Which joint and soft tissue conditions may benefit from treatment with corticosteroid injection?

Updated: Mar 01, 2019
  • Author: Jess D Salinas, Jr, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Answer

Indications for injection therapy may include any of the following inflammatory conditions [7] :

A study by Rhon et al indicated that corticosteroid injections and physical therapy are equally effective in the treatment of shoulder impingement syndrome, although patients receiving corticosteroids may require more medical visits related to their condition. The study, a randomized, single-blind, comparative-effectiveness, parallel-group trial, involved 104 adult patients (aged 18-65 years) with unilateral shoulder impingement syndrome. One group of patients received a subacromial corticosteroid injection of 40 mg of triamcinolone acetonide, while a second group underwent six manual physical therapy sessions. Patient outcomes were evaluated using the Shoulder Pain and Disability Index, the Global Rating of Change, and the Numeric Rating Scale for pain and by assessing the extent of patient health-care use related to shoulder impingement syndrome over the course of a year. [14]

Results from both groups, which included an improvement of about 50% in the Shoulder Pain and Disability Index score, indicated that corticosteroid injections and physical therapy each were effective in shoulder impingement syndrome. The level of improvement, however, did not significantly differ between the two groups, although it was found that over a one-year period, the injection patients visited their primary care providers for reasons related to shoulder impingement syndrome more often than the physical therapy patients did (60% vs 37%, respectively). Moreover, 19% of the injection patients required physical therapy over this follow-up period. [14]

A prospective study by Althoff et al indicated that the pain and symptoms of active sacroiliitis can be sufficiently relieved for 6 months through computed tomography (CT) scan-guided corticosteroid injection of the sacroiliac joints. The study involved 29 patients with sacroiliitis who were injected with 40-60 mg of triamcinolone acetonide per joint, with substantially reduced inflammatory back pain reported after 3 and 6 months by 55% and 45% of the patients, respectively. [15]

A prospective study by Earp et al indicated that a single corticosteroid injection can alleviate the symptoms of de Quervain tendinopathy for at least a year. The single injection resulted in symptom resolution in 82% of patients at 6 weeks postinjection, with more than half of the patients maintaining their symptom-free status for at least 12 months. [16]

A study by Sarifakioglu et al indicated that both physical therapy and corticosteroid injections in the pes anserine area are effective treatments for patients with a combination of knee osteoarthritis and pes anserine tenindobursitis. Patients with these concurrent conditions who were treated with one therapy or the other showed, after 8 weeks, significant improvements in their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and three-meter timed up-and-go scores. No significant differences were found between improvements associated with either treatment. [17]

However, a randomized, placebo-controlled, double-blind study by McAlindon et al found that in patients with knee osteoarthritis, intra-articular corticosteroid injections (40 mg of triamcinolone acetonide, administered quarterly over 2 years) led to an increase in cartilage loss and was associated with less pain reduction than placebo injections. The study determined that the mean change in index compartment cartilage thickness in the corticosteroid patients was about twice that of the placebo subjects. (The investigators stated, though, that due to the timing of pain measurements, the study could have missed transient pain reductions in the corticosteroid group.) [18, 19]


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