Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

Table 2 Common injectable corticosteroids. Common Injectable Corticosteroids ("Cortisones")

				Recommended Dose Range^c
Solubility/Generic Name	Common Trade Name	Strength^a (mg/cc)	Relative Potency^b	Intermediate Joint [A-C Joint] (mg)	Large 'Joint' [S-A Bursa and G-H Joint] (mg)
Most Soluble
* Betamethasone sodium phosphate	Celestone Phosphate^F	3	25	1.5–3	6–12
Soluble
* Dexamethasone sodium phosphate	Decadron^F	4	25	2–4	7.5–15
Prednisone sodium phosphate	Hydeltrasol	20	4	12.5–25	50–100
Slightly Soluble
* Methylprednisolone acetate	Depo-Medrol	20/40/80	5	10–20	40–80
Triamcinolone diacetate	Aristospan Forte^F	25/40	5	10–20	40–80
Prednisolone tebutate	Hydeltra-TBA	20	4	12.5–25	40–80
Relatively insoluble
* Triamcinolone acetonide	Kenalog^F	10/40	5	10–20	40–80
* Triamcinolone hexacetonide	Aristospan^F	20	5	10–20	40–80
Hydrocortisone acetate	Hydrocortone	25	1	25–50^d	100–200^d
Dexamethasone acetate	Decadron-LA^F	8	25	2–4	7.5–15
Combination
* Betamethasone sodium phosphate-Betamethasone acetate	Celestone Soluspan^F	6	25	1.5–3	6–12

Chart adapted from: Noerdlinger and Fadale (2001)², Saunders (2002)⁴, Tallia and Cardone (2003)³, Axelrod (1976)¹⁰, and Klippel et al. (2001)⁹.
* The most commonly used cortisones among the physicians surveyed in the present study.
F = fluorinated compounds.
^a Adjustments in reported "cortisone" volumes (doses) in our survey respondents were made in cases where different strengths are available. In these cases the volumes reported in the results section are: 40 mg/cc for Depo-Medrol, Aristospan Forte, and Kenalog; 25 mg/cc for Hydrocortone.
^b For example, 1 mg Celestone = 5 mg Depo-Medrol = 5 mg Aristospan = 25 mg Hydrocortisone (See Table 3).
^c The dose equivalents for some "Large Joint" doses are derived from Klippel et al. (2001)⁹ and Noerdlinger and Fadale (2001)². A-C joint ranges are adapted from Saunders (Kenalog), and Tallia and Cardone (Depo-Medrol, Celestone Soluspan). Doses for other cortisone types not conisderered in these sources are derived from the dose equivalents shown above, with some corrections for inconsistencies in Noerdlinger and Fadale (2001) ².
^d These values are estimated.

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