Intratendinous steroid injection

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture , American Academy of Orthopaedic Surgeons , American Orthopaedic Association , American Society for Surgery of the Hand , Arkansas Medical Society , Florida Medical Association , Florida Orthopaedic Society

Disclosure: Nothing to disclose.

An acute myopathy has been reported with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (., myasthenia gravis), or in patients receiving concomitant therapy with anticholinergics, such as neuromuscular blocking drugs (., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.

Sounds like they had a DeQuervain’s injection (if it’s intratendinous instead of just under the tendon sheath there can be a lot of resistance…especially if using a tuberculin syringe/needle), and then had either a trigger thumb injection or an intraarticular injection of the 1st carpometacarpal joint. Either way, they shouldn’t have had “nerve damage” from either injection. The “nerve damage” was probably already there. Without a pre- and post-injection EMG/NCS, it’s impossible to know for sure. The skin atrophy and other signs can be relatively common with kenalog and other insoluble steroids. I don’t what the “thumb locking” is unless the patient means trigger thumb. Some physicians will use sterile saline injections in the atrophied area to speed up the recovery.

Debate still exists over the benefits of using ultrasonography versus arthrography to evaluate bicipital tendon disease in dogs. Rivers et al 21 reported that ultrasonography was less sensitive for diagnosing bicipital tenosynovitis compared with arthrography. However, more recent reports have suggested that ultrasonography is more accurate, particularly in identifying intratendinous or tendon sheath pathology. 1,5,26-28 This is consistent with findings in humans, in whom ultrasonography is often used as the modality of choice in biceps tendon imaging, with magnetic resonance imaging (MRI) being used in cases in which ultrasonography is inconclusive. 29

Intratendinous steroid injection

intratendinous steroid injection

Debate still exists over the benefits of using ultrasonography versus arthrography to evaluate bicipital tendon disease in dogs. Rivers et al 21 reported that ultrasonography was less sensitive for diagnosing bicipital tenosynovitis compared with arthrography. However, more recent reports have suggested that ultrasonography is more accurate, particularly in identifying intratendinous or tendon sheath pathology. 1,5,26-28 This is consistent with findings in humans, in whom ultrasonography is often used as the modality of choice in biceps tendon imaging, with magnetic resonance imaging (MRI) being used in cases in which ultrasonography is inconclusive. 29

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