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Image-guided steroid injections

Issue 27 Synovium (Summer 2009)

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In Synovium 26 we highlighted a study demonstrating that image-guided injection of corticosteroid into the subacromial bursa was no better than a depot intramuscular injection of steroid in relieving shoulder pain. Another study to disappoint the proponents of image-guided injections has appeared in BMJ.1 This compared fluoroscopically guided steroid injections with blind injections to the trochanteric bursa in patients with trochanteric pain. There were no significant differences in positive outcomes between the two methods of injection 1 month and 3 months after the injection, suggesting that the five-fold increase in costs of image-guided injections was not justifiable.

Furthermore, in a study published in Rheumatology2 blind intra-articular injections of 232 peripheral joints in patients with rheumatoid arthritis were found to be accurately placed, safe and effective. So perhaps those of us without access to imaging can carry on injecting as we have done for many years and not feel we are doing our patients a disservice.

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