Aspiration and injection therapies for joints

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

“…Deleterious consequences and other sequelae of corticosteroid injections are frequently a result of chronic use, and may be more prevalent if the corticosteroid spreads to adjacent tissues [8,32,33]. Consideration for systemic consequences are also important, especially for patients with diseases that cause immunosupression (e.g., diabetes mellitus and rheumatoid arthritis) [4,16,17,34,35].…”

AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes

“…Furthermore, the relatively large and persistent placebo effects found in trials of knee OA in general, but particularly seen among trials employing intra-articular saline controls, have been recognised as substantial barriers to OA therapeutics,34 including viscosupplements 35. In fact, given that arthrocentesis with or without a saline injection has been recognised as an effective intervention in patients with knee OA presenting with a significant knee effusion,36 some researchers have suggested that intra-articular saline ‘placebo’ injections might better be categorised as active controls rather than as ‘placebos’ 33. As a consequence of the uncertainty generated by these issues, when the results of prior systematic reviews and meta-analyses have been used to generate evidence-based guidelines for the treatment of knee OA, recommendations regarding the use of HA injections have typically been measured.…”

Topical and Regional Treatment for Osteoarthritis

“…lignocaine) because of the risk of clumping and precipitation of steroid crystals. However this remains common practice and provides additional benefits: there is early temporary relief of symptoms; it verifies delivery of steroid to site of pain (66); and it dilutes the suspension, enabling even distribution within the joint, (especially in shoulder joint injections), and hence avoids placement of highly concentrated fluid into a single area. Several randomised controlled trials (67)(68)(69)(70) and one Cochrane systematic review (71) have shown significant short-term efficacy (between 1 to 4 weeks) in terms of pain reduction for a single IA corticosteroid (TCA, MPA and cortivazol) over placebo in knee OA although effects on function appear less marked.…”