Table 1.
Summary of the included prospective studies.
| Author, Year of publication | Type of study, number of cases | Indication | Corticosteroid injection agent (no. of injected cases, sides) | Methods of reporting adverse events | Complications reported Major/minor Period of time | Follow-up (%) |
|---|---|---|---|---|---|---|
| Rompe 2009 [69] | RCT (229) | GTPS | Prednisolon 25 mg/meaverin 0.5% (75) | In method section: adverse effects were recorded by the physician Results: summarised in a table | Minor: increased or radiating pain: 44%, skin irritation 3%, swelling 9% | 92% after 15 months |
| Gunter 2004 [70] | RCT (18) | Iliotibial band friction syndrome | Methylprednisolone acetate 40 mg/lignocaine 1% (9) | In method section: side effects/adverse reactions: are reported in both intervention groups as a separate issue Results: mentioned as a separate issue | No side-effects after 7 and 14 days | 100% at 2 weeks |
| Chao 2009 [71] | RCT (97) | Trigger thumb | Triamcenolon 10 mg (42) | In method section: no information Results: mentioned in a sentence | Minor: 2.2% had pain after 1 month | 100% after 12 months |
| Peters 2008 [72] | RCT (50) | Trigger finger | Triamcinolone acetonide: 10, 1 or 2 injections (41) | In method section: adverse event as secondary outcome Results: mentioned as a separate issue | Minor: hot flushes 22%, steroid-flare 14.6% | 82% after 12 months follow-up |
| Jianmongkol 2007 [73] | RCT (101) | Trigger finger, 2 types of injection therapy were compared (48/53) | Triamcinolone 10 mg/lidocaine (101) | In method section: no information Results: reported in one sentence | No complications | Follow-up 6 weeks (% lost to follow-up not mentioned) |
| Goldfarb 2007 [74] | RCT (154) | Trigger finger or De Quervain's tenosynovitis | Methylprednisolone acetate 40 mg/lidocaine 1%/bupivacaine 0.5% (154) | In method section: incidence of post injection pain flare was the aim of the study, no other complications are monitored Results: flare reaction mentioned as a separate issue | Minor: in 33% increase in pain score of 2 points or more (VAS scale 0-10). | 81% follow-up after 1 and 6 weeks |
| Baumgarten 2007 [75] | RCT (59) | Trigger finger in diabetics versus non diabetics | Betamethasone 6 mg/lidocaine 1% (44) | In method section: in follow-up section: complications related to treatment were reported Results: complications reported as a separate issue | No adverse events at 6 weeks, 3 months and 1 year | 98% follow-up at 12 month (range 13-41 months) |
| Kazuki 2006 [76] | Pros (100) | Trigger finger | Betamethasone 2.5 mg/lidocaine 1% (129 fingers) | In method section: not mentioned. Results: one sentence: no complications of steroid injections were observed | No complications after 6 months | 100% follow-up after 6 months (range 1-42) |
| Gurcay 2009 [77] | RCT (36) | Carpal tunnel syndrome | Betamethasone 6 mg (18) | In method section: not mentioned Results: no complications or side effects to treatment were observed | No side effects | 100% follow-up after 3 months |
| Nalamachu 2006 [78] | RCT (40) | Carpal tunnel syndrome | Methylprednisolone 40 mg/lidocaine 1% (20) | In method section: adverse events were classified according to MedDRA and the incidence of treatment emergent events was summarized Results: adverse events were described | Minor: numbness (5%), local pain (5%), tingling in hands at 4 weeks (5%) | 85% follow-up after 4 weeks |
| Dammers 2005 [79] | RCT (132) | Carpal tunnel syndrome | Methylprednisolone 20 mg (45), 40 mg (43), 60 mg (44) with lidocaine 10 mg | In method section: not mentioned Results: no side effects were recorded | No side-effects after 1 and 12 months | 97% follow-up after 12 months |
| Hui 2005 [60] | RCT (50) | Carpal tunnel syndrome | Methylprednisolon 15 mg (25) | In method section: surgical complications are assessed after one week, no other adverse events mentioned. Results: one patient with cellulitis is reported and four patients with pain at the injection side | Minor: pain at injection side 16% Major: cellulitis 4% | 100% at 6 and 20 weeks |
