Summary Points/Introduction The Clinical Evidence for Efficacy of Steroid Injections Contraindications to Corticosteroid Injections Complications General Arthrocentesis Technique and Other Measures Summary References Editorial Board Contact Us Sign Up Archives

The Rational Use of Steroid Injections in Arthritis and Nonarticular Musculoskeletal Pain Syndromes

Volume 52, Number 1

Christopher Wise, MD
Division of Rheumatology
Medical College of Virginia
Virginia Commonwealth University Health System
Richmond, VA

Summary Points

• Local steroid injections may have lasting benefit when used in one or two involved joints in
  rheumatoid arthritis, inflammatory oligoarthritis, peripheral joints in ankylosing spondylitis, juvenile rheumatoid arthritis, and crystal-induced arthritis.

• Local steroid injections have short-term benefit in the involved knee of osteoarthritis, painful
  shoulder, lateral epicondylitis, and carpal tunnel syndrome.

• There is no documented benefit from trigger point injections.

Introduction

The injection of joints and periarticular structures with corticosteroids is commonly used by rheumatologists, orthopedists, and other practitioners to treat musculoskeletal pain. Few procedures in medical practice have the potential to be as effective in achieving symptomatic relief. Surveys have estimated that a majority of internists finishing their residency training feel a need for more training in these procedures. 

In 1950, Hollander first reported transient improvement in patients with rheumatoid arthritis injected with cortisone. By the early 1960s, he had reported a series of more than 100,000 injections of joints, bursae, and tendon sheaths in patients (1). Aspiration and therapeutic injection of joints and periarticular tissues has become a common and essential part of rheumatology practice.

The evidence to support the efficacy of injections is mostly anecdotal or based on uncontrolled or retrospective observations. 

In general, localized conditions are more amenable to injection than are generalized conditions, and inflammatory types of arthritis are more likely to benefit than noninflammatory or degenerative conditions.