Best Practice & Research Clinical Rheumatology
Volume 23, Issue 2 , Pages 193-219 , April 2009

How to perform local soft-tissue glucocorticoid injections

  • J.W. Jacobs, MD, PhD (Associate Professor, Rheumatologist)

      Affiliations

    • Corresponding Author InformationTel.: +31 88 7557357; Fax: +31 30 2523741.

References 

  1. Paavola M, Kannus P, Jarvinen TA, et al. Treatment of tendon disorders. Is there a role for corticosteroid injection?. Foot Ankle Clin. 2002;7:501–513
  2. Speed CA. Injection therapies for soft-tissue lesions. Best Pract Res Clin Rheumatol. 2007;21:333–347
  3. Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 2007;8:63
  4. Kang MN, Rizio L, Prybicien M, et al. The accuracy of subacromial corticosteroid injections: a comparison of multiple methods. J Shoulder Elbow Surg. 2008;17:61S–66S
  5. Eustace JA, Brophy DP, Gibney RP, et al. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 1997;56:59–63
  6. Chen MJ, Lew HL, Hsu TC, et al. Ultrasound-guided shoulder injections in the treatment of subacromial bursitis. Am J Phys Med Rehabil. 2006;85:31–35
  7. Akkus S, Kutluhan S, Akhan G, et al. Does fibromyalgia affect the outcomes of local steroid treatment in patients with carpal tunnel syndrome?. Rheumatol Int. 2002;22:112–115
  8. Davidson JA, Boom SJ. Warming lignocaine to reduce pain associated with injection. BMJ. 1992;305:617–618
  9. Altay T, Gunal I, Ozturk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res. 2002;127–130
  10. Draeger HT, Twining JM, Johnson CR, et al. A randomised controlled trial of the reciprocating syringe in arthrocentesis. Ann Rheum Dis. 2006;65:1084–1087
  11. Berger RG, Yount WJ. Immediate “steroid flare” from intraarticular triamcinolone hexacetonide injection: case report and review of the literature. Arthritis Rheum. 1990;33:1284–1286
  12. Goldfarb CA, Gelberman RH, McKeon K, et al. Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg [Am]. 2007;32:1513–1520
  13. Mens JM, Nico dW, Berkhout BJ, Stam HJ. Disturbance of the menstrual pattern after local injection with triamcinolone acetonide. Ann Rheum Dis. 1998;57:700
  14. Hollander JL. Intrasynovial corticosteroid therapy in arthritis. Md State Med J. 1970;19:62–66
  15. Gray RG, Tenenbaum J, Gottlieb NL. Local corticosteroid injection treatment in rheumatic disorders. Semin Arthritis Rheum. 1981;10:231–254
  16. Seror P, Pluvinage P, d'Andre FL, et al. Frequency of sepsis after local corticosteroid injection (an inquiry on 1160000 injections in rheumatological private practice in France). Rheumatology (Oxford). 1999;38:1272–1274
  17. Kaandorp CJ, Krijnen P, Moens HJ, et al. The outcome of bacterial arthritis: a prospective community-based study. Arthritis Rheum. 1997;40:884–892
  18. DeSio JM, Kahn CH, Warfield CA. Facial flushing and/or generalized erythema after epidural steroid injection. Anesth Analg. 1995;80:617–619
  19. Black DM, Filak AT. Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection. J Fam Pract. 1989;28:462–463
  20. DiStefano V, Nixon JE. Skin and fat atrophy complications of local steroid injection. Pa Med. 1974;77:38
  21. Stapczynski JS. Localized depigmentation after steroid injection of a ganglion cyst on the hand. Ann Emerg Med. 1991;20:807–809
  22. McCarty DJ, Harman JG, Grassanovich JL, Qian C. Treatment of rheumatoid joint inflammation with intrasynovial triamcinolone hexacetonide. J Rheumatol. 1995;22:1631–1635
  23. Kleinman M, Gross AE. Achilles tendon rupture following steroid injection. Report of three cases. J Bone Joint Surg Am. 1983;65:1345–1347
  24. Linskey ME, Segal R. Median nerve injury from local steroid injection in carpal tunnel syndrome. Neurosurgery. 1990;26:512–515
