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Table 1 Summary of the included prospective studies.

From: Adverse effects of extra-articular corticosteroid injections: a systematic review

Author, Year of publication Type of study, number of cases Indication Corticosteroid injection agent (no. of injected cases, sides) Methods of reporting adverse events Complications reported Major/minor Period of time Follow-up (%)
Rompe 2009 [69] RCT (229) GTPS Prednisolon 25 mg/meaverin 0.5% (75) In method section: adverse effects were recorded by the physician Results: summarised in a table Minor: increased or radiating pain: 44%, skin irritation 3%, swelling 9% 92% after 15 months
Gunter 2004 [70] RCT (18) Iliotibial band friction syndrome Methylprednisolone acetate 40 mg/lignocaine 1% (9) In method section: side effects/adverse reactions: are reported in both intervention groups as a separate issue Results: mentioned as a separate issue No side-effects after 7 and 14 days 100% at 2 weeks
Chao 2009 [71] RCT (97) Trigger thumb Triamcenolon 10 mg (42) In method section: no information Results: mentioned in a sentence Minor: 2.2% had pain after 1 month 100% after 12 months
Peters 2008 [72] RCT (50) Trigger finger Triamcinolone acetonide: 10, 1 or 2 injections (41) In method section: adverse event as secondary outcome Results: mentioned as a separate issue Minor: hot flushes 22%, steroid-flare 14.6% 82% after 12 months follow-up
Jianmongkol 2007 [73] RCT (101) Trigger finger, 2 types of injection therapy were compared (48/53) Triamcinolone 10 mg/lidocaine (101) In method section: no information Results: reported in one sentence No complications Follow-up 6 weeks (% lost to follow-up not mentioned)
Goldfarb 2007 [74] RCT (154) Trigger finger or De Quervain's tenosynovitis Methylprednisolone acetate 40 mg/lidocaine 1%/bupivacaine 0.5% (154) In method section: incidence of post injection pain flare was the aim of the study, no other complications are monitored Results: flare reaction mentioned as a separate issue Minor: in 33% increase in pain score of 2 points or more (VAS scale 0-10). 81% follow-up after 1 and 6 weeks
Baumgarten 2007 [75] RCT (59) Trigger finger in diabetics versus non diabetics Betamethasone 6 mg/lidocaine 1% (44) In method section: in follow-up section: complications related to treatment were reported Results: complications reported as a separate issue No adverse events at 6 weeks, 3 months and 1 year 98% follow-up at 12 month (range 13-41 months)
Kazuki 2006 [76] Pros (100) Trigger finger Betamethasone 2.5 mg/lidocaine 1% (129 fingers) In method section: not mentioned. Results: one sentence: no complications of steroid injections were observed No complications after 6 months 100% follow-up after 6 months (range 1-42)
Gurcay 2009 [77] RCT (36) Carpal tunnel syndrome Betamethasone 6 mg (18) In method section: not mentioned Results: no complications or side effects to treatment were observed No side effects 100% follow-up after 3 months
Nalamachu 2006 [78] RCT (40) Carpal tunnel syndrome Methylprednisolone 40 mg/lidocaine 1% (20) In method section: adverse events were classified according to MedDRA and the incidence of treatment emergent events was summarized Results: adverse events were described Minor: numbness (5%), local pain (5%), tingling in hands at 4 weeks (5%) 85% follow-up after 4 weeks
Dammers 2005 [79] RCT (132) Carpal tunnel syndrome Methylprednisolone 20 mg (45), 40 mg (43), 60 mg (44) with lidocaine 10 mg In method section: not mentioned Results: no side effects were recorded No side-effects after 1 and 12 months 97% follow-up after 12 months
Hui 2005 [60] RCT (50) Carpal tunnel syndrome Methylprednisolon 15 mg (25) In method section: surgical complications are assessed after one week, no other adverse events mentioned. Results: one patient with cellulitis is reported and four patients with pain at the injection side Minor: pain at injection side 16% Major: cellulitis 4% 100% at 6 and 20 weeks
