Steroid injection

Steroid treatment, i.e. the injection of a cortizone, typically kenalog or equivalent, has been reported to be efficient to shrink nodules of Dupuytren's disease and Ledderhose (e.g. J Hhueston tried it on his own Dupuytren nodule: Hueston JT, Dupuytren's disease, current views on etiology and pathogenesis. In Tubiana R, ed. The Hand, vol 5. Philadelphia: WB Saunders, 1999: 426). Steroid injection reduces the rate of fibroblast cell proliferation and increases the rate of apoptosis (programmed cell death) in nodules of Dupuytren's disease. 

An overview can be found in this steroid_article and a pathogenesis oriented explanation of its effect in an article by Meek et al. "Dupuytren's disease. A model for the mechanism of fibrosis and its modulation by steroids" J. Bone Joint Surg Br. 81 (1999) p 732-738 link. Another study shows that 50% of patients did experience reactivation of the disease in the nodules 1 to 3 years after the last injection, necessitating 1 or more injections, see steroid_article2. Positively expressed injection of steroids can stop the disease for 50 percent of the patients longer than 1-3 years, which make it a successful treatment for some patients.

An article from Brazil reports failure of the steroid treatment in a specific case: steroid_failure_article. Patients might consider the danger of a potential atrophy or discoloration of the tissue. A study claims dose dependent loss of bone at the hip in premenopausal women (bone_loss) but has been criticized. General information of side effects of kenalog (cortizone) can e.g. be found at netdoctor or arthritis.about.com.

Steroid injection is being used to treat Dupuytren's contracture as well as Ledderhose disease. - If you are prefering personal experience, have a look at this web page.

A paper by Trojian and Chu in the American Family Physician describes the star-like injection technique.

Side effects

A potential side effect of cortizone injections is that they can destroy fatty cells under the skin. This is not a major probblem in the hand but in the feet where they serve as a cushion. The cortizone can also attack other cells in the hand/foot. Side effects generally become worse when steroids are applied frequently and long term. We therefore consider injection of steroids as a means to reduce acute pain, e.g. for Ledderhose, but not as a long term or permanent treatment.

Combination of triamcinolone with hyaluronidase

Occasionally triamcinolone is injected together with the enzyme hyaluronidase, which can dissolve scar tissue. While in the Internet this combination is claimed to be very effective so far no results have been published in generally accepted scientific journals.

Combination of steroid injection with needle fasciotomy (PNF)

McMillan and Binhammer report results of a 6-months-trial on the combination of NA and steroid injection (JHS 37 (2012):p1307-1312). The steroid group showed better outcome. Abstract. See also comments fom Borekstra and Werker (JHS 37 (2012):p2429-2430).

 

 


Page last modified: 01/18/2013


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