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From part of the guide:. Bro, can i ask? Atlantica Indonesia now hv caps If someone is Lvthey should get a higher quality box, but that is all dependent on if the developers of AO Indonesia actually made that change.

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Depo-Medrone is a long-acting steroid injection that's given to reduce inflammation. The injection is given into the muscle of the buttock to treat conditions affecting various different areas of the body.

These include rheumatoid arthritis , inflammatory bowel disease such as Crohn's disease or ulcerative colitis , the autoimmune disease systemic lupus erythematosus and allergies such as severe asthma , hayfever allergic rhinitis or skin reactions. Depo-Medrone can also be injected directly into a joint or soft tissue, to reduce inflammation and pain in conditions such as rheumatoid arthritis , tennis elbow , plantar fasciitis , or bursitis. In arthritis, you might be offered a joint injection to reduce pain and increase mobility in the joint while you're waiting for the effect of another medicine to kick in.

It's important not to overuse joints that feel better after joint injection, as the inflammatory process may remain active. Depo-Medrone is sometimes injected directly into inflamed skin lesions, for example in lichen planus , lichen simplex, keloid scars and discoid lupus erythematosus. Depo-Medrone injection contains the active ingredient methylprednisolone, which is a type of medicine known as a corticosteroid.

Corticosteroids are hormones that are produced naturally by the adrenal glands. They have many important functions in the body, including control of inflammatory responses. Corticosteroid medicines like methylprednisolone are man-made derivatives of the natural hormones.

Corticosteroids are often simply called steroids, but they are not the same as anabolic steroids, which are abused by some athletes and body builders. Methylprednisolone reduces inflammation by stopping cells from releasing substances that are involved in producing immune and allergic responses.

This can help control a wide number of disease states that involve excessive inflammation, including severe allergic reactions, inflammation of the lungs in asthma and inflammation of the joints in arthritis. Long-term use or high doses of methylprednisolone can stop your adrenal glands producing natural corticosteroids this is called adrenal suppression , which means that your body becomes temporarily reliant on the medicine.

This can also happen after repeated joint injections. When your treatment is stopped this will usually be done slowly, to allow your adrenal glands to start producing enough natural steroids again. You'll be given a blue steroid card that contains details about your Depo-Medrone treatment. Read it and carry it with you at all times.

Show it to anyone who treats you eg doctor, nurse, pharmacist, dentist, anaesthetist because the effects that corticosteroids can have on the body may affect other medical treatment you may be given. If you have an accident the card contains information that could save your life.

You should also show your steroid card to anyone who treats you for at least a year after you stop treatment with steroids. Most people can have Depo-Medrone injections. However, if you've got an infection your doctor will need to make sure that it's being effectively treated before you have the injection. The injection shouldn't be given into the achilles tendon, unstable joints, or joints of the spine. Some people will need a lower dose or extra monitoring while having Depo-Medrone injections.

These include:. If you need steroid treatment while you're pregnant or breastfeeding the benefits will usually outweigh any possible risks to the baby. Obviously it's important that you tell your doctor if you are or think you could be pregnant , or if you're breastfeeding, so that any extra monitoring can be done if needed. Your doctor can give you more information and advice. It's hard to predict how likely you are to get side effects from Depo-Medrone injection.

It depends how many injections you have and any conditions you have that might make you more susceptible to problems. Side effects become more likely with higher doses and longer treatment. Make sure to contact your doctor if you experience the following-. Thus make sure to provide him a detailed history of your allergies, overall fitness and existing health problems.

Inform him if you suffer from problems like hypertension , heart disease, kidney or liver issues, tuberculosis , pinworms, thyroid disorders , mental illness, epilepsy or cataracts. In case of children dosage is decided depending upon the health of the patient and condition that is being treated.

Certain precautions should also be taken to prevent side effects from aggravating. For instance avoid grapefruit juice consumption. Thus they should also avoid interacting with sick family members or friends. Nephrotic Syndrome. Rheumatoid Arthritis. Fungal Infections. Below is the list of medicines, which have the same composition, strength and form as Depo Medrol 80 MG Injection , and hence can be used as its substitute.