Wong 2005 [80] RCT (40) Carpal tunnel syndrome Methylprednisolone 15 mg single dose (20) or double dose (20) In method section: any side effects were recorded at 8, 24 and 40 weeks Results: reported as a sentence at the end of the result section Minor: local pain (30% in 20 mg group and 10% in 20 mg group) 100% follow-up at 8 weeks
Agarwal 2005 [81] Pros (48) Carpal tunnel syndrome Methylprednisolone acetate 40 mg/xylocaine 2% (67 hands) In method section: not mentioned Results: at the end of the result section adverse effects were mentioned Minor: mild discoloration of the skin over the injection site (6%) 100% follow-up after 3 months, 78% after 12 months
Ly-Pen 2005 [82] RCT (163) Carpal tunnel syndrome Paramethasone acetonide 20 mg (82, 69 wrists required second injection) In method section: not mentioned Results: safety and tolerability was a separate chapter No relevant side-effects 79.5% follow-up at 12 months
Sevim 2004 [83] RCT (120) Carpal tunnel syndrome Betamethasone 6 mg. (60) In method section: not mentioned Results: complications and side effects are described Minor: moderate pain lasting less than 24 hours after injection (3.4%), haematoma (1.7%) 90% follow-up at 11 months follow-up (range 9 to 14 months)
Armstrong 2004 [84] RCT (81) Carpal tunnel syndrome Betamethasone 6 mg/lidocaine 1% (43 with a total of 364 injections) In method section: side effects and complications are recorded Results: adverse effects described Minor: severe pain after injection (5%), acute transient sympathetic reaction after injection (2%) 89% follow-up after 18 months
Wong 2001 [85] RCT (62) Carpal tunnel syndrome Methylprednisolone 15 mg (30) In method section: any side effects were recorded by telephone interview Results: summarized in a table Minor: injection pain (6.7%) 100% after 12 weeks
Kalaci 2009 [64] RCT (100) Plantar fasciitis Triamcinolone 20 mg (50) In method section: not mentioned Results: description of the side effects not found No side effects or complications All of the patients found the injection painful 100% after 6 months
Porter 2005 [86] RCT (132) Plantar fasciopathy Betamethason 5.7 mg/lignocaine 1% (64) In method section: patients were asked to report any possible side effects at 3 and 12 months Results: no infections or rupture are found, description of the side effects Minor: post-injection pain (12.5%) that required analgesia and/or ice application 95% follow-up at 12 months
Genc 2005 [87] Pros (30) Plantar fasciitis Methylprednisolone 20 mg/prolocaine 2% (47 heels) In method section: ultrasonografy measurement of the facia at 1 and 6 months Results: reported as one sentence No rupture observed 100% follow-up at 6 months
Lindenhovius 2008 [88] RCT (64) Lateral elbow pain Dexamethasone 4 mg/lidocaine 1% (31) In method section: not mentioned Results: adverse events are described Minor: discoloration of skin 3.2% increased elbow pain 3.2% 77% after 1 and 6 months
Tonks 2007 [53] RCT (48) Epicondylitis lateralis Triamcinolone acetonide 10 mg/lignocaine 2% (24) In method section: complications of treatment were one of the outcome measurements Result section: complications are described Major: skin depigmentation and atrophy in 4% after 7 weeks 77% follow-up at 7 weeks
Bisset 2006 [54] RCT (198) Tennis elbow Triamcinolone 10 mg/lidocaine 1% (65) In method section: not mentioned Results: side effects were mentioned in a separate section Minor: pain (18.5%). Major: loss of skin pigment (3%), atrophy of subcutaneous tissue (1.5%) 100% follow-up in injection group at 12 months
Wang 2003 [89] Pros (94) Hand and elbow injections Betamethasone/lidocaine 1% In method section: registration of pain levels after injection of corticosteroid to hand and elbow was the aim of the study, no other side effects were recorded Results: post injection pain is shown in table and list Minor: 50% increased post-injection pain during 1.2 days 71% follow-up at 5 days
