Extra-Articular Steroid Injection: Early Patient Response and the Incidence of Flare Reaction

Blocking the Greater Occipital Nerve: Utility in Headache Management

“…The use of local steroids, particularly triamcinolone, has been associated with alopecia and hypopigmentation [32•, 33-35]. Up to one-third of patients may get a steroid flare with worsening pain for up to 1 week [36]. Some patients experience a few minutes of dizziness and lightheadedness after the local anesthetic injection, and some report local tenderness, sometimes for as long as a few days.…”

An iatrogenic septic tenosynovitis of the digital flexor tendon sheath after diagnostic anaesthesia in a horse

“…Acute cellulitis after extrasynovial injection (Goldfarb et al 2007) or acute synovitis after intrasynovial injection (most commonly intra-articular), a so-called flare, are rare complications in a lameness examination (Kuemmerle et al 2006, Smith 2010. A flare may occur following injection of many substances, including local anaesthetics, HA, corticosteroids or PSGAGs (Cole et al 2005, Kuemmerle et al 2006, Smith 2010.…”

Adverse events from diagnostic and therapeutic joint injections: a literature review

“…The most frequent mild reaction is local pain. Other minor reactions include pressure in the joint, slight swelling, local tissue atrophy, urticaria, rash, facial or general flushing, hypopigmentation (which usually normalizes over a period of 12 months), reactivation of herpes zoster, flare reactions (explained in a later section), and mild cellulitis [12,35,36,39,54,60,61,63,64,68,69,74,75]. Some of these moderate, severe, and life-threatening reactions deserve more attention and will be briefly discussed in categories.…”

“…However, the descriptions of flare reactions and pseudosepsis in the literature are inconsistent and overlapping. Some authors describe the flare reaction as simply a delayed postinjection transient increase in pain of at least 2 points on a 0-10 visual analogue scale [39], while others use the terms flare reaction and pseudosepsis interchangeably, describing the symptoms as severe pain, warmth, joint swelling, and effusion [37], symptoms that most definitely mimic true septic arthritis. Flare reactions or pseudosepsis are most appropriately categorized as a moderate adverse event and are self limiting in most cases.…”