined non-pharmacological and pharmacological treatment is recommended as optimal management of knee osteoarthritis (OA). However, the two treatment approaches have mostly been investigated separately. We aimed to assess the efficacy of combined intra-articular corticosteroid injection and exercise compared to placebo injection and exercise in patients with knee OA. Methods: This randomized, double blind, placebo-controlled trial running over 26 weeks was designed as a superiority study comparing the efficacy of a single intra-articular corticosteroid injection (1 mL of 40 mg/mL methylprednisolone dissolved in 4 mL 10 mg/mL Lidocaine) plus exercise, with a single placebo injection (1 mL isotonic saline mixed with 4 mL 10 mg/mL Lidocaine) plus exercise. Participants with clinical and radiographic knee OA were randomly allocated (1:1) to either corticosteroid (Steroid Group) or saline (Placebo Group) injection. Two weeks after injection, all participants started a 12 week supervised exercise program with 3 weekly sessions. Outcomes were assessed at baseline, week 2 (exercise start), week 14 (end of exercise), and week 26 (follow-up). The primary outcome was the mean change in KOOS pain subscale at week 14. Analyses were done on the intention-to-treat (ITT) population (all randomized participants). Missing data were replaced using multiple imputation. A repeated measures mixed model was used to analyze the primary outcome; week, treatment, and week x treatment were included as fixed effects, adjusting for the baseline value. Results: A total of 263 patients were screened and 100 patients were randomized to receive either Steroid (n=50) or Placebo (n=50). Of these, 93 completed the week 14 assessment and 89 completed the 26 weeks trial. There were no group differences in the proportions completing. Mean age was 63.4 (SD 9.3) years, 61% were women. The mean exercise attendance rate was 79% (SD 15); no group difference observed. The mean (SD) KOOS pain score at randomization was 53.3 (11.4) and 55.2 (16.0) in the Steroid and Placebo groups, respectively. The mean (SE) change in pain at week 14 was 13.6 (1.8) and 14.8 (1.8) in the Steroid and Placebo Groups, respectively, corresponding to a mean difference of 1.2 units (95% CI -3.8 to 6.2; P=0.64). These results were robust according to all sensitivity analyses - incl. using baseline observation carried-forward imputation and no imputation. There were no group differences at week 2, 14, and 26 in any of the 5 KOOS subscales and the 95% confidence intervals of the group differences did not exceed the suggested minimal clinical important difference of 8-10 KOOS points. Conclusions: These results show comparable efficacy of intra-articular corticosteroid and placebo when combined with exercise for pain relief in knee OA. Trial registration. EU clinical trials register (EudraCT): 2012-002607-18 and clinicaltrials.gov NCT01945749

Local effects of intra-articular corticosteroids

Intra-articular corticosteroid injection (IACI) is a very popular procedure. In this review, we wanted to review all that had been published about local effects of IACIs. English literature search was made through PubMed using the terms intra-articular and local effect. Effects on subjective, functional, structural, cellular, humoral, molecular, and imaging aspects were included. Also, all local adverse effects were documented. The main beneficial effect of IACI is pain relief. The duration of this effect is variable and depends on underlying disease, type of disease, amount of structural damage, type of IACI, dose of IACI, presence of joint effusion, level of inflammatory mediators, emptiness of joint effusion, availability of imaging, and others. At large, inflammatory problems had higher rate of favorable response in terms of pain and function. IACI at the knee joint in juvenile idiopathic arthritis patients resulted in remission for >6 months in >80% of the patients with a mean duration of approximately 1.2 years, while in the osteoarthritic knee there was a pain relief for 3 weeks only and in rheumatoid arthritis (RA) knee for 8 weeks. There was no joint space loss at the knee joint following multiple IACI in osteoarthritis and also no increase in cartilage or bone erosions in RA following a single IACI. IACI guide imaging is important in achieving better results in particular joints. Joint infection rate is very low. Other adverse effects included intra-articular and periarticular calcifications, cutaneous atrophy, cutaneous depigmentation, avascular necrosis, rapid destruction of the femoral head, acute synovitis, Charcot's arthropathy, tendinopathy, Nicolau's syndrome, and joint dislocation. IACI is associated with a wide range of local effects. Subjective and functional favorable response is prominent mainly in juvenile idiopathic arthritis patients. Adverse effects are either rare or insignificant.