| Wong 2005 [80] | RCT (40) | Carpal tunnel syndrome | Methylprednisolone 15 mg single dose (20) or double dose (20) | In method section: any side effects were recorded at 8, 24 and 40 weeks Results: reported as a sentence at the end of the result section | Minor: local pain (30% in 20 mg group and 10% in 20 mg group) | 100% follow-up at 8 weeks |
| Agarwal 2005 [81] | Pros (48) | Carpal tunnel syndrome | Methylprednisolone acetate 40 mg/xylocaine 2% (67 hands) | In method section: not mentioned Results: at the end of the result section adverse effects were mentioned | Minor: mild discoloration of the skin over the injection site (6%) | 100% follow-up after 3 months, 78% after 12 months |
| Ly-Pen 2005 [82] | RCT (163) | Carpal tunnel syndrome | Paramethasone acetonide 20 mg (82, 69 wrists required second injection) | In method section: not mentioned Results: safety and tolerability was a separate chapter | No relevant side-effects | 79.5% follow-up at 12 months |
| Sevim 2004 [83] | RCT (120) | Carpal tunnel syndrome | Betamethasone 6 mg. (60) | In method section: not mentioned Results: complications and side effects are described | Minor: moderate pain lasting less than 24 hours after injection (3.4%), haematoma (1.7%) | 90% follow-up at 11 months follow-up (range 9 to 14 months) |
| Armstrong 2004 [84] | RCT (81) | Carpal tunnel syndrome | Betamethasone 6 mg/lidocaine 1% (43 with a total of 364 injections) | In method section: side effects and complications are recorded Results: adverse effects described | Minor: severe pain after injection (5%), acute transient sympathetic reaction after injection (2%) | 89% follow-up after 18 months |
| Wong 2001 [85] | RCT (62) | Carpal tunnel syndrome | Methylprednisolone 15 mg (30) | In method section: any side effects were recorded by telephone interview Results: summarized in a table | Minor: injection pain (6.7%) | 100% after 12 weeks |
| Kalaci 2009 [64] | RCT (100) | Plantar fasciitis | Triamcinolone 20 mg (50) | In method section: not mentioned Results: description of the side effects not found | No side effects or complications All of the patients found the injection painful | 100% after 6 months |
| Porter 2005 [86] | RCT (132) | Plantar fasciopathy | Betamethason 5.7 mg/lignocaine 1% (64) | In method section: patients were asked to report any possible side effects at 3 and 12 months Results: no infections or rupture are found, description of the side effects | Minor: post-injection pain (12.5%) that required analgesia and/or ice application | 95% follow-up at 12 months |
| Genc 2005 [87] | Pros (30) | Plantar fasciitis | Methylprednisolone 20 mg/prolocaine 2% (47 heels) | In method section: ultrasonografy measurement of the facia at 1 and 6 months Results: reported as one sentence | No rupture observed | 100% follow-up at 6 months |
| Lindenhovius 2008 [88] | RCT (64) | Lateral elbow pain | Dexamethasone 4 mg/lidocaine 1% (31) | In method section: not mentioned Results: adverse events are described | Minor: discoloration of skin 3.2% increased elbow pain 3.2% | 77% after 1 and 6 months |
| Tonks 2007 [53] | RCT (48) | Epicondylitis lateralis | Triamcinolone acetonide 10 mg/lignocaine 2% (24) | In method section: complications of treatment were one of the outcome measurements Result section: complications are described | Major: skin depigmentation and atrophy in 4% after 7 weeks | 77% follow-up at 7 weeks |
| Bisset 2006 [54] | RCT (198) | Tennis elbow | Triamcinolone 10 mg/lidocaine 1% (65) | In method section: not mentioned Results: side effects were mentioned in a separate section | Minor: pain (18.5%). Major: loss of skin pigment (3%), atrophy of subcutaneous tissue (1.5%) | 100% follow-up in injection group at 12 months |
| Wang 2003 [89] | Pros (94) | Hand and elbow injections | Betamethasone/lidocaine 1% | In method section: registration of pain levels after injection of corticosteroid to hand and elbow was the aim of the study, no other side effects were recorded Results: post injection pain is shown in table and list | Minor: 50% increased post-injection pain during 1.2 days | 71% follow-up at 5 days |
