Intra articular steroid injection for frozen shoulder

Intramuscular Injection: Provides an extended duration of therapeutic effect and fewer side effects of the kind associated with oral corticosteroid therapy, particularly gastro-intestinal reactions such as peptic ulceration. Studies indicate that, following a single intramuscular dose of 80 mg triamcinolone acetonide, adrenal suppression occurs within 24 - 48 hours and then gradually returns to normal, usually in approximately three weeks. This finding correlates closely with the extended duration of therapeutic action of triamcinolone acetonide.

Transient idiopathic synovitis of the hip is a condition of unknown cause, which causes an irritable hip syndrome. The diagnosis is one of exclusion, as all tests and the X-Rays are normal. Osteoarthritis, is characterised by pain and joint limitation. Stiffness is usually of short duration and the discomfort is worse with weight bearing, activity and through the day, rather than on waking in the morning. X-Ray changes are usually on the upper aspect of the articulation, with superior migration of the femoral head. Osteophytes, sclerosis and cyst formation, of the femoral and acetabular surfaces are common.

In the Patient-Oriented Evidence that Matters (POEMs) of the Journal of Family Practice, Bailey (2002) stated that arthroscopy does not provide any benefit over sham surgery in reducing pain or physical functioning of patients with knee OA.  In the Interpreting Key Trials section of the Cleveland clinic Journal of Medicine, Bernstein and Quach (2003) stated that the value of arthroscopy in treating patients with arthritic joints must be proved.  Furthermore, in the American College of Physicians Journal Club, Gillespie (2003) stated that the study by Moseley et al (2002) made a case for questioning the value of arthroscopic lavage and debridement in active men younger than 65 years of age with OA of the knee.  In addition, the Centers for Medicare and Medicaid Services (2003) will be issuing a national non-coverage determination stating that arthroscopic lavage alone is not reasonable and necessary for patients with OA of the knee; and that arthroscopic debridement is not reasonable and necessary for patients presenting with knee pain only or with severe OA (Outerbridge classification III or IV).

Hiccups following regional injections of corticosteroids including IACI are very rare. It is possible that the hiccups in our case occurred by chance and were unrelated to the IACI. However, the temporal relationship and existing data in the literature support this association. All the cases of hiccups following regional corticosteroid injection belonged to males (Table 1 ). In fact, most cases following intravenous treatment were also to males, suggesting an important role for sex hormones in the pathogenesis. Among the regional cases, 3 were 2 brothers and a nephew suggesting also a genetic role. All types of corticosteroids were used suggesting a class effect. The earliest time of the appearance of hiccups following the regional injection was 4 hours (glenohumeral joint). In 3 cases including our case, the hiccups were very disturbing. Hiccups lasted from 1 to 10 days; in some days it was self-limited and in others required regular antihiccup treatment with good response. In two cases, regional injection was repeated followed by recurrence of hiccups, even 6 years following the first episode, supporting the possibility of inherent tendency to develop hiccups. Recurrent hiccups were severe; in one case lasted for 2 weeks and in the other necessitated admission to the hospital. Intra-articular hyaluronic acid injection in two cases, were uneventful indicating that the hiccups were most probably related to the steroid compound in the injection.

Intra articular steroid injection for frozen shoulder

intra articular steroid injection for frozen shoulder

Hiccups following regional injections of corticosteroids including IACI are very rare. It is possible that the hiccups in our case occurred by chance and were unrelated to the IACI. However, the temporal relationship and existing data in the literature support this association. All the cases of hiccups following regional corticosteroid injection belonged to males (Table 1 ). In fact, most cases following intravenous treatment were also to males, suggesting an important role for sex hormones in the pathogenesis. Among the regional cases, 3 were 2 brothers and a nephew suggesting also a genetic role. All types of corticosteroids were used suggesting a class effect. The earliest time of the appearance of hiccups following the regional injection was 4 hours (glenohumeral joint). In 3 cases including our case, the hiccups were very disturbing. Hiccups lasted from 1 to 10 days; in some days it was self-limited and in others required regular antihiccup treatment with good response. In two cases, regional injection was repeated followed by recurrence of hiccups, even 6 years following the first episode, supporting the possibility of inherent tendency to develop hiccups. Recurrent hiccups were severe; in one case lasted for 2 weeks and in the other necessitated admission to the hospital. Intra-articular hyaluronic acid injection in two cases, were uneventful indicating that the hiccups were most probably related to the steroid compound in the injection.

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