Mepresso-D 80 MG Injection. It works by binding to the receptor and inhibits the release of inflammatory substances thus helps in the treatment of inflammation or allergic disorders. Whenever you take more than one medicine, or mix it with certain foods or beverages, you"re at risk of a drug interaction. We don't support your browser. Please upgrade your browser or download modern browsers from here!

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Foley B, Christopher TA. Injection therapy of bursitis and tendinitis. Clinical Procedures in Emergency Medicine. Philadelphia, Pa. Saunders; — Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. Prognosis of trochanteric pain in primary care. Br J Gen Pract. 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. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am. 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. Corticosteroid injections for shoulder pain.

Cochrane Database Syst Rev. A combination of systematic review and clinicians' beliefs in interventions for subacromial pain. Local steroid injections for tennis elbow: does the pain get worse before it gets better? Results from a randomized controlled trial. Clin J Pain. Corticosteroid injections for lateral epicondylitis: a systematic overview. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial.

Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis.

Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, cortico-steroid, and isotonic saline. Osteoarthritis Cartilage. A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis.

Local corticosteroid injection for carpal tunnel syndrome. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. Combe B. Early rheumatoid arthritis: strategies for prevention and management. Best Pract Res Clin Rheumatol. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.

Lack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients. Clin Rheumatol. The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients. Joint Bone Spine. Diagnostic and therapeutic injection of the hip and knee. Denkler K. Helpful hints for injections of wrist and hand region.

Diagnostic and therapeutic injection of the shoulder region. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. Hall S, Buchbinder R.

Do imaging methods that guide needle placement improve outcome? A randomized controlled trial of the reciprocating procedure device for intraarticular injection of corticosteroid. Courtney P, Doherty M. Joint aspiration and injection. O'Connor FG. Common injections in sports medicine: general principles and specific techniques. In: O'Connor FG, ed. Sports Medicine: Just the Facts. Division; — Intra-articular corticosteroids. An updated assessment. Clin Orthop Relat Res. Complications of plantar fascia rupture associated with corticosteroid injection.

Foot Ankle Int. Caldwell JR. Guide to selection and indications for use. Intra-articular injection. Med Clin North Am. The effect of corticosteroid on collagen expressionin injured rotator cuff tendon. Preferred intraarticular corticosteroids and associated practice: a survey of members of the American College of Rheumatology.

Arthritis Care Res. Hermosilla Molina A. Treatment of refractory traumatic arthritis of the fingers with intra-articular Ledercort [in Spanish]. Hisp Med. A comparison of plasma methylprednisolone concentrations following intra-articular injection in patients with rheumatoid arthritis and osteoarthritis. Aust N Z J Med. National Library for Health. Osteoarthritis: management issues.

Clinical knowledge summaries. Accessed December 14, Pfenninger JL. Injections of joints and soft tissue: part II. Guidelines for specific joints. Injection and aspiration techniques for the primary care physician. Compr Ther. Diagnostic and therapeutic injection of the ankle and foot. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Recurrent Miscarriage. Oct 15, Issue. Musculoskeletal Injections: A Review of the Evidence. Abstract Who to Inject? What about Diabetes? How to Inject? What to Inject?

Article Sections Abstract Who to Inject? B 1 , 2 Corticosteroid injection for trochanteric pain is safe and highly effective. C 4 , 5 Subacromial corticosteroid injection provides short-term pain relief that is greater than placebo and at least equal to nonsteroidal anti-inflammatory drug therapy. B 9 , 11 , 12 Corticosteroid injection reduces short-term less than six weeks symptoms from lateral epicondylitis, but physical therapy is superior to steroid injection after six weeks.

A 13 , 15 , 16 Intra-articular steroid injections reduce pain and swelling in osteoarthritis of the knee. A 17 The addition of local anesthetics to steroid injections improves pain relief and can be used to differentiate local from referred pain. Who to Inject? How Often to Inject? Determine indication for procedure. Use cooling spray or local anesthetic for patient comfort as needed. Gently aspirate fluid procedure should not be painful.

Remove needle and apply bandage. Provide post-procedural counseling. Table 3 Joint Injection Procedure Steps for combined intra-articular aspiration and injection 1. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles.

Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Inflammatory arthritides. Respiratory Diseases : Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic Disorders : As adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis selected cases may require low-dose maintenance therapy.

For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus. Methylprednisolone acetate injectable suspension is indicated as adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

Methylprednisolone acetate injectable suspension is indicated for intralesional use in alopecia areata, discoid lupus erythematosus; keloids, localized hypertrophic, infiltrated inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus neurodermatitis and psoriatic plaques; necrobiosis lipoidica diabeticorum.

Methylprednisolone acetate injectable suspension also may be useful in cystic tumors of an aponeurosis or tendon ganglia. Methylprednisolone acetate injectable suspension is contraindicated in patients with known hypersensitivity to the product and its constituents.

Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura. Methylprednisolone acetate injectable suspension is contraindicated for intrathecal administration. This formulation of methylprednisolone acetate has been associated with reports of severe medical events when administered by this route. Methylprednisolone acetate injectable suspension is contraindicated in systemic fungal infections, except when administered as an intra-articular injection for localized joint conditions see WARNINGS : Infections, Fungal Infections.

Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids. Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke.

These serious neurologic events have been reported with and without use of fluoroscopy. The safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use.

This product is not suitable for multi-dose use. Following administration of the desired dose, any remaining suspension should be discarded. In order to minimize the incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections. Multiple small injections into the area of the lesion should be made whenever possible. The technique of intra-articular and intramuscular injection should include precautions against injection or leakage into the dermis.

Injection into the deltoid muscle should be avoided because of a high incidence of subcutaneous atrophy. It is critical that, during administration of methylprednisolone acetate injectable suspension, appropriate technique be used and care taken to ensure proper placement of drug. Increased dosage of rapidly acting corticosteroids is indicated in patients on corticosteroid therapy subjected to any unusual stress before, during, and after the stressful situation.

Results from one multicenter, randomized, placebo-controlled study with methylprednisolone hemisuccinate, an IV corticosteroid, showed an increase in early at 2 weeks and late at 6 months mortality in patients with cranial trauma who were determined not to have other clear indications for corticosteroid treatment. High doses of systemic corticosteroids, including methylprednisolone acetate, should not be used for the treatment of traumatic brain injury.

Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. These effects are less likely to occur with synthetic derivatives when used in large doses.

Dietary salt restriction and potassium supplementation may be necessary. All corticosteroids increase calcium excretion. Literature reports suggest an apparent association between use of corticosteroids and left ventricular free wall rupture after a recent myocardial infarction; therefore, therapy with corticosteroids should be used with great caution in these patients.

Hypothalamic-pituitary adrenal HPA axis suppression. Corticosteroids can produce reversible HPA axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment. Drug induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted.

Persons who are on corticosteroids are more susceptible to infections than are healthy individuals. There may be decreased resistance and inability to localize infection when corticosteroids are used. Infections with any pathogen viral, bacterial, fungal, protozoan, or helminthic in any location of the body, may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents.

These infections may be mild, but can be severe and at times fatal. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. Do not use intra-articularly, intrabursally, or for intratendinous administration for local effect in the presence of an acute infection.

Corticosteroids may mask some signs of infection and new infections may appear during their use. Corticosteroids may exacerbate systemic fungal infections and therefore should not be used in the presence of such infections unless they are needed to control drug interactions. Latent disease may be activated or there may be an exacerbation of intercurrent infections due to pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, and Toxoplasma.

It is recommended that latent amebiasis or active amebiasis be ruled out before initiating corticosteroid therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea. Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides threadworm infestation. In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia.

Corticosteroids should not be used in cerebral malaria. There is currently no evidence of benefit from steroids in this condition. The use of corticosteroids in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen. If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary, as reactivation of the disease may occur.

During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis. Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines cannot be predicted. Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy e.

Chicken pox and measles can have a more serious or even fatal course in pediatric and adult patients on corticosteroids. In pediatric and adult patients who have not had these diseases, particular care should be taken to avoid exposure. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin VZIG may be indicated. If exposed to measles, prophylaxis with immunoglobulin IG may be indicated see the respective package inserts for complete VZIG and IG prescribing information.

