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Articular Steroid Injections


- Discussion: 
     - Steroid Menu:
     - Relative Potency of Various Steroids:
     - Triamcinolone: is the most common choice for joint injection (see knee osteoarthritis)

     - Cautions for Intra-Articular Injection:

          - local complications:
                 - may cause fat necrosis and loss of skin pigmentation in blacks;
                 - in some cases may accelerate joint degeneration;
          - system absorption may occur from intra-articular injection;
                 - absorption is increased by usage of water soluble preparations, dose injected, and injection into multiple joints;
                 - may cause transient hyperglycemia in diabetic patients (and therefore is contraindicated in type I or brittle diabetics);
                 - avascular necrosis of the femoral head is a rare complication;
          - iatrogenic septic arthritis: (see septic arthritis)
                 - uncommon problem but it does occur;
                 - all joint injections should be performed using sterile technique, with a formal betadine prep and use of sterile gloves or use of "no touch technique";
                 - association between total knee infection and prior steroid injections;
                        - Infection in knee replacements after previous injection of intra-articular steroid.
                        - Effect of intra-articular steroids on deep infections following total knee arthroplasty.
                        - Does intraarticular steroid infiltration increase the rate of infection in subsequent total knee replacements?

         - other
                 - note that intra-articular steroids may interfere w/ lactation in nursing mothers; (see pregnancy considerations)



Intraarticular corticosteroids in treatment of osteoarthritis.

Intra-articular corticosteroid treatment in osteoarthritis.

Injections in the treatment of osteoarthritis.

Alterations of rabbit articular cartilage by intra-articular injections of glucocorticoids.

Effect of intra-articular corticosteroids on ligament properties: a biomechanical and histological study in rhesus knees.

Intrasynovial injection of steroids uses and abuses.

Effects of local injection of corticosteroids on the healing of ligaments. A follow-up report.

Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.

Variation patterns of two degradation enzyme systems in articular cartilage in different stages of osteoarthritis: regulation by dehydroepiandrosterone.

In Vitro Cytotoxic Effects of Benzalkonium Chloride in Corticosteroid Injection Suspension

A randomized, prospective, double-blind study to investigate the effectiveness of adding DepoMedrol to a local anesthetic injection in postmeniscectomy patients with osteoarthritis of the knee

Intra-articular glucocorticoid, bupivacaine and morphine reduces pain, inflammatory response and convalescence after arthroscopic meniscectomy

Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

Intraarticular triamcinolone acetonide for pain control after arthroscopic knee surgery

Skin Sterility After Application of Ethyl Chloride Spray