corticosteroid injection
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Both the range of motion and load transfer of the sacroiliac (SI) joint improve considerably after lumbar spine surgery. When, following surgery, SI joint pain develops in spite of appropriate physical therapy, injection of an anaesthetic with added corticosteroid into the SI joint is a first choice treatment. The aim of this presentation is to provide information on our experience with this therapy. MATERIAL AND METHODS Thirty-four patients after lumbar spine fusion reported lumbalgia different form pain before surgery. In 14 (41 %) of them, pain in one of the SI joints was diagnosed as the cause. This group included 12 women and two men at an average age of 56 (range, 47 to 68) years. Ten patients underwent lumbosacral fixation and four had segmental ("floating") lumbar spine fusion. All patients experienced lumbalgia at more than 3 months following surgery, at 8 months on the average (range, 4 to 12 months). None of them had SI joint pain before surgery. The diagnosis was based on specific manoeuvres on physical examination of the joint. Each patient was given an injection of 20 mg (0.5 ml) Methylprednisolone (Depo-Medrol?, Pfizer, Puurs, Belgium) and 4.5 ml 1% Mesocain (Zentiva, Praha, CR).They were inquired as to pain relief 24 h later and then at 1, 3 and 6 months after injection. Subjective feelings were assessed by a visual analogue scale (VAS). The results were analysed using descriptive statistics. RESULTS All patients reported pain relief within 24 h of injection, but not its complete resolution. The average VAS score before and after the blockage of the SI joint was 9.1 points (8-10) and 4.8 points (2-7), respectively; this implies improvement by an average of 4.3 points (1-6), i.e., approximately by 47.3% (12.5-62.5). The duration of effects varied greatly from patient to patient. The average interval between injection and pain recurrence lasted for 5 weeks (1 -28). Most frequently, relief was experienced for 2 weeks, or for 6.8 weeks with the standard deviation included. DISCUSSION Sacroiliac joint dysfunction is a very frequent cause of lumbalgia, particularly after lumbar spine surgery. Physical therapy may not always be effective. SI joint arthrodesis is indicated only in rare cases. One of the few possibilities of pain relief involves intra-articular injection of an anaesthetic with corticosteroid for booster effect. The treatment of SI joint blockage after spinal fusion has recently been dealt with in three reports in the international literature; their conclusions are in accordance with the results of this study. CONCLUSIONS Lumbar spine stabilisation surgery may result in overloading the SI joints as the "adjacent segments". An intra-articular injection of anaesthetic can be considered a reliable method for ascertaining the SI joint as the source of a patient's problems. However, even with corticosteroid added, pain relief is not usually long-lasting.
- MeSH
- anestetika lokální aplikace a dávkování MeSH
- bederní obratle chirurgie MeSH
- fúze páteře MeSH
- injekce intraartikulární MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie terapie MeSH
- měření bolesti MeSH
- methylprednisolon analogy a deriváty aplikace a dávkování MeSH
- sakroiliakální kloub MeSH
- senioři MeSH
- trimekain aplikace a dávkování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
PURPOSE OF THE STUDY This study aimed to explore the effects of new therapeutic procedures in patients with shoulder impingement syndrome. The primary goal of the study was to confirm the hypothesis that the application of the platelet-rich plasma (PRP) in patients with shoulder impingement syndrome will have a positive effect on both the subjective and objective evaluation of their condition. The clinical condition before and after the treatment was evaluated. The secondary goal was to compare the effect achieved by a series of 3 PRP injections and that achieved by treating the impingement syndrome with a standard single depot corticosteroid injection. MATERIAL AND METHODS The randomized prospective blinded study carried out in the period 2013-2015 included 25 patients (Group I), to whom 3 PRP injections were applied in the subacromial (SA) space at a 1-week interval at the outpatient department. The control group of 25 patients (Group II) was treated by a standard single depot corticosteroid injection applied in the SA space. The subjective and objective conditions were evaluated immediately before the treatment, at 6 weeks, 3 months and 6 months after the administration of the injection. The evaluation comprised a physical examination, an evaluation using the Visual Analogue Scale (VAS), ASES (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form) and the Constant score. A part of the study was the statistical processing of the results. RESULTS Both the groups were comparable when assessing the mean age of patients as well as the share of both sexes in the groups; Group I with the mean age of 48.7 years (15 men and 10 women), Group II with the mean age of 50.1 years (16 men and 9 women), but also when assessing the baseline mean VAS score, Constant score and ASES score. In Group I, the baseline mean VAS score improved from 2.96 (range: 1-5; median: 3.0; SD: 0.77) to 2.0 (range: 1-3; median: 2.0; SD: 0.49) at 3 months after the administration and to the mean value of 1.16 (range: 0-2; median: 1.0; SO: 0.67) at 6 months after the last PRP injection. In Group II, the baseline mean VAS score improved from 3.12 (range: 2-5; median: 3.0; SD: 0.82) to the mean value of 2.16 (range: 1-4; median: 2.0; SD: 0.73) at 3 months after the administration of the depot corticosteroid injection and to 1.8 (range: 1-3; median: 2.0; SD: 0.57) at 6 months after the administration. In both the groups of patients, the p-value obtained by the Student s t-test was statistically significant (p < 0.05) when comparing the results of all the three scoring systems before the treatment and 6 months after the treatment. DISCUSSION Although the treatment of musculoskeletal disorders with the concentrate of a platelet-rich plasma (PRP) is a frequently used method, particularly in private medical practice, the scientific literature can offer just a very few studies studying in depth the use of this method of treatment in humane medicine. CONCLUSIONS Based on the results of our study, the hypothesis can be accepted that the concentrate of platelet-rich plasma administered through a series of 3 injections applied in the subacromial space in patients with shoulder impingement syndrome has positive effects on the daily activities of patients as well as on the objective evaluation via the selected scoring systems. Key words:platelet-rich plasma, shoulder impingement syndrome.