If chicken pox develops, treatment with antiviral agents should be considered. Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses.

The use of systemic corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes. Corticosteroids should be used cautiously in patients with ocular herpes simplex because of corneal perforation. Corticosteroids should not be used in active ocular herpes simplex. This product, like many other corticosteroids, is sensitive to heat. Therefore, it should not be autoclaved when it is desirable to sterilize the exterior of the vial.

The lowest possible dose of corticosteroid should be used to control the condition under treatment. When reduction in dosage is possible, the reduction should be gradual. Discontinuation of corticosteroids may result in clinical improvement. Caution is required in patients with systemic sclerosis because an increased incidence of scleroderma renal crisis has been observed with corticosteroids, including methylprednisolone.

As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure or renal insufficiency. Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients.

Changes in thyroid status of the patient may necessitate adjustment in dosage. Steroids should be used with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since they may increase the risk of perforation.

Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent. There is an enhanced effect due to decreased metabolism of corticosteroids in patients with cirrhosis. A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis. If this complication occurs and diagnosis of sepsis is confirmed, appropriate antimicrobial therapy should be instituted.

Injection of a steroid into an infected site is to be avoided. Local injection of a steroid into a previously infected joint is not usually recommended. Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation e. This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to an inhibition of bone growth in pediatric patients and the development of osteoporosis at any age.

Special consideration should be given to patients at increased risk of osteoporosis i. An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission e. This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevation of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.

Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids. Intraocular pressure may become elevated in some individuals. If steroid therapy is continued long-term, intraocular pressure should be monitored.

Corticosteroids should be used cautiously in patients with ocular herpes simplex for fear of corneal perforation. Patients should be warned not to discontinue the use of corticosteroids abruptly or without medical supervision, to advise any medical attendants that they are taking corticosteroids and to seek medical advice at once should they develop a fever or other signs of infection.

Persons who are on corticosteroids should be warned to avoid exposure to chicken pox or measles. Patients should also be advised that if they are exposed, medical advice should be sought without delay. Aminoglutethimide : Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression.

Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium depleting agents e. There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure. Anticholinesterases: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis.

If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy. Anticoagulants , oral : Co-administration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports.

Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect. Antidiabetics: Because corticosteroids may increase blood glucose concentration, dosage adjustments of antidiabetic agents may be required. Antitubercular drugs: Serum concentrations of isoniazid may be decreased. Cholestyramine: Cholestyramine may increase the clearance of oral corticosteroids. Cyclosporine: Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently.

Convulsions have been reported with this concurrent use. Digitalis glycosides: Patients on digitalis glycosides may be at risk of arrhythmias due to hypokalemia. Estrogens, including oral contraceptives: Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect. Hepatic Enzyme Inducers e. Hepatic Enzyme Inhibitors e.

Nonsteroidal anti-inflammatory drugs NSAIDs : Concomitant use of aspirin or other nonsteroidal anti-inflammatory agents and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids. Vaccines : Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response.

Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. No adequate studies have been conducted in animals to determine whether corticosteroids have a potential for carcinogenesis or mutagenesis. Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose.

Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring. There are no adequate and well-controlled studies in pregnant women. Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers who have received corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects.

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Since difficulty is not infrequently encountered in entering the hip joint, precautions should be taken to avoid any large blood vessels in the area. Joints not suitable for injection are those that are anatomically inaccessible such as the spinal joints and those like the sacroiliac joints that are devoid of synovial space.

Treatment failures are most frequently the result of failure to enter the joint space. Little or no benefit follows injection into surrounding tissue. If failures occur when injections into the synovial spaces are certain, as determined by aspiration of fluid, repeated injections are usually futile. The area around the injection site is prepared in a sterile way and a wheal at the site made with 1 percent procaine hydrochloride solution.

A 20 to 24 gauge needle attached to a dry syringe is inserted into the bursa and the fluid aspirated. The needle is left in place and the aspirating syringe changed for a small syringe containing the desired dose. After injection, the needle is withdrawn and a small dressing applied.

