Background/Purpose:

Despite wide use of corticosteroid injection in the treatment of soft tissue and articular disorders, there is little data about its efficacy.  We conducted a retrospective study to evaluate the effectiveness of corticosteroid (CS) and local anesthetic (LA) injections for treatment of musculoskeletal disorders (MSD).

Methods:

The study was conducted at VA NYHHS; Brooklyn facility.  Patients 18-85 years old who underwent CS or LA injection for MSD were identified by billing codes. The patients were invited to participate in a 28-question telephone survey. Information was collected regarding informed consent, impact on pain using pain score (PS 0-10), patient global assessment (PGA 0-100, 0 very poor-100 very well), functional status (M-HAQ) and side effects.  Additional data was obtained by chart review.  Descriptive analysis of all data collected and comparison of PS and PGA before and after the procedure were conducted. 

Results:

116 patients were included in the final analysis.  The average patient age was 60 years old, 85.3% men and 14% women.

The procedures were performed by different specialties, Rheumatology (30.17%), Podiatry (28.45%), Orthopedics (17.24%), Physical Medicine and Rehabilitation (12.07%), and Pain Management (12.07%). The most common indications were knee osteoarthritis (20.68%), plantar fasciitis (15.92%), rotator cuff tendinitis/impingment (15.92%) and trigger finger (8.62%). LA were used in combination with CS in the majority of procedures (91.96%). 

Patients’ overall satisfaction with their procedure was 85%. The average PS prior to the procedure was 8.6; post-procedure average PS decreased to 2.8 (p<0.001Wilcoxon signed rank test).  69.93% of patients reported immediate relief after the injection.   PGA before and after the procedure improved from an average 24 to 75 (p<0.001Wilcoxon signed rank test).  87.9% of patients reported that they experienced improvement in functional status; patients reported improvement in the ability to dress (34%), ability to get in and out of bed (45%), ability to lift a cup to their mouth (24%), ability to walk outdoors on flat ground (50%), ability to turn regular faucets (23%), ability to get in and out of a vehicle (49%). 57.76% of patients reported less analgesic use after the procedure; the average benefit of the injection was 6.18 months (range 0-24 months).  25.86% of the patients had a second injection and 12.93% of the patients underwent surgery for the same MSD. No serious adverse effects were reported; 3 patients reported bruising, 1 patient mild bleeding with the injection, 3 patients reported skin changes and 1 uncontrolled hypertension afer the procedure.  No infections were reported.

Conclusion:

This retrospective study found that CS injections for MSD are associated with significant self-reported reduction in pain and improvement in functional status. There was high reported satisfaction with the procedures and benefits were long-lasting (average 6 months).  Corticosteroid injections should be considered an important tool for clinicians treating musculoskeletal conditions.  This study is limited by recall bias and diversity of procedures.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-joint-and-soft-tissue-injections-a-retrospective-study/