Musculoskeletal 6

What are the risks and benefits of steroid injection for lateral epicondylitis?
• Only minor complications reported: 10% postinjection pain, 2% skin atrophy, skin depigmentation, localized erythema, facial flushing
• Post-injection exacerbation lasts < 4 days
• Multiple injections may be a risk for tendon rupture
• Lit review concluded that injections associated with improved pain and grip strength in short term (<6 weeks)
• Botox has shown mixed results

What are the risks and benefits of steroid injection for de Quervain’s tenosynovitis?
• Pooled analysis recently showed symptomatic cure was established in 83% of wrists that received injection alone with low risk of complications
• Side effects: skin color changes, SQ fat atrophy, flare, nontender nodules, and superficial thrombophlebitis

What are the risks and benefits of steroid injection for carpal tunnel syndrome?
• Inject just ulnar to Palmaris longus tendon at wrist into ulnar bursa
• Meta-analysis showed steroid injection had benefit over placebo or oral steroids at 1 month
• RCT showed local steroids better than surgical decompression at 3 months and equal at 1 year
• Median nerve latencies may improve with injection, even at 12 months
• Intracarpal insulin injections may be effective in patients with NIDDM

What are the risks and benefits of steroid injection for Achilles tendonitis?
• No definitive consensus regarding benefits and risks
• 1% incidence of side effects
• No rigorous studies evaluating risk of Achilles rupture
• Weak benefit from NSAIDs
• Studies have shown no real benefit of injection

What are the risks and benefits of steroid injection for persistent plantar fasciitis?
• 80-90% of patients respond to nonsurgical treatment of plantar fasciitis
• Injections found to be more effective than extracorporeal shockwave therapy
• Posterior tibial nerve block may prevent injection pain
• Risk of rupture difficult to determine --> one study showed correlation
• Plantar fat pad necrosis may be another complication of injection