In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken following application of a suitable antiseptic to the overlying skin to inject the suspension into the tendon sheath rather than into the substance of the tendon. The tendon may be readily palpated when placed on a stretch. When treating conditions such as epicondylitis, the area of greatest tenderness should be outlined carefully and the suspension infiltrated into the area.

For ganglia of the tendon sheaths, the suspension is injected directly into the cyst. In many cases, a single injection causes a marked decrease in the size of the cystic tumor and may effect disappearance. The usual sterile precautions should be observed, of course, with each injection. The dose in the treatment of the various conditions of the tendinous or bursal structures listed above varies with the condition being treated and ranges from 4 to 30 mg.

In recurrent or chronic conditions, repeated injections may be necessary. It may be necessary to distribute doses ranging from 20 to 40 mg by repeated local injections in the case of large lesions. Care should be taken to avoid injection of sufficient material to cause blanching since this may be followed by a small slough. One to four injections are usually employed, the intervals between injections varying with the type of lesion being treated and the duration of improvement produced by the initial injection.

When multidose vials are used, special care to prevent contamination of the contents is essential. The intramuscular dosage will vary with the condition being treated. When a prolonged effect is desired, the weekly dose may be calculated by multiplying the daily oral dose by 7 and given as a single intramuscular injection. In pediatric patients, the initial dose of methylprednisolone may vary depending upon the specific disease entity being treated.

The range of initial doses is 0. Dosage must be individualized according to the severity of the disease and response of the patient. In patients with the adrenogenital syndrome, a single intramuscular injection of 40 mg every two weeks may be adequate. For maintenance of patients with rheumatoid arthritis , the weekly intramuscular dose will vary from 40 to mg.

The usual dosage for patients with dermatologic lesions benefited by systemic corticoid therapy is 40 to mg of methylprednisolone acetate administered intramuscularly at weekly intervals for one to four weeks. In acute severe dermatitis due to poison ivy, relief may result within 8 to 12 hours following intramuscular administration of a single dose of 80 to mg.

In chronic contact dermatitis, repeated injections at 5 to 10 day intervals may be necessary. In seborrheic dermatitis, a weekly dose of 80 mg may be adequate to control the condition. Following intramuscular administration of 80 to mg to asthmatic patients, relief may result within 6 to 48 hours and persist for several days to two weeks.

If signs of stress are associated with the condition being treated, the dosage of the suspension should be increased. If a rapid hormonal effect of maximum intensity is required, the intravenous administration of highly soluble methylprednisolone sodium succinate is indicated. For the purpose of comparison, the following is the equivalent milligram dose of the various glucocorticoids:. These dose relationships apply only to oral or intravenous administration of these compounds.

When these substances or their derivatives are injected intramuscularly or into joint spaces, their relative properties may be greatly altered. Different brands of triamcinolone injection have different uses. You may not be able to receive triamcinolone if you have a fungal infection, or a condition called idiopathic thrombocytopenic purpura ITP.

You may not be able to receive triamcinolone injection if you have a fungal infection, or a condition called idiopathic thrombocytopenic purpura ITP. Triamcinolone injection is given through a needle and can be injected into different areas of the body: into a muscle, into the space around a joint or tendon, or into a lesion on the skin.

A healthcare provider will give you this injection. Not every brand of triamcinolone is used for the same conditions or injected into the same body areas. Some brands are given only one time as needed. Others may be given at regular intervals. Carefully follow your doctor's dosing instructions. Triamcinolone can weaken suppress your immune system, and you may get an infection more easily. Call your doctor if you have unusual bruising or bleeding, or signs of infection fever, weakness, cold or flu symptoms, skin sores, diarrhea, frequent or recurring illness.

Long-term use of steroids can cause harmful effects on the eyes. If you receive triamcinolone injection for longer than 6 weeks, your doctor may want you to have regular eye exams. Your doctor may instruct you to limit your salt intake while you are receiving triamcinolone injection. You may also need to take potassium supplements. Follow all instructions. This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using triamcinolone.

