Steroid injection at 28 weeks pregnant

Sounds like they had a DeQuervain’s injection (if it’s intratendinous instead of just under the tendon sheath there can be a lot of resistance…especially if using a tuberculin syringe/needle), and then had either a trigger thumb injection or an intraarticular injection of the 1st carpometacarpal joint. Either way, they shouldn’t have had “nerve damage” from either injection. The “nerve damage” was probably already there. Without a pre- and post-injection EMG/NCS, it’s impossible to know for sure. The skin atrophy and other signs can be relatively common with kenalog and other insoluble steroids. I don’t what the “thumb locking” is unless the patient means trigger thumb. Some physicians will use sterile saline injections in the atrophied area to speed up the recovery.

This product contains benzyl alcohol as a preservative. Benzyl alcohol, a component of this product, has been associated with serious adverse events and death, particularly in pediatric patients. The “gasping syndrome” (characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine) has been associated with benzyl alcohol dosages > 99 mg/kg/day in neonates and low-birth-weight neonates. Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia , and cardiovascular collapse. Although normal therapeutic doses of this product deliver amounts of benzyl alcohol that are substantially lower than those reported in association with the “gasping syndrome,” the minimum amount of benzyl alcohol at which toxicity may occur is not known. Premature and low-birth-weight infants, as well as patients receiving high dosages, may be more likely to develop toxicity. Practitioners administering this and other medications containing benzyl alcohol should consider the combined daily metabolic load of benzyl alcohol from all sources.

Guidelines from the American College of Rheumatology conditionally recommend the use of intra-articular corticosteroid injections for treatment of knee osteoarthritis. 51 The duration of pain relief is one to two weeks in most trials, with a few showing improvements lasting three to four weeks. 60 – 63 Research uniformly supports the safety of intra-articular corticosteroid injections for treatment of knee osteoarthritis; however, these studies are limited by lack of histologic data and poor long-term follow-up. 64 A Cochrane review found weak evidence for the use of corticosteroid injections for the treatment of knee rheumatoid arthritis. 52

22 patients were randomised to ultrasound guided steroid injection, 21 patients to palpation guided steroid injection and 22 to ultrasound guided placebo injection. There was a significant difference in VAS scores between the groups at 6 and 12 weeks (p= and p=, respectively). There was a (95% CI to ) difference in mean VAS scores at 6 weeks between the ultrasound guided steroid group and the placebo group and a (95% CI to ) difference between the unguided steroid group and the placebo group at 6 weeks. At 12 weeks, the mean difference was (95% CI to ) and (95% CI to ) respectively between both steroid injection groups and the placebo group. There was no difference in VAS scores following steroid injection between the ultrasound guided and the unguided groups at either time point. Plantar fascia thickness was significantly reduced after injection in both active treatment groups (p=).

Steroid injection at 28 weeks pregnant

steroid injection at 28 weeks pregnant

22 patients were randomised to ultrasound guided steroid injection, 21 patients to palpation guided steroid injection and 22 to ultrasound guided placebo injection. There was a significant difference in VAS scores between the groups at 6 and 12 weeks (p= and p=, respectively). There was a (95% CI to ) difference in mean VAS scores at 6 weeks between the ultrasound guided steroid group and the placebo group and a (95% CI to ) difference between the unguided steroid group and the placebo group at 6 weeks. At 12 weeks, the mean difference was (95% CI to ) and (95% CI to ) respectively between both steroid injection groups and the placebo group. There was no difference in VAS scores following steroid injection between the ultrasound guided and the unguided groups at either time point. Plantar fascia thickness was significantly reduced after injection in both active treatment groups (p=).

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