Musculoskeletal Corticosteroid Injection during COVID-19 Pandemic in Sabah: Is It Safe?

Abstract

Musculoskeletal corticosteroid injection is commonly used as an adjunct to help patients in pain management. In this current COVID-19 pandemic, many clinicians would differ from this treatment as steroid is considered an immunosuppressive drug and could risk the patient of developing severe adverse effects if contracting COVID-19. This is a retrospective study based in Sabah, Malaysia, examining the prevalence of COVID-19 infection following musculoskeletal corticosteroid injection from 1 December 2019 until 30 June 2020 in the sports medicine clinic and the orthopedic clinic. Patients who received musculoskeletal corticosteroid injection were called by telephone and asked about visits to the emergency department or government health clinic for influenza-like illness symptoms or severe acute respiratory infection that would require screening of COVID-19. Thirty-five patients who responded to the call were included, with mean ages of 47.9 years ± 15.1. 52% were male respondents, while 48% were female. 25% of them were diabetics, and 2.9% of them had a history of lymphoproliferative disorders. The mean pain score before injection was 6.74 ± 1.03 and after injection pain was 2.27 ± 1.63. In this study, there were 11.4% (n = 4) with minor complications of steroid injection, that is, skin discoloration. Nonetheless, there were no severe complications due to corticosteroids reported. There were no reported cases of COVID-19 among the respondents following corticosteroid injection. Musculoskeletal pain would affect a person’s well-being and activities; thus, its management requires that careful consideration with risk-benefit analysis be made before administering musculoskeletal corticosteroid injection during COVID-19 pandemic.

Musculoskeletal steroid injections during the COVID-19 pandemic

“…A recent literature review showed that only two studies have been published to determine the safety of corticosteroid injections during the COVID-19 pandemic. 1 , 3 Mohamad et al 1 conducted a retrospective study at the sports medicine clinic and the orthopaedic clinic in Queen Elizabeth Hospital and Queen Elizabeth II Hospital, in the state of Sabah, Malaysia, between 1 st December 2019 and 30th June 2020. This study enrolled 35 patients, and these were given triamcinolone as a steroid injection with a dose of 20 mg for fingers and 40 mg for other body areas.…”

“…This study enrolled 35 patients, and these were given triamcinolone as a steroid injection with a dose of 20 mg for fingers and 40 mg for other body areas. 1 Patients were then contacted via telephone and enquired about COVID-19 symptoms, and about attendance to clinics or hospitals for COVID-19 screening. 1 None of the patients developed any COVID-19 symptoms following steroid injection.…”

“…Corticosteroid injections are routinely used for the localised management of a broad range of painful musculoskeletal conditions, with the knee and shoulder being the two most common areas injected. 1 , 2 , 3 The injection is predominantly given to patients suffering from joint arthritis, bursitis, tendinopathy, and synovitis. 1 , 2 The objective is to control pain, improve the quality of activities of daily living, increase range of motion, and in some instances it may also delay or prevent surgery.…”

“… 1 , 2 , 3 The injection is predominantly given to patients suffering from joint arthritis, bursitis, tendinopathy, and synovitis. 1 , 2 The objective is to control pain, improve the quality of activities of daily living, increase range of motion, and in some instances it may also delay or prevent surgery. 1 The injection offers a high concentration of corticosteroid at the site of injection, thus exerting its anti-inflammatory and immunosuppressive effects locally with limited systemic absorption.…”

“… 1 , 2 The objective is to control pain, improve the quality of activities of daily living, increase range of motion, and in some instances it may also delay or prevent surgery. 1 The injection offers a high concentration of corticosteroid at the site of injection, thus exerting its anti-inflammatory and immunosuppressive effects locally with limited systemic absorption. 2 The first corticosteroid injection dates back to 1950 when George W. Thorn instilled 10 mg 17-hydroxycorticosterone into the painful knee of a patient suffering from rheumatoid arthritis.…”