The Efficacy of Intra-Articular Versus Extra-Articular Corticosteroid Injections in the Thumb Carpometacarpal Joint

Katt, Brian M.; Tawfik, Amr; Aryee, Jomar; Aita, Daren; Beredjiklian, Pedro K.; Fletcher, Daniel J.

doi:10.1016/j.jhsg.2022.01.002

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…35 Another study showed inadvertent extra-articular corticosteroid (triamcinolone) when treating thumb CMC arthritis occurred in up to 20% of cases. 36 However, the patients also reported improvements in pain and function relative to baseline for up to 3 months (compared with 6 months with CMC joint intra-articular corticosteroid), possibly due to GC anti-inflammatory effects on the joint capsule and peri-joint tissues. 36 The literature indicated that surgeons should be cautious in giving injections to patients with diabetes due to some inaccuracy in joint deposition with potential delivery of the corticosteroid to peripheral tissues and hepatocytes.…”

Section: Discussionmentioning

confidence: 90%

Hand and Upper Extremity Surgical Site Infection Rates Associated With Perioperative Corticosteroid Injection: A Review of the Literature

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Pavlesen

Ablove

2023

Hand (New York, N,Y.)

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Background: Corticosteroid injection (CSI) has a relatively high benefit-to-risk ratio and is commonly administered to treat musculoskeletal conditions. However, perioperative CSI has been associated with an increased risk of postoperative infection. The literature suggests delaying surgery after CSI to minimize the risk of postoperative infection. We review the literature to summarize the most current knowledge on the association between perioperative CSI and infection rates for different hand and upper extremity procedures. Methods: Two independent reviewers conducted a literature search using PubMed and Web of Science databases (through October 1, 2022). The database searches used were (((injection) AND (infection)) AND (risk)) AND ((hand) OR (wrist) OR (elbow) OR (shoulder)). English-language articles were screened for infection rates associated with CSI given temporally around upper extremity surgery, focusing between 6 months preoperatively and 1 month postoperatively. Results: Nineteen articles including database queries and retrospective case-control or cohort studies were used after screening 465 articles. Most infection rates were increased in hand, wrist, elbow, and shoulder surgery between 3 months preoperatively and 1 month postoperatively. Intraoperative injection during elbow arthroscopy demonstrated increased infection rate relative to other upper extremity surgeries. Conclusions: Corticosteroid injection increased the risk of infection temporally around upper extremity surgeries; however, CSI provides benefits. The consensus regarding CSI timeline perioperatively has yet to be determined. The evidence supports an increased benefit-to-risk ratio when giving corticosteroids greater than 3 months preoperatively and greater than 1 month postoperatively for most upper extremity procedures, with relative contraindications within 1 month of upper extremity surgery.

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Section: Discussionmentioning

confidence: 90%

Hand and Upper Extremity Surgical Site Infection Rates Associated With Perioperative Corticosteroid Injection: A Review of the Literature

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Pavlesen

Ablove

2023

Hand (New York, N,Y.)

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“…However, research on the cost-effectiveness and current utilization of image-guided IAIs is limited and inconclusive [ 74 ]. The short- and long-term clinical benefits of image-guided vs blind IAIs need to be studied further [ 8 ], although there are some data reporting improved outcomes in terms of pain, function, and mobility when image guidance is used, potentially secondary due to increased accuracy [ 23 , 37 , 75 ]. Regardless, given the improved accuracy rates, image-guided IAIs should have a continually increasing role in the diagnostic and therapeutic management of peripheral joint pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, this study showed that the accuracy was lower in smaller joints of the hand [ 36 ]. More recently, Katt et al evaluated 82 patients with thumb CMC joint arthritis and found the accuracy of blind IAIs to be 80% [ 37 ].…”

Section: Upper Extremitymentioning

confidence: 99%

Accuracy of Intraarticular Injections: Blind vs. Image Guided Techniques—A Review of Literature

Saha

Smith

Hasan

2023

JFMK

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Intra-articular injections are widely used for diagnostic and therapeutic purposes of joint pathologies throughout the body. These injections can be performed blind by utilizing anatomical landmarks or with the use of imaging modalities to directly visualize the joint space during injections. This review of the literature aims to comprehensively identify differences in the accuracy of intra-articular injections via palpation vs. image guidance in the most commonly injected joints in the upper and lower extremities. To our knowledge, there are no such comprehensive reviews available. A narrative literature review was performed using PubMed and Google Scholar databases to identify studies focusing on the accuracy of blind or image-guided intra-articular injections for each joint. A total of 75 articles was included in this review, with blind and image-guided strategies being discussed for the most commonly injected joints of the upper and lower extremities. Varying ranges of accuracy with blind and image-guided modalities were found throughout the literature, though an improvement in accuracy was seen in nearly all joints when using image guidance. Differences are pronounced, particularly in deep joints such as the hip or in the small joints such as those in the hand or foot. Image guidance is a useful adjunct for most intra-articular injections, if available. Though there is an increase in accuracy in nearly all joints, minor differences in accuracy seen in large, easily accessed joints, such as the knee, may not warrant image guidance.

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“…A meta-analysis about wrist joints has suggested that the variability in clinical outcomes after steroid injections might be due to inclusion of cases where the steroid was unintentionally injected in extra-articular space [ 14 ]. Katt et al [ 15 ] reported that intra-articular injections into the carpometacarpal joint guided by fluoroscopy demonstrated superior pain reduction and functional improvement compared to extra-articular injections.…”

mentioning

confidence: 99%

Isolated acromioclavicular osteoarthritis and steroid injection

2023

Clin Shoulder Elb

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The Efficacy of Intra-Articular Versus Extra-Articular Corticosteroid Injections in the Thumb Carpometacarpal Joint

Cited by 7 publications

References 24 publications

Hand and Upper Extremity Surgical Site Infection Rates Associated With Perioperative Corticosteroid Injection: A Review of the Literature

Hand and Upper Extremity Surgical Site Infection Rates Associated With Perioperative Corticosteroid Injection: A Review of the Literature

Accuracy of Intraarticular Injections: Blind vs. Image Guided Techniques—A Review of Literature

Isolated acromioclavicular osteoarthritis and steroid injection

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