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Injection therapies for plantar fasciopathy ('plantar fasciitis): a systematic review and network meta-analysis of 22 randomised controlled trials
Objective To compare the efficacy of different injection therapies for plantar fasciopathy (historically known as ‘plantar fasciitis’). Design Systematic review and network meta-analysis. Data sources Electronic databases (MEDLINE, CENTRAL, Web of Science and Scopus) were searched up to 11 July 2015 for completed studies. Eligibility criteria for selecting studies We considered randomised trials comparing various injection therapies in adults with plantar fasciopathy. The primary outcome was pain relief. Secondary outcomes included functional disability, composite and health-related outcomes. All outcomes we...
Source: British Journal of Sports Medicine - October 31, 2016 Category: Sports Medicine Authors: Tsikopoulos, K., Vasiliadis, H. S., Mavridis, D. Tags: BJSM Reviews with MCQs, Musculoskeletal syndromes Source Type: research

Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial
Aim To determine the cost-effectiveness of corticosteroid injection, physiotherapy and a combination of these interventions, compared to a reference group receiving a blinded placebo injection. Methods 165 adults with unilateral lateral epicondylalgia of longer than 6 weeks duration from Brisbane, Australia, were randomised for concealed allocation to saline injection (placebo), corticosteroid injection, saline injection plus physiotherapy (eight sessions of elbow manipulation and exercise) or corticosteroid injection plus physiotherapy. Costs to society and health-related quality of life (estimated by EuroQol-5D) ov...
Source: British Journal of Sports Medicine - October 31, 2016 Category: Sports Medicine Authors: Coombes, B. K., Connelly, L., Bisset, L., Vicenzino, B. Tags: Physiotherapy, Physiotherapy Original article Source Type: research

Looking Back: Safety of Current Treatments
The clinical utilization of corticosteroid, viscosupplementation, and local anesthestic injections for intra-articular musculoskeletal pathologies remains a popular treatment option. For patients these options offer a low-risk, minimally-invasive, pain-relieving solution for a variety of joint-related complaints. For clinicians, injections often provide diagnostic information in addition to providing therapeutic benefit to the patient. In general, intra-articular injections are considered safe with a low risk profile; however, adverse events have been reported, and it is critical for patients to understand all possible out...
Source: Operative Techniques in Sports Medicine - December 27, 2016 Category: Sports Medicine Authors: Eamon D. Bernardoni, Rachel M. Frank, Andreas H. Gomoll Source Type: research

Conservative management of lateral hip pain: the future holds promise
It goes by many names but lateral hip pain, essentially gluteal tendinopathy has a profound impact on quality of life and activity level. Currently, there is little high-level evidence as to how to manage it. Evidence to date In the systematic review regarding greater trochanteric pain syndrome (GTPS) Barratt et al1 found only eight non-surgical treatment studies eligible for review. Of these, all but one had a moderate-to-high risk of bias. The strongest evidence, both in terms of study design and outcomes, is for corticosteroid injection (CSI). With pain reduction occurring in the majority of patients within 4 weeks...
Source: British Journal of Sports Medicine - January 3, 2017 Category: Sports Medicine Authors: Grimaldi, A. Tags: Editorial Source Type: research

Conservative treatments for greater trochanteric pain syndrome: a systematic review
Conclusions This review demonstrates a paucity of high-quality research for the conservative treatments of GTPS. The risk of bias was low in only one study, demonstrating no additional benefit with fluoroscopically guided injections. Risk of bias in all remaining studies was varied. Standardisation of diagnostic criteria and outcome measures is essential to enable more powerful analysis.
Source: British Journal of Sports Medicine - January 3, 2017 Category: Sports Medicine Authors: Barratt, P. A., Brookes, N., Newson, A. Tags: BJSM Reviews with MCQs, Degenerative joint disease, Musculoskeletal syndromes Source Type: research

Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect?
Introduction Rotator cuff tendinopathies are the most commonly diagnosed musculoskeletal shoulder conditions and are associated with pain, weakness and loss of function.1 Tendon swelling may be associated with tendinopathy and may result from acute overload.2–3 An increase in tendon cells (tenocytes) and upregulation of large molecular weight proteoglycans, such as aggrecan, may increase tendon water content.2 There is uncertainty as to whether the swelling is related to the pain or is instead an observed but unrelated phenomenon. Weakness detected clinically may be due to pain inhibition.4–5 Early treatment of...
Source: British Journal of Sports Medicine - January 17, 2017 Category: Sports Medicine Authors: Parle, P. J., Riddiford-Harland, D. L., Howitt, C. D., Lewis, J. S. Tags: PostScript Source Type: research

Diagnosis and Management of Plantar Fasciitis in Primary Care
Patients with foot pain present to their primary care providers for treatment. Plantar fasciitis is easily diagnosed based on history and exam with little to no need for diagnostic testing. Initial treatment is conservative and is easily initiated in the primary care office, with the focus on alleviation and resolution of the foot pain. Initial treatment modalities include taping, icing, proper footwear, stretching, and rest. When pain persists, other modalities include night splints or referrals to physical therapy and podiatry or orthopedic or sports medicine for a corticosteroid injection.
Source: The Journal for Nurse Practitioners - February 20, 2017 Category: Nursing Authors: Jacquelyn M. Owens Tags: Feature Article Source Type: research

