Injectable Corticosteroids: Take Precautions and Use Caution

Abstract

Corticosteroids are routinely injected into soft tissues, tendon sheaths, bursae, and joints. These anti-inflammatory agents have different potency and solubility, and solubility is inversely correlated with the duration of action. Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects. The use of intra-articular corticosteroid injections in the treatment of inflammatory arthritis and osteoarthritis is well established. Evidence also supports the use of injectable corticosteroids in the treatment of inflammatory tenosynovitis and bursitis associated with rheumatic diseases, trigger finger and de Quervain disease, and carpal tunnel syndrome. The role of corticosteroid injections in the management of rotator cuff disease remains unclear. Strong scientific evidence indicates that corticosteroid injections for lateral epicondylosis worsen the long-term outcomes of patients. This review article discusses the considerations related to the use of corticosteroid injections in the management of nonspinal musculoskeletal conditions.

Intra-Articular Injection of Hydrolyzed Collagen to Treat Symptoms of Knee Osteoarthritis. A Functional In Vitro Investigation and a Pilot Retrospective Clinical Study

“…Treatment of symptomatic knee OA may involve oral or topical administration of non-steroidal anti-inflammatory drugs (NSAIDs) or intra-articular injection of corticosteroids. Topical application of NSAIDs calls for multiple daily application to show effectiveness, while oral NSAIDs administration and intra-articular corticosteroid injection have a short-term effect and exhibit several side-effects [7,8,9]. This has led to investigations using non-pharmacological interventions alternatively to or in combination with pharmacological treatments [2,10], including manual and physical therapies [11] and viscosupplementation [12,13].…”

Effect of Intra-articular Ketorolac Versus Corticosteroid Injection for Knee Osteoarthritis: A Retrospective Comparative Study

“…The safety of intra-articular corticosteroid injections is still controversal. 8 Side effects associated with intra-articular corticosteroid injections do exist. Other known complications include an increased incidence of joint infections, skin atrophy, and tendinopathy.…”

Local Anesthetics and Steroids: Contraindications and Complications - Clinical Update

“…dexamethasone and betamethasone) are freely soluble in water and preparations are clear (non-particulate). Non-esters are taken by cells rapidly and have a faster onset of activity but shorter duration of action when compared with esters ( 27 ).…”

“…These complications could be minimized by injection with caution from an experienced practitioner. Soft tissue injections may cause skin depigmentation, fat necrosis, as well as, cutaneous atrophy which may be effectively treated by local infiltration of normal saline ( 27 ).…”