- MeSH
- antiflogistika aplikace a dávkování MeSH
- glukokortikoidy aplikace a dávkování MeSH
- injekce intraartikulární MeSH
- lidé středního věku MeSH
- lidé MeSH
- management bolesti metody MeSH
- měření bolesti metody MeSH
- plazma bohatá na destičky * MeSH
- syndrom zhmožděného ramene diagnóza patofyziologie terapie MeSH
- určení symptomu metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Corticosteroid injections are proven to be effective in the management of carpal tunnel syndrome (CTS); however, the optimal injection site still remains unclear. AIM: The aim of this study is to compare the efficacy of perineural vs. peritendinous target sites for corticosteroid injection in CTS. DESIGN: A randomized, single-blind, controlled trial. SETTING: Outpatients, tertiary care center. POPULATION: Forty-six patients were equally randomized into two intervention groups as group A (18 female and five male patients; mean age: 50.0±15.9 years; mean symptom duration: 5.9±3.3 months) and group B (19 female, four male patients; mean age: 54.3±15.0 years; mean symptom duration: 5.9±4.7 months). METHODS: Methylprednisolone acetate (40 mg) and 1 mL of 1% trimecaine hydrochloride was injected next to the median nerve (group A) or among flexor tendons away from the nerve (group B) under ultrasound (US) guidance. The visual analogue scale was used as the primary outcome measure, and the symptom severity scale and functional status scale of the Boston Carpal Tunnel Questionnaire were used as the secondary subjective outcome measures. Two-point discrimination, grip strength, cross-sectional area, and distal motor latency were assessed as objective outcome measures. The data were collected at baseline and at 2, 6 and 12 weeks after the injection. RESULTS: Both groups showed improvement in subjective and objective measures at 2 weeks following the injection - also maintained up to 12 weeks during the follow-up (P<0.05). However, no difference was observed between the two groups (P<0.05). No serious adverse effects were observed in either group. CONCLUSIONS: Both intervention techniques seem to be effective and safe in the conservative treatment of CTS. CLINICAL REHABILITATION IMPACT: Based on this study results, it might be noteworthy that physicians can opt for perineural or peritendinous injections without compromising the treatment efficacy and safety. Herewith, US guidance is, for sure, necessary for performing safe and accurate injections.
- MeSH
- dospělí MeSH
- hormony kůry nadledvin MeSH
- intervenční ultrasonografie MeSH
- jednoduchá slepá metoda MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervus medianus diagnostické zobrazování MeSH
- senioři MeSH
- syndrom karpálního tunelu * diagnostické zobrazování farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Glukokortikoidy hrají v terapii revmatických onemocnění velmi důležitou roli. Mnohdy je ale zapotřebí ke zvládnutí aktivity onemocnění poměrně vysokých dávek podávaných systémově, což s sebou přináší celou řadu závažných nežádoucích účinků. Aplikace glukokortikoidů intraartikulárně nebo periartikulárně pomáhá zvládnout bolestivé a zánětlivé stavy v krátkém čase za minimalizace těchto nežádoucích účinků. Práce přináší přehled dostupných intraartikulárních glukokortikoidů, porovnání jejich farmakokinetiky, farmakodynamiky, účinnosti a bezpečnosti u různých revmatických onemocnění a blíže seznámí s triamcinolonem hexacetonidem, syntetickým glukokortikoidem s výrazným protizánětlivým a depotním účinkem.
Glucocorticoids play a very important role in the treatment of rheumatic diseases. In order to control the disease activity it is sometimes necessary to use relatively high doses of systemically administered glucocorticoids, which are associated with a number of serious side effects. Intra-articular or peri-articular steroid injections help manage pain and inflammatory conditions in a short time, minimizing these side effects. This work provides a summary of available intra-articular glucocorticoids and the comparison of their pharmacokinetics, pharmacodynamics, efficacy and safety in various rheumatic diseases and introduces triamcinolone hexacetonide, a synthetic glucocorticoid with a prominent anti-inflammatory and depot effect.