Systematic review is the highest level of evidence for knee osteoarthritis injection options, not expert society guidelines
It was pleasing to read the BMJ-reprinted article of Buchbinder et al1 in the BJSM. Key recommendations from the article1 which are consistent with systematic review (SR) evidence include that knee arthroscopy is not superior to less invasive treatment for knee osteoarthritis (OA) (or degenerative meniscal tear); that degenerative meniscal tears are common in asymptomatic knees in the middle-aged and elderly; and that moderate level exercise is an effective treatment for knee OA. Based on expert society guidelines only2 (not SRs), the authors make recommendations that corticosteroid injections are a ‘first line&rsquo...
Source: British Journal of Sports Medicine - March 13, 2017 Category: Sports Medicine Authors: Orchard, J. W. Tags: PostScript Source Type: research

Nonoperative Options for Management of Articular Cartilage Disease
Nonoperative options for articular cartilage injury are pervasive but have not shown to be curative. Recommendations for low-impact exercise and weight loss provide benefit and are a foundation for the treatment of osteoarthritis. Judicious use of NSAIDs and acetaminophen can be appropriate for pain management. Topical NSAIDs may be a treatment option with fewer side effects than its oral counterpart. Additionally, viscosupplementation injections are useful for mild to moderate knee osteoarthritis, whereas short-term pain relief is provided by intra-articular corticosteroid injections. Future studies to individualize treat...
Source: Clinics in Sports Medicine - April 22, 2017 Category: Sports Medicine Authors: Sourav K. Poddar, Luke Widstrom Source Type: research

Corticosteroids and Hyaluronic Acid Injections
Osteoarthritis is a common condition that affects many individuals resulting in pain, reduced mobility, and decreased function. Corticosteroids have been a mainstay of osteoarthritis treatment. Studies have shown that they provide short-term pain improvement and can be used for osteoarthritis flares. Hyaluronic acid injections have extensively been studied in knee osteoarthritis but to a lesser degree in other joints. Despite some debate between societies, a large number of recent studies have shown hyaluronic acid to be a viable treatment option showing longer-term improvement in both pain and function.
Source: Clinics in Sports Medicine - November 20, 2018 Category: Sports Medicine Authors: Nina A. Yaftali, Kathleen Weber Source Type: research

PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity —results from a randomised trial
ConclusionsAlbeit corticosteroid injections show good short-term results at 6  weeks, patients receiving PRP injections fare better at 3 and 12 months.
Source: Musculoskeletal Surgery - August 25, 2019 Category: Orthopaedics Source Type: research

Mayo Clinic Minute: Benefits and risks of corticosteroid shots
Corticosteroid injections are used to relieve pain in joints due to arthritis and overuse injuries. A recent study suggests that frequent steroid use may affect cartilage health. Dr. Raul Rosario-Concepcion, a Mayo Clinic sports medicine specialist, explains the benefits and risks of these injections. Watch: The Mayo Clinic Minute https://youtu.be/tYwUHex9HSc Journalists: Broadcast-quality video pkg (0:59) is [...]
Source: News from Mayo Clinic - November 5, 2019 Category: Databases & Libraries Source Type: news

Osteoarthritis and ACL Reconstruction —Myths and Risks
AbstractPurpose of ReviewAnterior cruciate ligament (ACL) injury is one of the most common ligamentous injuries suffered by athletes participating in cutting sports. A common misperception is that ACL reconstruction can prevent osteoarthritis (OA). The goal of this paper is to review and discuss the contributing factors for the development of OA following ACL injury.Recent FindingsThere has been interesting new research related to ACL reconstruction. As understanding of knee biomechanics following ACL injury and reconstruction has changed over time, many surgeons have changed their surgical techniques to low anterior drill...
Source: Current Reviews in Musculoskeletal Medicine - January 1, 2020 Category: Orthopaedics Source Type: research

Sport-Related Concussion Preceding Adrenal Insufficiency and Hypopituitarism
A 49-year-old female with history of daily inhaled corticosteroid use for asthma presented to a concussion clinic 7 wk after sport-related head injury with headache, visual blurring, dizziness, nausea, fatigue, polydipsia, and polyuria. Examination revealed difficulty with vestibuloocculomotor testing due to nausea and visual straining. Cranial computed tomography/magnetic resonance imaging was unremarkable. Laboratory testing revealed critically low serum cortisol, hypernatremia, and urine studies suggesting diabetes insipidus. The patient was referred to the emergency department. Intravenous fluid resuscitation, corticos...
Source: Current Sports Medicine Reports - January 1, 2020 Category: Sports Medicine Tags: Case Report Source Type: research

Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis
ConclusionOn average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.
Source: Sports Medicine - January 9, 2020 Category: Sports Medicine Source Type: research