You should not stop using triamcinolone suddenly after long-term repeated use , or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine. Call your doctor for instructions if you miss an appointment for a scheduled triamcinolone injection. Since triamcinolone is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

Using too much triamcinolone is not likely to cause serious problems. However, long term use of high doses can lead to thinning skin, easy bruising, changes in body fat especially in your face, neck, back, and waist , increased acne or facial hair, menstrual problems, impotence , or loss of interest in sex. After injection of triamcinolone into a joint, avoid overusing that joint through strenuous activity or high-impact sports. You could cause damage to the joint. Avoid being near people who are sick or have infections.

Call your doctor for preventive treatment if you are exposed to chickenpox or measles. These conditions can be serious or even fatal in people who are using triamcinolone. Do not receive a "live" vaccine or a toxoid vaccine while using triamcinolone, or you could develop a serious infection.

Introduction: Low back pain and lumbar radicular pain are the leading causes of job loss worldwide.

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This is the initial action of the local anesthetic. Patients then often experience a transient increase in pain as the local anesthetic wears off. Longer-term symptom relief results as the injected corticosteroid takes effect. It is helpful to provide this anticipatory guidance to patients before the injection. Already a member or subscriber? Log in. Stephens earned a master's degree in exercise physiology from The Pennsylvania State University, Hershey.

Address correspondence to Mark B. Reprints are not available from the authors. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U. Navy Medical Department, the Navy at large, the U. Air Force Medical Department, the U. Air Force at large, the U. Treatment of de Quervain's disease: role of conservative management. J Hand Surg [Br]. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation.

J Am Board Fam Pract. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg [Am]. Foley B, Christopher TA. Injection therapy of bursitis and tendinitis. Clinical Procedures in Emergency Medicine. Philadelphia, Pa. Saunders; — Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol. Prognosis of trochanteric pain in primary care. Br J Gen Pract. 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. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am. 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. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. A combination of systematic review and clinicians' beliefs in interventions for subacromial pain. Local steroid injections for tennis elbow: does the pain get worse before it gets better? Results from a randomized controlled trial.

Clin J Pain. Corticosteroid injections for lateral epicondylitis: a systematic overview. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial.

Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, cortico-steroid, and isotonic saline. Osteoarthritis Cartilage. A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis.

Local corticosteroid injection for carpal tunnel syndrome. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. Combe B. Early rheumatoid arthritis: strategies for prevention and management. Best Pract Res Clin Rheumatol. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.

Lack of effect of corticosteroid injection at the shoulder joint on blood glucose levels in diabetic patients. Clin Rheumatol. The effect of corticosteroid injection for trigger finger on blood glucose level in diabetic patients. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients.

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Hall S, Buchbinder R. Do imaging methods that guide needle placement improve outcome? A randomized controlled trial of the reciprocating procedure device for intraarticular injection of corticosteroid. Courtney P, Doherty M. Joint aspiration and injection. O'Connor FG. Common injections in sports medicine: general principles and specific techniques. In: O'Connor FG, ed. Sports Medicine: Just the Facts. Division; — Intra-articular corticosteroids. An updated assessment. Clin Orthop Relat Res.

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Injections of joints and soft tissue: part II. Guidelines for specific joints. Injection and aspiration techniques for the primary care physician. Compr Ther. Diagnostic and therapeutic injection of the ankle and foot. This content is owned by the AAFP.

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Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Recurrent Miscarriage. Oct 15, Issue. Musculoskeletal Injections: A Review of the Evidence. Abstract Who to Inject? What about Diabetes? How to Inject? What to Inject? Article Sections Abstract Who to Inject?

B 1 , 2 Corticosteroid injection for trochanteric pain is safe and highly effective. C 4 , 5 Subacromial corticosteroid injection provides short-term pain relief that is greater than placebo and at least equal to nonsteroidal anti-inflammatory drug therapy.

B 9 , 11 , 12 Corticosteroid injection reduces short-term less than six weeks symptoms from lateral epicondylitis, but physical therapy is superior to steroid injection after six weeks. A 13 , 15 , 16 Intra-articular steroid injections reduce pain and swelling in osteoarthritis of the knee.

A 17 The addition of local anesthetics to steroid injections improves pain relief and can be used to differentiate local from referred pain. Who to Inject? Call your doctor for preventive treatment if you are exposed to chickenpox or measles.

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