- MeSH
- dnavá artritida farmakoterapie MeSH
- glukokortikoidy aplikace a dávkování farmakokinetika škodlivé účinky terapeutické užití MeSH
- injekce intraartikulární využití MeSH
- juvenilní artritida farmakoterapie MeSH
- lidé MeSH
- osteoartróza farmakoterapie MeSH
- revmatoidní artritida farmakoterapie MeSH
- triamcinolonacetonid * analogy a deriváty aplikace a dávkování farmakokinetika škodlivé účinky terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- hormony kůry nadledvin MeSH
- lidé MeSH
- loket * MeSH
- loketní kloub MeSH
- neuropatie nervus ulnaris MeSH
- syndrom karpálního tunelu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- komentáře MeSH
Background: Oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics and intra-articular corticosteroid injections are the recommended first line of treatment for knee osteoarthritis (OA); however, they have serious side effects. Platelet-rich plasma (PRP) has been posited as an effective and safer alternative treatment for knee OA. Hitherto, there is only one study comparing the effectiveness of PRP against an NSAID. Aim of the study: The aim of this study was to determine the effectiveness of PRP against celecoxib in the treatment of early knee OA. Methods: 60 patients with knee OA grade II and III were randomly alocated in two groups. Group 1 received one injection of autologous PRP in each affected knee, with a reinjection after 15 days; Group 2 received 200 mg of oral celecoxib each 24 h for a year. Visual Analogue Scale (VAS), total Western Ontario and McMaster Universities Arthritis Index (WOMAC) and WOMAC subscales for pain, stiffness and function were measured at baseline and at 1, 3, 6 and 12 months after the start of the treatment. Results: At the end of the study PRP was significantly better than celecoxib (p < 0.05) in improving VAS (40.40%), total WOMAC (58.95%) and WOMAC subscales of pain (50.60%), stiffness (34.13%) and function (51.90%). Significant differences remained after adjusting for age, sex or knee OA grade II or III. Conclusions: Intra-articular PRP is significantly better than celecoxib in improving pain, function and stiffness in early knee OA. This significant difference is independent of age, sex or knee OA grade II or III.
This report aimed to present a case of wrist-tendon rupture and to discuss a rare complication after corticosteroid injection. A 67-year-old woman had difficulty extending her left-thumb interphalangeal joint several weeks after a palpation-guided local corticosteroid injection. Passive motions remained intact without sensory abnormalities. Ultrasound examination showed hyperechoic tissues at the site of the extensor pollicis longus (EPL) tendon at the wrist level and an atrophic EPL muscle stump at the forearm level. Dynamic imaging demonstrated no motion in the EPL muscle during passive thumb flexion/extension. The diagnosis of complete EPL rupture, possibly due to inadvertent intratendinous corticosteroid injection, was therefore confirmed.
- Publikační typ
- časopisecké články MeSH
Purpose: functioal and anatomical results afer combinationof intravitreal dexamethasone implant with anti-VGF bevacizumab in macular edema secondary to retinal ein occlusion. Methods: Retrospectie analysis of 50 patints, average age 72 years, 15 men and 35 women. Inclusion criteria for treatment were retinalvein occlusion, best corrected visual acuity (BCVA) more than 20/200 and macular edema more than 250 μm. Algorithm of treatment was dexamethason, anti-VGF (bevacizumab), dexamethason. Applicationof anti-VGF bevacizumab was in interval between two applicationsof dexamethasone, for the fist timein every patiet. If there were nonperfusion areas on fluoesceine angiography (FA), or ischemia on slit lamp, repeatedly. Patiets observed for 12 months at least. This cohort included patiets with branch retinalvein occlusion together with central retinalvein oc-clusion. This is an evaluationof nonperfusion areas based on FA, BCVA, macular edema on optial coherence tomography (OCT) and number of reapplicationof anti-VGF bevacizumab. Observed adverse efects are elevationof intraocular pressure and number of patiets who underwent cataract surgery. Results: The gain of 8 letters in 1st month after 1st application of dexamethasone, central retinal thickness (CRT) reduced from 512 μm to 318 μm in average. 33 patients get 1, 3 patients get 2 and 14 patients 3 injections of bevacizumab. On the day of 2nd application of dexamethasone, in 7th month in average, the CRT increased on 465 μm, and 1th month after, the gain from the baseline was 10 letters and CRT reduced on 380 μm. All the pa-tients were phackic at the baseline, 18 (36 %) patients underwent cataract surgery with intraocular lens implantation. Transient elevation of intraocular pressure in 15 (30 %) eyes, treated by local therapy. Conclusion: Combination of intravitreal dexamethasone implant with anti-VEGF bevaci-zumab is functionally and anatomically effective.
- MeSH
- bevacizumab terapeutické užití MeSH
- dexamethason aplikace a dávkování MeSH
- hormony kůry nadledvin aplikace a dávkování MeSH
- injekce intravitreální MeSH
- kombinovaná farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- makulární edém * farmakoterapie MeSH
- okluze retinální žíly * farmakoterapie komplikace patofyziologie MeSH
- retina patologie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statistika jako téma MeSH
- výsledek terapie MeSH
- zraková ostrost účinky léků MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