  25. Sheon RP. Repetitive strain injury. 2. Diagnostic and treatment tips on six common problems. The Goff Group. Postgrad Med. 1997;102:72–7881, 85
  26. Riley G. The pathogenesis of tendinopathy. A molecular perspective. Rheumatology (Oxford). 2004;43:131–142
  27. Saunders S. Injection techniques in orthopaedic and sports medicine. 2nd edn.. Edinburgh: W.B. Saunders; 2002;
  28. Nichols AW. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med. 2005;15:370–375
  29. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1998;19:91–97
  30. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1994;15:376–381
  31. Alexeeff M. Ligamentum patellae rupture following local steroid injection. Aust N Z J Surg. 1986;56:681–683
  32. Jones JG. Achilles tendon rupture following steroid injection. J Bone Joint Surg Am. 1985;67:170
  33. Yu CM, Chen CH, Liu HT, et al. Subacromial injections of corticosteroids and xylocaine for painful subacromial impingement syndrome. Chang Gung Med J. 2006;29:474–479
  34. Gruson KI, Ruchelsman DE, Zuckerman JD. Subacromial corticosteroid injections. J Shoulder Elbow Surg. 2008;17:118S–130S
  35. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;CD004016
  36. Patton WC, McCluskey GM. Biceps tendinitis and subluxation. Clin Sports Med. 2001;20:505–529
  37. Ford LT, DeBender J. Tendon rupture after local steroid injection. South Med J. 1979;72:827–830
  38. Bales CP, Placzek JD, Malone KJ, et al. Microvascular supply of the lateral epicondyle and common extensor origin. J Shoulder Elbow Surg. 2007;16:497–501
  39. Green S, Buchbinder R, Barnsley L, et al. Acupuncture for lateral elbow pain. Cochrane Database Syst Rev. 2002;CD003527
  40. Zeisig E, Ohberg L, Alfredson H. Sclerosing polidocanol injections in chronic painful tennis elbow-promising results in a pilot study. Knee Surg Sports Traumatol Arthrosc. 2006;14:1218–1224
  41. Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg. 2008;16:19–29
  42. Assendelft WJ, Hay EM, Adshead R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic overview. Br J Gen Pract. 1996;46:209–216
  43. Smidt N, Assendelft WJ, Van der Windt DA, et al. Corticosteroid injections for lateral epicondylitis: a systematic review. Pain. 2002;96:23–40
  44. Korthals-de Bos IB, Smidt N, van Tulder MW, et al. Cost effectiveness of interventions for lateral epicondylitis: results from a randomised controlled trial in primary care. Pharmacoeconomics. 2004;22:185–195
  45. Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2:1–8
  46. Ciccotti MG, Ramani MN. Medial epicondylitis. Tech Hand Up Extrem Surg. 2003;7:190–196
  47. Stahl S, Kaufman T. Ulnar nerve injury at the elbow after steroid injection for medial epicondylitis. J Hand Surg [Br]. 1997;22:69–70
  48. Wearing SC, Smeathers JE, Sullivan PM, et al. Plantar fasciitis: are pain and fascial thickness associated with arch shape and loading?. Phys Ther. 2007;87:1002–1008
  49. Karabay N, Toros T, Hurel C. Ultrasonographic evaluation in plantar fasciitis. J Foot Ankle Surg. 2007;46:442–446
  50. Wynne MM, Burns JM, Eland DC, et al. Effect of counterstrain on stretch reflexes, hoffmann reflexes, and clinical outcomes in subjects with plantar fasciitis. J Am Osteopath Assoc. 2006;106:547–556
  51. Donley BG, Moore T, Sferra J, et al. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int. 2007;28:20–23
  52. Younger A. Customized or prefabricated foot orthoses improved function only in the short term in patients with plantar fasciitis. J Bone Joint Surg Am. 2007;89:458
  53. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2006;7:64
