Glucocorticoid injection therapy

2018 ◽  
pp. 689-706
Author(s):  
Gavin Clunie ◽  
Nick Wilkinson ◽  
Elena Nikiphorou ◽  
Deepak R. Jadon
Keyword(s):  
Tennis Elbow ◽  
Pain Syndrome ◽  
Tendon Sheath ◽  
Injection Therapy ◽  
Line Drawings ◽  
Injection Techniques ◽  
Greater Trochanter Pain Syndrome ◽  
Tunnel Syndrome ◽  
Tendon Insertion ◽  
Specific Disorders

The Oxford Handbook of Rheumatology, 4th edition, includes a chapter on glucocorticoid (‘steroid’) injection therapy. Soft tissue, tendon sheath, tendon insertion (enthesis), and joint injections are commonly carried out by rheumatologists in outpatient clinics. The chapter outlines the principles of injection techniques referring to the utility of both image-guided and non-imaging-guided injection procedures and cross-refers to line drawings of joint and tendons elsewhere in the book. The chapter focuses also on the use of injections in the context of managing specific disorders such as tennis elbow, plantar fasciitis, carpal tunnel syndrome, and greater trochanter pain syndrome, thus placing injection therapy in the context of alternatively available therapies.

scholarly journals Identifying and Evaluating Vocation-Related Neuro-Musculoskeletal Deficiencies in Professional Musicians: A Review

2021 ◽  
Vol 11 (5) ◽  
pp. 2035
Author(s):  
Joseph Mizrahi
Keyword(s):  
Myofascial Pain ◽  
Tennis Elbow ◽  
Traumatic Injury ◽  
Lateral Epicondylitis ◽  
Upper Extremities ◽  
Upper Body ◽  
Professional Musicians ◽  
Shoulder Muscles ◽  
Repetitive Movements ◽  
Tunnel Syndrome

A combination of factors exposes musicians to neuro-musculoskeletal disorders, which lead to pain and damage. These involve overuse due to long playing hours, containing repetitive movements under stressful conditions, usually performed in an unnatural posture. Although the evoked disorders are usually non-traumatic, they may often lead to prolonged or even permanent damage. For instance, in upper string players, these include bursitis and tendinopathies of the shoulder muscles, tendonitis of the rotator cuff, injury at the tendon sheaths, medial or lateral epicondylitis (also known as tennis elbow), myofascial pain, and wrist tendonitis (also known as carpal tunnel syndrome, or De Quervein’s syndrome). In cases of intensive performance, a traumatic injury may result, requiring drastic means of intervention such as surgery. It should be pointed out that the upper body and upper extremities are the most commonly affected sites of playing musicians. This review provides a description of the playing-related motor disorders in performing musicians, and of the methodologies used to identify and evaluate these disorders, particularly for violinists and other upper string players.

Ultrasound evaluation of greater trochanter pain syndrome in patients with spondyloarthritis: Are there any specific features?

2014 ◽  
Vol 34 (7) ◽  
pp. 947-952 ◽  
Author(s):  
Julio Ramírez ◽  
Isaac Pomés ◽  
Beatriz Sobrino-Guijarro ◽  
Jaume Pomés ◽  
Raimón Sanmartí ◽  
...  
Keyword(s):  
Pain Syndrome ◽  
Greater Trochanter ◽  
Ultrasound Evaluation ◽  
Greater Trochanter Pain Syndrome

Interventional pain management techniques for chronic pain

2013 ◽  
pp. 474-485
Author(s):  
Navil F. Sethna ◽  
Pradeep Dinakar ◽  
Karen R. Boretsky
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Case Series ◽  
Pain Syndrome ◽  
Treatment Modalities ◽  
Neuraxial Blockade ◽  
Paediatric Case ◽  
Injection Techniques ◽  
Interventional Pain Management ◽  
Management Techniques

As part of multidisciplinary management of paediatric chronic pain, interventional pain management techniques can play an important role when pain is unrelieved by conventional treatment modalities. Many procedures and indications are extrapolated from adult studies, and evidence for long-term efficacy in paediatric populations is limited. Interventions range from injection techniques with local anaesthetic and/or corticosteroids to neuraxial blockade with implanted catheters. Paediatric case series have reported benefit in selected patients with complex regional pain syndrome and cancer-related pain.

Pathology of the Flexor Tendon Sheath in the Spontaneous Carpal Tunnel Syndrome

1987 ◽  
Vol 12 (2) ◽  
pp. 229-232
Author(s):  
N. C. NEAL ◽  
J. McMANNERS ◽  
G. A. STIRLING
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Vascular Lesions ◽  
Foreign Body Giant Cell ◽  
Pathological Changes ◽  
Histological Features ◽  
Flexor Tendon Sheath ◽  
Tunnel Syndrome

The histological features of the flexor tendon sheath in the spontaneous carpal tunnel syndrome were studied. The main differences between our findings and previous studies were twofold. Firstly a striking absence of inflammation in our material and secondly the diversity of the pathological changes encountered — alterations in the connective tissue especially the collagen; proliferation with thickening of the tissues of the tendon sheath; fibrosis; amyloid deposition; oedema; vascular lesions including thickening of vessels walls, intimal hyperplasia, and thrombosis; and a foreign body giant cell reaction. Although the lesions described here may not be significant in every case in which they are encountered, they do appear to support the view that pressure in the carpal tunnel and ischaemia are the important factors in a majority of cases of the spontaneous carpal tunnel syndrome.

scholarly journals Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study

2016 ◽  
Vol 134 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Eduardo Jun Sadatsune ◽  
Plínio da Cunha Leal ◽  
Rachel Jorge Dino Cossetti ◽  
Rioko Kimiko Sakata
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Surgical Treatment ◽  
Postoperative Pain ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Postoperative Analgesia ◽  
Pain Syndrome ◽  
Double Blind ◽  
Tunnel Syndrome

ABSTRACT CONTEXT AND OBJECTIVES: Effective postoperative analgesia is important for reducing the incidence of chronic pain. This study evaluated the effect of preoperative gabapentin on postoperative analgesia and the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgical treatment. DESIGN AND SETTINGS: Randomized, double-blind controlled trial, Federal University of São Paulo Pain Clinic. METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period), incidence of postoperative neuropathic pain (over a six-month period), need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4) questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome) were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg) did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery.