Smidt 2002 [90] RCT (185) Epicondylitis lateralis Triamcinolone acetonide 10 mg/lidocaine (62) In method section: details of any adverse effects were reported on standardised forms Results: adverse effects summarized in a table Minor: facial flush (3%), skin irritation (5%), red swollen elbow (3%), change of skin colour (11%), other not specified side-effects (13%) 96% follow-up at 52 weeks
Jensen 2001 [91] RCT (30) Tennis elbow Methylprednisolone 20 mg/lidocaine 1% (16) In method section: daily pain registration for six weeks Results: described in result section Minor: pain increase after injection (81%) 100% follow-up 6 weeks
Hay 1999 [57] RCT (164) Tennis elbow Methylprednisolone 20 mg/lignocaine (51) In method section: complications of treatment is one of the secondary outcome Results: described in a separate section side effects Major: local skin atrophy in the overall group (3 of 111), one with steroids (1.9%) 100% follow-up at 12 months
Stahl 1997 [92] RCT (58) Medial epicondylitis Methylprednisolone 40 mg/lidocaine (30) In method section: interviews and physical examination for possible local complications Results: complications are reported in a separate part Major: non reported Minor: facial flushing in one female patient 100%follow-up 12 months
Verhaar 1995 [93] RCT (106) Tennis elbow Triamcinolone 1% (53) In method section: side effects not specified Results: no infection or skin hypopigmentation No side effects in the injection group 100% follow up after 12 months
Price 1991 [58] RCT (145) Tennis elbow Triamcinolone 10 mg/lignocaine 1% or Hydrocortisone 25 mg/lignocaine 1% compared with lignocaine 1% or with Triamcinolone 20 mg. Second study Triamcinolone 10 mg versus 20 mg In method section: severe post-injection pain and skin atrophy were noted Results: table with the adverse effects Minor: post-injection pain (11%-58%). Major: skin atrophy (17%-40%) Follow-up at 24 weeks (% lost to follow-up not clear)
Jirarattanaphochai 2004 [55] RCT (160) De Quervain's tenosynovitis Triamcinolone acetonide 10 mg (100) In method section: the adverse events reported at 3 weeks, 6 and 12 months are secondary outcome measurements Results: adverse effects are mentioned in a table Minor: post-injection pain (13%), subcutaneous nodule (2.5%), ecchymosis (1.3%). Major: skin hypopigmentation (1.3%) 100% follow-up, 3% lost between 6 and 12 months
Avci 2002 [94] CT (19) Pregnant or lactating women with De Quervain's tenosynovitis Methylprednisolone 10 mg (10) In method section: not mentioned Result section: not specified No side effects or local complications of corticosteroid injection were noted 100% follow (range 9-17 months)
Anderson 1991[95] Pros (56) De Quervain tenosynovitis Methylprednisolone acetate 40 mg In method section: adverse reaction were recorded, particularly signs of atrophy Result: adverse reactions are summarised in a table Minor; pain 18%, pain, swelling, heat 5% ecchymosis 9% temporary radial nerve paresthesia 2% vasovagal reaction 2% Major: subcutaneous fat atrophy 16% 95% follow-up at 4.2 years
Crawford 1999 [96] RCT (106) Heel pain Methylprednisolone 25 mg (53) In methods and results sections: not mentioned No side-effects reported 52% follow-up after 6 months
Capasso 1997 [97] RCT (116) Patellar tendopathy Methylprednisolone 40 mg/lignocaine (39) In method section: not mentioned Results: acceptability of treatment is separately discussed in a chapter Minor: burning sensation (10.3%) injection pain (5.1%) 82% follow-up after 12 months
Mens 1998 [59] Pros (77 ♀) Musculo-skeletal disease Triamcinolone acetate intra-articular (46) and extra-articular (24) Method section: patients were asked to report appearance of flushing and any abnormality of the menstrual pattern Results: shown in a table Disturbance in menstruation at 6 weeks (50.6%), flushes (28.6%) 100% follow-up after 6 weeks
  1. RCT: randomized controlled trial, CT: controlled trial, Pros: prospective clinical study