A Systematic Review of the Efficacy of Corticosteroid Injections of Tendon Sheaths, Excluding Stenosing Tenosynovitis of the Wrist and Hand.

OBJECTIVE: Corticosteroid injections into tendon sheaths are common in clinical practice for treatment of a variety of tendon disorders. Previous systematic reviews have been performed on injections for stenosing tenosynovitis (DeQuervain tenosynovitis and trigger finger), but little high-level evidence remains for other tendon sheath injections. This systematic review analyzes the available literature on improvements in pain and function after these injections. DESIGN: This systematic review of MEDLINE and Embase databases, as well as article bibliographies, examined studies of adult tendon sheath injections, excluding DeQuervain and trigger finger injections. Studies with and without comparison groups were examined. Risk of bias assessment was additionally performed. RESULTS: Abstracts from 1293 records were screened, and 187 full-text articles were reviewed. Seven articles met final inclusion criteria, of which five were prospective trials and none were compared with a placebo. The proximal biceps, peroneal, finger flexor, and posterior tibialis tendons were explicitly examined. All articles reported at least short-term improvements in pain, and some reported improvement in function. CONCLUSIONS: Low-quality studies exist that suggest tendon sheath injections may provide at least short-term improvement in pain. Controlled studies are required to fully demonstrate efficacy.

Reliability of the balance error scoring system in a population with protracted recovery from mild traumatic brain injury.

OBJECTIVE: This study aimed to identify the Balance Error Scoring System's (BESS) intraclass reliability in a cohort of patients with prolonged symptoms using variance component analysis and intraclass correlation coefficient (ICC). SETTING: Outpatient sports medicine/concussion clinic. PARTICIPANTS: A total of 241 paediatric and 102 adult patients with symptoms lasting longer than 10 days. INTERVENTIONS: BESS testing. DESIGN: Retrospective review. MAIN OUTCOME MEASURES: Percent variance for each BESS component and intraclass reliability. A five-component model (including all components except for firm double-leg) and a four- component model (including all components except for firm and foam doubleleg) were also performed to compare ICC values. RESULTS: The largest source of variance came from stance (41.1%). The BESS components firm single (25.5%) and foam tandem (27.5%) stances accounted for the largest percentages of variance, while firm double (1.1%) and foam double (6.9%) accounted for the smallest percentages. The ICC for all patients was 0.800, and increased both if the firm double stance was excluded, or if both double-leg stances were excluded. CONCLUSION: BESS reliability appears to be high in a concussed cohort, regardless of age. Removing the two double-leg stance portions increases the ICC of the test without failing to identify balance deficits.

The effect of body mass index on fluoroscopy time and radiation dose in intra-articular glenohumeral joint injections.

PURPOSE: To determine the relationship between body mass index (BMI) and fluoroscopy time and radiation dose during fluoroscopy-guided glenohumeral joint injections. METHODS: This was a retrospective analysis of prospectively collected data. Physicians with board certification in Physical Medicine and Rehabilitation and/or Sports Medicine performed or supervised all injections. BMI was calculated within three months of the injection. Fluoroscopy time and radiation dose data were recorded by the fluoroscopy system and transcribed into the clinical database after each procedure. RESULTS: A total of 335 intra-articular GHJ injections were performed, 230 on the right shoulder and 105 on the left shoulder; none were bilateral. The mean fluoroscopy time for all injections was 18.8±12.6s, and the mean radiation DAP was 656±1190mGy-cm2. There was no significant difference in fluoroscopy time or dose between first-time and repeat injections (P=.405; P=.011) and no significant differences in fluoroscopy time or radiation dose when a trainee was involved (P=.756 for time and P=.149 for dose). Needle lengths of 1.5, 2.5, or 3.5in. were used during the injection, and there was no significant difference in needle length selection between BMI groups (P=.319). CONCLUSIONS: Intra-articular glenohumeral joint injection fluoroscopy time and radiation dose are not affected by body mass index, age, gender, trainee-involvement, first versus repeat injection, or needle length. This procedure is associated with a dose of radiation that likely has minimal to no clinical significance.