  54. Gollwitzer H, Diehl P, von Korff A, et al. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg. 2007;46:348–357
  55. Pribut SM. Current approaches to the management of plantar heel pain syndrome, including the role of injectable corticosteroids. J Am Podiatr Med Assoc. 2007;97:68–74
  56. Kiter E, Celikbas E, Akkaya S, et al. Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial. J Am Podiatr Med Assoc. 2006;96:293–296
  57. Tsai WC, Hsu CC, Chen CP, et al. Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance. J Clin Ultrasound. 2006;34:12–16
  58. Yoon HS, Kim SE, Suh YR, et al. Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci. 2005;20:109–112
  59. DaCruz DJ, Geeson M, Allen MJ, Phair I. Achilles paratendonitis: an evaluation of steroid injection. Br J Sports Med. 1988;22:64–65
  60. Anderson BC, Manthey R, Brouns MC. Treatment of De Quervain's tenosynovitis with corticosteroids. A prospective study of the response to local injection. Arthritis Rheum. 1991;34:793–798
  61. Richie CA, Briner WW. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003;16:102–106
  62. Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31:265–268
  63. Zingas C, Failla JM, Van Holsbeeck M. Injection accuracy and clinical relief of de Quervain's tendinitis. J Hand Surg [Am]. 1998;23:89–96
  64. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Corticosteroid injections effective for trigger finger in adults in general practice: a double-blinded randomized placebo controlled trial. Ann Rheum Dis. 2008;67:1262–1266
  65. Fleisch SB, Spindler KP, Lee DH. Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review. J Am Acad Orthop Surg. 2007;15:166–171
  66. Nimigan AS, Ross DC, Gan BS. Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil. 2006;85:36–43
  67. Cebesoy O, Kose KC, Baltaci ET, Isik M. Percutaneous release of the trigger thumb: is it safe, cheap and effective?. Int Orthop. 2007;31:345–349
  68. Liu N, Canoso JJ. Dynamic injection of the digital flexor tendon sheaths. Ann Rheum Dis. 1990;49:327–328
  69. Weinstein PS, Canoso JJ, Wohlgethan JR. Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis. Ann Rheum Dis. 1984;43:44–46
  70. Smith DL, McAfee JH, Lucas LM, et al. Treatment of nonseptic olecranon bursitis. A controlled, blinded prospective trial. Arch Intern Med. 1989;149:2527–2530
  71. Canoso JJ. Aspiration and injection of joints and periarticular tissues. In:  Klippel JH,  Dieppe PA editor. Rheumatology. Philadelphia: Mosby; 2000;p. 2.12.1–2.12.12
  72. Lequesne M, Mathieu P, Vuillemin-Bodaghi V, et al. Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum. 2008;59:241–246
  73. Kong A, Van d V, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol. 2007;17:1772–1783
  74. Mandell BF. Avascular necrosis of the femoral head presenting as trochanteric bursitis. Ann Rheum Dis. 1990;49:730–732
  75. Sayegh F, Potoupnis M, Kapetanos G. Greater trochanter bursitis pain syndrome in females with chronic low back pain and sciatica. Acta Orthop Belg. 2004;70:423–428
  76. Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006;77:263–265
  77. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;CD001554
  78. Celiker R, Arslan S, Inanici F. Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome. Am J Phys Med Rehabil. 2002;81:182–186
  79. Agarwal V, Singh R, Sachdev A, et al. A prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rheumatology (Oxford). 2005;44:647–650
  80. Ayhan-Ardic FF, Erdem HR. Long-term clinical and electrophysiological results of local steroid injection in patients with carpal tunnel syndrome. Funct Neurol. 2000;15:157–165