Risk factors in lateral epicondylitis (tennis elbow): a case-control study

2012 ◽  
Vol 38 (2) ◽  
pp. 159-164 ◽  
Author(s):  
A. G. Titchener ◽  
A. Fakis ◽  
A. A. Tambe ◽  
C. Smith ◽  
R. B. Hubbard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Case Control ◽  
Smoking History ◽  
Health Improvement ◽  
Tunnel Syndrome ◽  
Associated Risk Factors ◽  
Control Study

Lateral epicondylitis is a common condition, but relatively little is known about its aetiology and associated risk factors. We have undertaken a large case-control study using The Health Improvement Network database to assess and quantify the relative contributions of some constitutional and environmental risk factors for lateral epicondylitis in the community. Our dataset included 4998 patients with lateral epicondylitis who were individually matched with a single control by age, sex, and general practice. The median age at diagnosis was 49 (interquartile range 42–56) years . Multivariate analysis showed that the risk factors associated with lateral epicondylitis were rotator cuff pathology (OR 4.95), De Quervain’s disease (OR 2.48), carpal tunnel syndrome (OR 1.50), oral corticosteroid therapy (OR 1.68), and previous smoking history (OR 1.20). Diabetes mellitus, current smoking, trigger finger, rheumatoid arthritis, alcohol intake, and obesity were not found to be associated with lateral epicondylitis.

Radial Tunnel Syndrome

1995 ◽  
Vol 20 (4) ◽  
pp. 454-459 ◽  
Author(s):  
T. LAWRENCE ◽  
P. MOBBS ◽  
Y. FORTEMS ◽  
J. K. STANLEY
Keyword(s):  
Radial Nerve ◽  
Tennis Elbow ◽  
Free Edge ◽  
Wrist Pain ◽  
Duration Of Symptoms ◽  
Supinator Muscle ◽  
Prolonged Duration ◽  
Tunnel Syndrome ◽  
Manual Tasks ◽  
Radial Tunnel Syndrome

Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery.

Acute and Nonacute Complications Associated with Interscalene Block and Shoulder Surgery

2001 ◽  
Vol 95 (4) ◽  
pp. 875-880 ◽  
Author(s):  
Alain Borgeat ◽  
Georgios Ekatodramis ◽  
Fabian Kalberer ◽  
Cedric Benz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Complex Regional Pain Syndrome ◽  
Carpal Tunnel ◽  
Brachial Plexus Block ◽  
Pain Syndrome ◽  
Muscular Weakness ◽  
Interscalene Brachial Plexus Block ◽  
Tunnel Syndrome ◽  
Sulcus Ulnaris ◽  
Plexus Block

Background The incidence, etiology, and evolution of complications after interscalene brachial plexus block (ISB) are not well-known. The authors prospectively monitored 521 patients for complications during the first 9 months after ISB. Methods A total of 521 adults scheduled for elective shoulder surgery performed with an ISB were included in this prospective study. The ISB procedure was standardized for all patients Acute complications were recorded. Patients were observed daily (for 10 days) for paresthesias, dysesthesias, pain not related to surgery, and muscular weakness and were evaluated at 1, 3, 6, and 9 months after surgery. Persistence of paresthesias dysesthesias, pain not related to surgery, or muscular weakness was investigated at 1 or 3 months by means of electroneuromyography. Final evaluation was performed at 9 months. Results A total of 520 patients completed the study; one was excluded after surgical axillary nerve damage. Two hundred thirty-four patients had an interscalene catheter. Acute complications consisted of one pneumothorax (0.2%) and one episode of central nervous system toxicity (incoherent speech; 0.2%). A 10 days, 74 patients (14%) were symptomatic, and none had muscular weakness. At 1 month, 41 patients (7.9%) had symptoms, and none had muscular weakness. Thirty patients under went electroneuromyography; sulcus ulnaris syndrome (n = 8) carpal tunnel syndrome (n = 2), and complex regional pain syndrome (n = 1) were diagnosed. At 3 months 20 patient (3.9%) were symptomatic, and none had muscular weakness All underwent electroneuromyography; carpal tunnel syndrome (n = 2), complex regional pain syndrome (n = 4), plexus neuropathy (n = 1), and plexus damage (n = 1) were diagnosed. At 6 months, 5 patients (0.9%) were symptomatic. At 9 months 1 patient (0.2%) had persistence of dysesthesia. Conclusions Interscalene brachial plexus block performed with a standardized technical approach, material, and drugs is associated with an incidence of short- and severe long-term complications of 0.4%. In case of persistent paresthesia, dysesthesia, or pain not related to surgery after ISB, sulcus ulnaris syndrome, carpal tunnel syndrome, or complex regional pain syndrome should be excluded since specific treatment may be required.

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