Use and safety of corticosteroid injections in joints and musculoskeletal soft tissue: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society
Methodological detailsmodified Delphi process, modified US Preventive Services Task Force grading, Consensus statements approved by all participants and societies' Boards after four rounds of discussion
- Modified Delphi process
- Modified US Preventive Services Task Force grading
- Consensus statements approved by all participants and societies' Boards after four rounds of discussion
Recommendations
As issued by the authors
Little evidence to guide selection of one corticosteroid over another
Ultrasound guidance increases injection accuracy and reduces procedural pain
Triamcinolone 20 mg as effective as 40 mg for shoulder intra-articular corticosteroid (IACS) and subacromial subdeltoid bursa injections
Commonly used dose for hip IACS is 40 mg triamcinolone or methylprednisolone
Triamcinolone 40 mg as effective as 80 mg for knee IACS
IACS injections give short-term pain relief from a few weeks to a few months
Adverse events: increased blood glucose, adrenal suppression, detrimental effect on cartilage, reduced bone mineral density, postoperative joint infection
Original publication
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