  81. Dammers JW, Roos Y, Veering MM, Vermeulen M. Injection with methylprednisolone in patients with the carpal tunnel syndrome: a randomised double blind trial testing three different doses. J Neurol. 2006;253:574–577
  82. Hui AC, Wong S, Leung CH, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074–2078
  83. Ly-Pen D, Andreu JL, de Blas G, et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. 2005;52:612–619
  84. Graham RG, Hudson DA, Solomons M, Singer M. A prospective study to assess the outcome of steroid injections and wrist splinting for the treatment of carpal tunnel syndrome. Plast Reconstr Surg. 2004;113:550–556
  85. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77:6–17
  86. Pearce JM. Meralgia paraesthetica (Bernhardt-Roth syndrome). J Neurol Neurosurg Psychiatry. 2006;77:84
  87. Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9:336–344
  88. AStJ Dixon, Graber J. Local injection therapy in rheumatic diseases. Basel: Eular Publishers; 1981;
  89. de Ridder VA, de Lange S, Popta JV. Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma. 1999;13:207–211
  90. Hurdle MF, Weingarten TN, Crisostomo RA, et al. Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil. 2007;88:1362–1364
  91. Nagaoka M, Matsuzaki H. Ultrasonography in tarsal tunnel syndrome. J Ultrasound Med. 2005;24:1035–1040
  92. Hassouna H, Singh D. Morton's metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg. 2005;71:646–655
  93. Basadonna PT, Rucco V, Gasparini D, Onorato A. Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report. Am J Phys Med Rehabil. 1999;78:283–285
  94. Kasten SJ, Louis DS. Carpal tunnel syndrome: a case of median nerve injection injury and a safe and effective method for injecting the carpal tunnel. J Fam Pract. 1996;43:79–82
  95. Tavares SP, Giddins GE. Nerve injury following steroid injection for carpal tunnel syndrome. A report of two cases. J Hand Surg [Br]. 1996;21:208–209
  96. McConnell JR, Bush DC. Intraneural steroid injection as a complication in the management of carpal tunnel syndrome. A report of three cases. Clin Orthop Relat Res. 1990;181–184
  97. Wang AA, Hutchinson DT. The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients. J Hand Surg [Am]. 2006;31:979–981
  98. Baack BR, Brown RE. Atypical mycobacterium soft-tissue infection of the dorsal radial wrist: a possible complication of steroid injection for de Quervain's disease. Ann Plast Surg. 1991;27:73–76
  99. Fitzgerald BT, Hofmeister EP, Fan RA, Thompson MA. Delayed flexor digitorum superficialis and profundus ruptures in a trigger finger after a steroid injection: a case report. J Hand Surg [Am]. 2005;30:479–482
  100. Csizy M, Hintermann B. [Rupture of the Achilles tendon after local steroid injection. Case reports and consequences for treatment], Swiss Surg. 2001;7:184–189
  101. Clark SC, Jones MW, Choudhury RR, Smith E. Bilateral patellar tendon rupture secondary to repeated local steroid injections. J Accid Emerg Med. 1995;12:300–301
  102. Karpman RR, McComb JE, Volz RG. Tendon rupture following local steroid injection: report of four cases. Postgrad Med. 1980;68:169–174
  103. Jacobs MB. Local subcutaneous atrophy after corticosteroid injection. Postgrad Med. 1986;80:159–160
  104. Okere K, Jones MC. A case of skin hypopigmentation secondary to a corticosteroid injection. South Med J. 2006;99:1393–1394
  105. Gallardo MJ, Johnson DA. Cutaneous hypopigmentation following a posterior sub-tenon triamcinolone injection. Am J Ophthalmol. 2004;137:779–780

PII: S1521-6942(08)00131-9

doi: 10.1016/j.berh.2008.11.002

Best Practice & Research Clinical Rheumatology
Volume 23, Issue 2 , Pages 193-219 , April 2009

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