| Smidt 2002 [90] | RCT (185) | Epicondylitis lateralis | Triamcinolone acetonide 10 mg/lidocaine (62) | In method section: details of any adverse effects were reported on standardised forms Results: adverse effects summarized in a table | Minor: facial flush (3%), skin irritation (5%), red swollen elbow (3%), change of skin colour (11%), other not specified side-effects (13%) | 96% follow-up at 52 weeks |
| Jensen 2001 [91] | RCT (30) | Tennis elbow | Methylprednisolone 20 mg/lidocaine 1% (16) | In method section: daily pain registration for six weeks Results: described in result section | Minor: pain increase after injection (81%) | 100% follow-up 6 weeks |
| Hay 1999 [57] | RCT (164) | Tennis elbow | Methylprednisolone 20 mg/lignocaine (51) | In method section: complications of treatment is one of the secondary outcome Results: described in a separate section side effects | Major: local skin atrophy in the overall group (3 of 111), one with steroids (1.9%) | 100% follow-up at 12 months |
| Stahl 1997 [92] | RCT (58) | Medial epicondylitis | Methylprednisolone 40 mg/lidocaine (30) | In method section: interviews and physical examination for possible local complications Results: complications are reported in a separate part | Major: non reported Minor: facial flushing in one female patient | 100%follow-up 12 months |
| Verhaar 1995 [93] | RCT (106) | Tennis elbow | Triamcinolone 1% (53) | In method section: side effects not specified Results: no infection or skin hypopigmentation | No side effects in the injection group | 100% follow up after 12 months |
| Price 1991 [58] | RCT (145) | Tennis elbow | Triamcinolone 10 mg/lignocaine 1% or Hydrocortisone 25 mg/lignocaine 1% compared with lignocaine 1% or with Triamcinolone 20 mg. Second study Triamcinolone 10 mg versus 20 mg | In method section: severe post-injection pain and skin atrophy were noted Results: table with the adverse effects | Minor: post-injection pain (11%-58%). Major: skin atrophy (17%-40%) | Follow-up at 24 weeks (% lost to follow-up not clear) |
| Jirarattanaphochai 2004 [55] | RCT (160) | De Quervain's tenosynovitis | Triamcinolone acetonide 10 mg (100) | In method section: the adverse events reported at 3 weeks, 6 and 12 months are secondary outcome measurements Results: adverse effects are mentioned in a table | Minor: post-injection pain (13%), subcutaneous nodule (2.5%), ecchymosis (1.3%). Major: skin hypopigmentation (1.3%) | 100% follow-up, 3% lost between 6 and 12 months |
| Avci 2002 [94] | CT (19) | Pregnant or lactating women with De Quervain's tenosynovitis | Methylprednisolone 10 mg (10) | In method section: not mentioned Result section: not specified | No side effects or local complications of corticosteroid injection were noted | 100% follow (range 9-17 months) |
| Anderson 1991[95] | Pros (56) | De Quervain tenosynovitis | Methylprednisolone acetate 40 mg | In method section: adverse reaction were recorded, particularly signs of atrophy Result: adverse reactions are summarised in a table | Minor; pain 18%, pain, swelling, heat 5% ecchymosis 9% temporary radial nerve paresthesia 2% vasovagal reaction 2% Major: subcutaneous fat atrophy 16% | 95% follow-up at 4.2 years |
| Crawford 1999 [96] | RCT (106) | Heel pain | Methylprednisolone 25 mg (53) | In methods and results sections: not mentioned | No side-effects reported | 52% follow-up after 6 months |
| Capasso 1997 [97] | RCT (116) | Patellar tendopathy | Methylprednisolone 40 mg/lignocaine (39) | In method section: not mentioned Results: acceptability of treatment is separately discussed in a chapter | Minor: burning sensation (10.3%) injection pain (5.1%) | 82% follow-up after 12 months |
| Mens 1998 [59] | Pros (77 ♀) | Musculo-skeletal disease | Triamcinolone acetate intra-articular (46) and extra-articular (24) | Method section: patients were asked to report appearance of flushing and any abnormality of the menstrual pattern Results: shown in a table | Disturbance in menstruation at 6 weeks (50.6%), flushes (28.6%) | 100% follow-up after 6 weeks |
RCT: randomized controlled trial, CT: controlled trial, Pros: prospective clinical study