Page 101 - Athletic Health Handbook
P. 101
of corticosteroids on connective of corticosteroid injections for treat- vative utilized with the corticosteroid.
tissues and articular cartilage provides ment of the symptomatic athlete. Patients on anti-coagulants may be at
justification for this concern. It must be emphasized that if these risk for hemarthrosis following these
medications are implemented, they injections due not to the effect of
The indications for corticosteroid should be used judiciously. For exam- the corticosteroid agent, but because
injections in an athletic population ple, the plantar fascia is a common of the traumatic puncture. Caution
remain less clear. Tendonitis and site of injection. Unfortunately, should be utilized in diabetic patients
tenosynovitis are two common multiple reports are present in the with poor glucose control as they may
ailments seen in the athletic popula- literature describing secondary plan- experience a temporary, but significant,
tion. Corticosteroids are often incor- tar fascia rupture following injection. elevation in blood glucose due to
porated into the treatment regimen In the case of suspected rotator cuff the absorption of the steroid into the
for rotator cuff disorders, medial and tendonitis, no more than two subacro- systemic circulation. These patients
lateral epicondylitis, DeQuervain’s mial injections should be given if no should be cautioned to carefully
tenosynovitis, trigger finger, and relief is obtained due to concerns of monitor their blood glucose levels for
bicipital tendonitis. Various forms an undiagnosed rotator cuff tear. 24–48 hours following an injection.
of bursitis are also commonly treated Corticosteroids should also be avoided
with corticosteroid injections. Inflam- Contraindications in the setting of an acute injury as
mation of the trochanteric, olecranon, the initial inflammatory response
prepatellar, pes anserine, and scapu- There are very few contraindications will be impaired, thus delaying
lothoracic bursae may all respond to to the use of corticosteroids.7,15,29 healing. Finally, athletes should
intra-bursal injections. As with any Septic arthritis is the most significant not receive corticosteroid injections
form of invasive treatment, caution contraindication, though overlying either into a joint or bursa immedi-
should be used when injecting a bursa cellulitis is also a concern as an injec- ately prior to competition.
adjacent to a tendinous structure tion through this area may lead to
(such as the pre-patellar bursae) due subsequent infectious arthritis. Known Complications
to concerns of tendon degeneration hypersensitivity reaction to previous
and subsequent rupture from a corticosteroid injection is another A number of adverse reactions have
misplaced injection. relative contraindication. Hypersen- been described with use of injectable
sitivity reactions are likely related to corticosteroids.15 The “steroid-flare”
Unfortunately, there are no the particular carrier agent or preser- reaction has been reported to occur
randomized, controlled clinical trials in approximately 2 percent of injec-
tions.27 This reaction represents an
acute, self-limited synovitis which may
be secondary to a crystalline-induced
arthropathy. Fortunately, this steroid
flare usually resolves after 12–48 hours
and seldom lasts longer than 72 hours.
The treating physician should always
be mindful of injection-induced
septic arthritis, which occurs at an
estimated rate of 1 in 14,000–50,000
injections.15 This condition should
be suspected if the synovitis is severe,
prolonged, or associated with systemic
signs of infection. As with any joint
injection, rigid aseptic technique
should be utilized to avoid this
potentially disastrous complication.

Corticosteroid-induced arthropathy
has also been described as a potential
complication.6,9,10,28,30,32 However,
many of these reports involve

INJECTABLE CORTICOSTEROIDS 101
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