HAMZA SUCUOĞLU, Sibel ÖZBAYRAK SÜZEN, Murat ULUDAĞ, Şansın TÜZÜN

Eklem ve yumuşak doku enjeksiyonlarının muskuloskeletal ağrı üzerine kısa dönem etkinliği: girişimsel kohort çalışması

Amaç: Muskuloskeletal enjeksiyonlar konservatif tedaviye dirençli olgularda sıklıkla kullanılmaktadır. Eklem veya yumuşak doku (YD), kortikosteroid (KS) veya lokal anestezik (LA) enjeksiyonları kas-iskelet ağrısını gidermek için kullanılabilir. Bu çalışmada, Mİ'ların farklı eklem ve YD bölgelerinde ağrı tedavisi üzerine kısa dönem etkinliği değerlendirildi. Gereç ve Yöntem: Bu çalışma, girişimsel prospektif kohort olarak tasarlandı. Konservatif tedavi yöntemlerine dirençli 18 yaş üzeri hastalara, kas iskelet patolojilerine göre eklem ve YD enjeksiyonları yapılmıştır. Hastaların, istirahat ve aktivite sırasındaki ağrıları başka bir doktor tarafından visual analog skalası (VAS) ile tedavi öncesi, tedavi sonrası 3. haftada değerlendirildi. Çalışmanın sonunda, yedi enjeksiyon bölgesine göre (miyofasyal tetik noktalar, omuz, diz, lateral epikondil, plantar fasya, lomber ve kuyruk sokumu) analiz yapıldı.Bulgular: Enjeksiyon çalışmaya dahil edilen 250 hastanın 225'ine uygulandı. 94'ü kadın, toplam 128 hasta çalışmayı tamamladı. Tedavi öncesi ve sonrası istirahat VAS değerleri sırasıyla 4.35±1,49 ve 1,74±1,63 idi. Tedavi öncesi ve sonrası aktivite VAS değerleri sırasıyla 8.41±1.33 ve 4.04±2,37 idi. İstirahat ve aktivite VAS değerlerinde değişiklikler anlamlıydı (p

Short-term efficacy of joint and soft tissue injections for musculoskeletal pain: An interventional cohort study

Objectives: Musculoskeletal injections (MIs) are frequently used in conservative treatment-resistant cases. Joint or soft tissue (ST) corticosteroid (CS) or local anesthetic (LA) injections can be used to relieve musculoskeletal pain. Assessed in the present study was the short-term efficacy of MIs for pain relief, as was the relative efficacy of injections in various joint and ST sites. Methods: An interventional prospective cohort design was employed in the present study. Joint or ST injections for musculoskeletal pathologies were performed in patients over 18 years of age who were resistant to conservative treatment methods. Pain during rest and activity were evaluated using visual analog scale (VAS) by different clinicians prior to treatment and 3 weeks after. At the end of the study, efficacy at 7 injection sites (myofascial trigger points, shoulder, knee, lateral epicondyle, plantar fascia, lumbar, and coccyx regions) was analyzed. Results: Injections were administered to 225 of the 250 patients included. A total of 128 patients, of whom 94 were female, completed the study. Resting VAS values before and after treatment were 4.35±1.49 and 1.63±1.74, respectively. Activity VAS values before and after treatment were 8.41±1.33 and 4.04±2.37, respectively. Changes in resting and activity VAS values were significant (p<0.005). Significant reductions in pain were observed at all injection sites following treatment. Conclusion: Significant improvement in pain scores was observed 3 weeks after injections among all injection sites. LA or CS injections can be used safely and efficiently for pain relief over short time periods.

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1. Wittich CM, Ficalora RD, Mason TG, Beckman TJ. Musculoskeletal injection. Mayo Clin Proc 2009;84(9):831-7.
2. Stephens MB, Beutler AI, O'Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician 2008;78(8):971-6.
3. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006;(2):CD005328.
4. Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes. Br J Sports Med 2007;41(4):217-23.
5. Wilson JJ, Best TM. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician 2005;72(5):811-8.
6. Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 1996;78(11):1685-9.
7. Hay EM, Thomas E, Paterson SM, Dziedzic K, Croft PR. A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Ann Rheum Dis 2003;62(5):394-9.
8. Berde CB, Strichartz GR. Local anesthetics: Anesthesia. In: Miller RD, editor. 5th ed. Churchill Livingstone; Phileldelphia: 2000. s. 491-521.
9. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2009;13(1):3-10.
10. Ga H, Choi JH, Park CH, Yoon HJ. Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients--a randomised trial. Acupunct Med 2007;25(4):130-6.
11. Buchbinder R1, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003;(1):CD004016.
12. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ 2004;328(7444):869.
13. Jørgensen TS, Graven-Nielsen T, Ellegaard K, Danneskiold-Samsøe B, Bliddal H, Henriksen M. Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients: An Interventional Cohort Study. Pain Res Treat 2014;2014:710490.
14. Mandıroglu S, Bal A, Gurcay E, Cakci A. Comparison of the effects of non-steroidal anti-inflammatory drugs, steroid injection and physical therapy in lateral epicondylitis. Turk J Phys Med Rehab 2007;53:104-7.
15. Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 2002;359(9307):657-62.
16. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006;333(7575):939.
17. Tonks JH, Pai SK, Murali SR. Steroid injection therapy is the best conservative treatment for lateral epicondylitis: a prospective randomised controlled trial. Int J Clin Pract 2007;61(2):240-6.
18. Newcomer KL, Laskowski ER, Idank DM, McLean TJ, Egan KS. Corticosteroid injection in early treatment of lateral epicondylitis. Clin J Sport Med 2001;11(4):214-22.
19. Boisaubert B, Brousse C, Zaoui A, Montigny JP. Nonsurgical treatment of tennis elbow. [Article in French] Ann Readapt Med Phys 2004;47(6):346-55. [Abstract]
20. Li S, Shen T, Liang Y, Zhang Y, Bai B. Miniscalpel-Needle versus Steroid Injection for Plantar Fasciitis: A Randomized Controlled Trial with a 12-Month Follow-Up. Evid Based Complement Alternat Med 2014;2014:164714.
21. Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford) 1999;38(10):974-7.
22. Ball EM, McKeeman HM, Patterson C, Burns J, Yau WH, Moore OA, et al. Steroid injection for inferior heel pain: a randomised controlled trial. Ann Rheum Dis 2013;72(6):996-1002.
23. Kamel M, Kotob H. High frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. J Rheumatol 2000;27(9):2139-41.
24. Tsai WC, Wang CL, Tang FT, Hsu TC, Hsu KH, Wong MK. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil 2000;81(10):1416- 21.
25. Ribeiro LH, Furtado RN, Konai MS, Andreo AB, Rosenfeld A, Natour J. Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2013;38(23):1995-2002.
26. Erdem HR, Nacır B, Özeri Z, Karagöz A. Episacral lipoma: a treatable cause of low back pain. [Article in Turkish] Agri 2013;25(2):83-6.
27. Dalbayrak S, Yaman O, Yilmaz T, Yilmaz M. Treatment principles for coccygodynia. Turk Neurosurg 2014;24(4):532-7.
28. Fogel GR, Cunningham PY 3rd, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg 2004;12(1):49-54.
29. Porter KM, Khan MAA, Piggott H. Coccydynia: Retrospective review. J Bone Joint Surg 1981;63:635-6.
30. Wray CC, Easom S, Hoskinson J. Coccydynia. Aetiology and treatment. J Bone Joint Surg Br 1991;73(2):335-8.