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Cortisone shot for costochondritis: Ultrasound-Guided Corticosteroid Injection in a Patient With Tietze Syndrome Combined With Costochondral Joint Swelling

by alexxlab

Ultrasound-Guided Corticosteroid Injection in a Patient With Tietze Syndrome Combined With Costochondral Joint Swelling

Case Reports

. 2019 Jul;98(7):e71-e73.

doi: 10.1097/PHM.0000000000001072.

Ju Young Cho 
1
, Donghwi Park

Affiliations

Affiliation

  • 1 From the Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea.

  • PMID:

    30362978

  • DOI:

    10.1097/PHM.0000000000001072

Case Reports

Ju Young Cho et al.

Am J Phys Med Rehabil.

2019 Jul.

. 2019 Jul;98(7):e71-e73.

doi: 10.1097/PHM.0000000000001072.

Authors

Ju Young Cho 
1
, Donghwi Park

Affiliation

  • 1 From the Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea.

  • PMID:

    30362978

  • DOI:

    10.1097/PHM.0000000000001072

Abstract

Tietze syndrome is an uncommon disease of unknown etiology that manifests as pain and tenderness of the parasternal joints. To date, however, there has been no report on ultrasonographic findings concerning swelling of the costochondral joint in Tietze syndrome. Moreover, there has been no research investigating images of ultrasound-guided corticosteroid injection, although corticosteroid injection is one of the most important treatments for Tietze syndrome. Therefore, we report a case of Tietze syndrome where ultrasound images were used in the diagnostic and therapeutic process. A 70-yr-old man was seen for left chest pain that had lasted for several weeks. Physical examination at our clinic revealed a focal tenderness of the left third costochondral joint, and an ultrasound showed a swelling of the left third costochondral joint. Considering both the radiological and the clinical examination, the patient received a diagnosis of Tietze syndrome with costochondral joint swelling. Then, the patient agreed to an ultrasound-guided left third costochondral corticosteroid injection after receiving a detailed explanation of the disease and treatment. After receiving three ultrasound-guided corticosteroid injections, his chest pain subsided, and the swelling and tenderness also disappeared completely. Collectively, our case suggests that ultrasound is important in the diagnosis and treatment of Tietze syndrome.

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BET 3: The use of corticosteroids in the management of costochondritis

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Best Evidence Topic reports

BET 3: The use of corticosteroids in the management of costochondritis

Abstract

A short cut review was carried out to establish whether there is any evidence that for the use of corticosteroids in the treatment of costochondritis. No papers were found using the reported search. The clinical bottom line is that further research is needed in this area.

http://dx.doi.org/10.1136/emermed-2012-201590.4

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Footnotes

  • Linked articles 201590.1, 201590.2, 201590.3, 201590.5.

  • Provenance and peer review Commissioned; internally peer reviewed.

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Cortisone injections for arthritis: pros and cons

In recent years, there has been a lot of talk in the medical community about the dangers of cortisone injections, which are prescribed for the treatment of arthritis pain. Negative opinions are based on the dangers of steroids for cartilage. Can cortisone really lead to further joint destruction? A new study, published in Arthritis and Rheumatology, refutes the fears, but so far only partially. Key takeaway: The judicious use of cortisone injections in the treatment of arthritis of the knee is acceptable and safe.

You can, but be careful!

Boston University Professor of Medicine and Epidemiology, Senior Research Fellow Dr. David Felson elaborates: “The study showed that multiple injections of cortisone in the knee will not lead to long-term negative consequences. But we still cannot guarantee that repeat injections every three months will be 100% problem-free.”

Researchers studied patients who were prescribed cortisone injections on an irregular basis. In this sample, the condition of the joints did not worsen faster than with injections of hyaluronic acid. What’s more, knee replacements were slightly less common in the cortisone injection group. This means that steroid injections can sometimes be given. Data on long-term and regular therapy are not yet available.

Are the fears justified?

Cartilage is the connective tissue that covers the edges of the bones that form the knee joint. It performs the function of depreciation during movement. Steroids damage cartilage, which leads to destruction of the knee joint. Melissa Leber, director of sports medicine at the Emergency Department of the Icahn School of Medicine at Mount Sinai (MSSM), says: “If you use cortisone in a course or too often, it will damage the cartilage.”

There is also a 2019 study that reports that the risk of progression of knee arthritis in people who receive repeated injections of cortisone is 3 times higher compared to patients who never had this injection. On the other hand, often injections into the knee are indispensable. The two most common drugs for this purpose, cortisone and hyaluronic acid, have never been compared in clinical trials. They have different effects on the joints and are sometimes used at the same time.

Which is better for arthritis: cortisone or hyaluronic acid?

According to Leber, these two types of injections affect the joints differently and are sometimes used in combination. Cortisone relieves inflammation, reduces pain. And hyaluronic acid, like a gel, lubricates the diseased joint, which ensures smooth sliding of the parts of the patella. At the same time, cortisone harms cartilage, but hyaluronic acid gel does not.

Of 800 study participants with knee arthritis, 4 out of 5 received cortisone blockade for pain, the rest received hyaluronic acid. Seven years of observation led to the conclusion that the destruction of cartilage in both groups was approximately the same. Also in the group that received cortisone injections, there were 25% fewer situations of knee replacement. Based on this, the researchers concluded that cortisone injections should not be feared.

“Nothing bad will happen from one or more steroid blockades,” Felson said. “Patients need to be reassured so they don’t avoid effective treatment.”

A smart approach is critical

New evidence supports the approach that orthopedic specialists already use when prescribing cortisone injections for the treatment of knee arthritis. “If the cartilage destruction in a patient with arthritic knees is already significant, we don’t worry too much about prescribing steroids. This will not have a critical impact on the situation. But the person will get relief from pain. Here, the risks are negligible compared to the benefits. On the contrary, in the group of young people from 20 to 40 years old with a small cartilage lesion, we are more careful. Here, we try to prescribe a steroid blockade no more than once, ”Leber comments. “The steroid is harmful to cartilage, but this does not mean that it is harmful for every patient. All situations must be considered on an individual basis.

Which clinics offer effective treatment for arthritis?

Diseases of the joints and connective tissues have long been effectively treated in the medical centers of Kazakhstan.