Periarticular calcifications in association with intra-articular corticosteroid injections.

Mk, Dalinka; Stewart, Victoria; Bomalaski, John S.; Halpern, M; Kricun, Morrie E.

doi:10.1148/radiology.153.3.6494459

Cited by 39 publications

(10 citation statements)

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“…Further, reports based on aspiration of periarticular calcifications resulting from IAS have suggested that the periarticular calcifications associated with steroid injections are hydroxyapatite crystals resulting from tissue necrosis from steroid leakage into soft tissue, and it has been hypothesized that these crystals themselves can induce a localized inflammatory arthritis 21 . In addition, an animal model of TMJ growth and repair indicated that experimentally induced mandibular shift may stimulate new bone formation within the contralateral condyle as a mechanism of repair 22 .…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification of the Temporomandibular Joint in Juvenile Idiopathic Arthritis

Ringold¹,

Thapa²,

Shaw³

et al. 2011

J Rheumatol

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Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification of the Temporomandibular Joint in Juvenile Idiopathic Arthritis

Ringold¹,

Thapa²,

Shaw³

et al. 2011

J Rheumatol

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“…Periarticular calcification is known to be associated with the use of triamcinolone hexacetonide and prednisone. [17][18][19] We are aware of only two studies which have explored the rate of success in injection of the ankle. Lopes et al 14 in a recent clinical study in patients with rheumatoid arthritis showed that 77% of injections were intra-articular in 54 ankles, although it was unclear which technique had been used.…”

Section: Discussionmentioning

confidence: 99%

Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle?

Heidari

Pichler²,

Grechenig³

et al. 2010

The Journal of Bone and Joint Surgery. British volume

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Injection or aspiration of the ankle may be performed through either an anteromedial or an anterolateral approach for diagnostic or therapeutic reasons. We evaluated the success of an intra-articular puncture in relation to its site in 76 ankles from 38 cadavers. Two orthopaedic surgical trainees each injected methylene blue dye into 18 of 38 ankles through an anterolateral approach and into 20 of 38 through an anteromedial. An arthrotomy was then performed to confirm the placement of the dye within the joint. Of the anteromedial injections 31 of 40 (77.5%, 95% confidence interval (CI) 64.6 to 90.4) were successful as were 31 of 36 (86.1%, 95% CI 74.8 to 97.4) anterolateral injections. In total 62 of 76 (81.6%, 95% CI 72.9 to 90.3) of the injections were intra-articular with a trend towards greater accuracy with the anterolateral approach, but this difference was not statistically significant (p = 0.25). In the case of trainee A, 16 of 20 anteromedial injections and 14 of 18 anterolateral punctures were intra-articular. Trainee B made successful intra-articular punctures in 15 of 20 anteromedial and 17 of 18 anterolateral approaches. There was no significant difference between them (p = 0.5 and p = 0.16 for the anteromedial and anterolateral approaches, respectively). These results were similar to those of other reported studies. Unintended peri-articular injection can cause complications and an unsuccessful aspiration can delay diagnosis. Placement of the needle may be aided by the use of ultrasonographic scanning or fluoroscopy which may be required in certain instances.

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“…Gerster and Fallet 15 described four cases of peri-articular calcification related to injection of corticosteroid into the small joints of the hands, and such changes are known to be caused by triamcinolone hexacetonide and by prednisone in particular. 4,16,17 Several studies in vivo and in animal experiments have described the effects of local corticosteroid injection on tendons such as tendon rupture and reduced strength of bony attachment of ligaments. 5,6,18,19 Diagnostic injections of acromioclavicular joints are carried out frequently and an unintended periarticular injection, giving no benefit, may possibly lead to a misinterpretation of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Serious complications following unintentional periarticular injection of corticosteroid are well documented as far as major joints and those of the fingers are concerned. [4][5][6] However, only a few reports exist regarding the frequency of unintentional peri-articular injections in acromioclavicular joint. 7,8 The objectives of this study were to estimate the overall frequency of peri-articular injections using a cadaver model, to investigate the degree to which experience contributes to successful injection of the joint and to compare the results using an image intensifier.…”

mentioning

confidence: 99%

Intra-articular injection of the acromioclavicular joint

Pichler

Weinberg

Grechenig

et al. 2009

The Journal of Bone and Joint Surgery. British volume

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Intra-articular punctures and injections are performed routinely on patients with injuries to and chronic diseases of joints, to release an effusion or haemarthrosis, or to inject drugs. The purpose of this study was to investigate the accuracy of placement of the needle during this procedure.A total of 76 cadaver acromioclavicular joints were injected with a solution containing methyl blue and subsequently dissected to distinguish intra-from peri-articular injection. In order to assess the importance of experience in achieving accurate placement, half of the injections were performed by an inexperienced resident and half by a skilled specialist. The specialist injected a further 20 cadaver acromioclavicular joints with the aid of an image intensifier. The overall frequency of peri-articular injection was much higher than expected at 43% (33 of 76) overall, with 42% (16 of 38) by the specialist and 45% (17 of 38) by the resident. The specialist entered the joint in all 20 cases when using the image intensifier.Correct positioning of the needle in the joint should be facilitated by fluoroscopy, thereby guaranteeing an intra-articular injection.Intra-articular aspirations and injections are performed routinely on patients with acute injuries and chronic conditions of their joints to aspirate an effusion or haemarthrosis, or to inject drugs. Corticosteroids, hyaluronic acid, local anaesthetics and miscellaneous agents are frequently injected into joints to alleviate pain caused by acute injuries or chronic diseases.1-3 Serious complications following unintentional periarticular injection of corticosteroid are well documented as far as major joints and those of the fingers are concerned.4-6 However, only a few reports exist regarding the frequency of unintentional peri-articular injections in acromioclavicular joint. 7,8 The objectives of this study were to estimate the overall frequency of peri-articular injections using a cadaver model, to investigate the degree to which experience contributes to successful injection of the joint and to compare the results using an image intensifier. Materials and MethodsThere were 76 acromioclavicular joints (38 left, 38 right) from 38 cadaver specimens (20 male, 18 female) with a mean age of 74.8 years (59 to 98) at the time of death. The cadavers were preserved using the method of Thiel. 9 In the image-guided control study the specialist injected 20 acromioclavicular joints (ten left, ten right) in a further ten cadaver specimens. This special embalming technique, which was developed over a period of 30 years, preserves the original colour, consistency and degree of transparency of the tissue, with a full range of passive movement of the joints.9 Joints with advanced arthritis, evidence of trauma or other pathological changes detected by radiography were excluded from the study. An inexperienced resident (SG) in his first year of training and a skilled specialist surgeon (WG) with 15 years of experience were chosen to perform the injections. Each punctured a total of 38 joints,...

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Periarticular calcifications in association with intra-articular corticosteroid injections.

Cited by 39 publications

References 0 publications

Heterotopic Ossification of the Temporomandibular Joint in Juvenile Idiopathic Arthritis

Heterotopic Ossification of the Temporomandibular Joint in Juvenile Idiopathic Arthritis

Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle?

Intra-articular injection of the acromioclavicular joint

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