10Injection therapies for soft-tissue disorders
Section snippets
Corticosteroid injections
Steroid hormones were initially recognized as potent anti-inflammatory substances in the 1930s and a flurry of activity during that decade resulted in the isolation of a number of steroids, most importantly ‘Compound E’, later known as cortisone.2 This was administered in 1948 to a patient with rheumatoid arthritis with dramatic results, and the evolution of steroid therapies for a spectrum of disorders swiftly followed.2., 3. Administration of local corticosteroid injections for
Local anaesthetic injections and dry needling
Injections of local anaesthetic alone are used for both diagnostic and therapeutic purposes in soft-tissue conditions. Local anaesthetics reversibly block sodium channels and hence nociceptive impulses. In some cases, the duration of analgesia obtained can exceed the duration of action of the local anaesthetic, for reasons that are not fully understood.
Subacromial injection of short-acting local anaesthetic (e.g. 2–5 ml 2% lignocaine) was recommended by Neer for the evaluation of the patient
Other agents
A number of other substances are used in local injections of soft-tissue complaints.
Neural blockade in the management of soft-tissue disorders
Neural blockade is used for the diagnosis and treatment of a variety of chronically painful conditions. Such procedures aim to reduce nociceptive input into the dorsal horn on the hypothesis that, if a nerve is quiescent for some time, peripheral sensitization can be reduced or reversed.58 Techniques can divided into peripheral somatosensory nerve blocks and neuraxial blockade.
Summary
A number of local injection therapies are available for the management of soft-tissue mediated pain. They should be reserved for the treatment of chronic soft-tissue lesions and as part of a programme that includes identification and correction of provocative factors. Although an increasing number of techniques and injectates are available, the current evidence for the use of many is scant. Accuracy of diagnosis and injection appears to be important for maximum benefit to be achieved.Box 4
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Cited by (21)
Corticosteroid injections compared to foot orthoses for plantar heel pain: protocol for the SOOTHE heel pain randomised trial
2017, Contemporary Clinical Trials CommunicationsCitation Excerpt :Betamethasone sodium phosphate combined with betamethasone acetate has been selected for use in this trial due to the combination of a long-acting acetate, which will increase potency, and a short-acting sodium phosphate which will increase solubility. This combination will balance the potency required for an anti-inflammatory action [46], against greater solubility which will decrease the likelihood of adverse effects such as plantar fascia rupture or fat pad atrophy [50]. An ultrasound-guided injection has been chosen as ultrasound-guided injections have been found to be more effective than palpation guided injections [51].
Ultrasound-guided versus palpation-guided local corticosteroid injection therapy for treatment of plantar fasciitis
2016, Egyptian RheumatologistCitation Excerpt :It was recommended for soft tissue injections [34]. However, it was considered by some authors to be inadequate for periarticular injection [35]. It was assumed that it is associated with greater risk of local complications as heel fat pad atrophy.
Posterior ankle impingement syndrome in football players: Case series of 26 elite athletes
2016, Acta Orthopaedica et Traumatologica TurcicaCitation Excerpt :During the rehabilitation process reducing the activity of the gastrocnemius muscle, deep ankle muscle strengthening exercises and proprioceptive exercises may alleviate the symptoms.13 Dry needling with physical therapy was suggested to accelerate healing via improving blood flow to injured area and collecting local inflammatory mediators to the region.14 In agreement with reported studies the symptoms of almost two thirds of our patients relieved with non-surgical treatment methods.15
The role of ultrasound guided peri-tendinous injection in the treatment of non-calcific tendinopathy
2015, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :We have never experienced this mixing as a major problem. Many studies (10,11,16,17), suggested adequate time between injections, generally a minimum of four to six weeks, however in our study the time interval was about 2 weeks. In all previous studies, blind method of injection was done that carries the risk of tendon injury, mainly due to lack of direct visualization of needle position, that is avoided in ultrasound guided methods.
Glucocorticoids and sport's performance
2006, Revista Clinica Espanola