Intratendinous steroid injection

Well-documented anatomical factors include the morphologic characteristics of the acromion. Hooked, curved, and laterally sloping acromia are strongly associated with cuff tears and may cause tractional damage to the tendon. [15] Conversely, flat acromia may have an insignificant involvement in cuff disease and consequently may be best treated conservatively. The development of these different acromial shapes is likely both genetic and acquired. In the latter case, only age has been positively correlated with progression from flat to curved or hooked. [15] The nature of mechanical activities, such as sports involving the shoulder, along with frequency and intensity of such sports, may be responsible for the adverse development. Sports such as bowling in cricket, swimming, tennis, baseball, and kayaking, are most frequently implicated. However, a progression to a hooked acromion may simply be an adaptation to an already damaged, poorly balanced rotator cuff that is creating increasing stress on the coracoacromial arch . [15] Other anatomical factors that may have significance include os acromiale and acromial spurs. Environmental factors implicated include increasing age, shoulder overuse, smoking, and any medical condition that affects circulation or impairs the inflammatory and healing response, such as diabetes mellitus. [15]

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture , American Academy of Orthopaedic Surgeons , American Orthopaedic Association , American Society for Surgery of the Hand , Arkansas Medical Society , Florida Medical Association , Florida Orthopaedic Society

Disclosure: Nothing to disclose.

The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone, or methylprednisolone in pediatric patients whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses. It is further recommended that short course, or "burst" therapy, be continued until the patient achieves a peak expiratory flow rate of 80% of his or her personal best or until symptoms resolve. This usually requires 3 to 10 days of treatment, although it can take longer. There is no evidence that tapering the dose after improvement will prevent a relapse.

() A 48-year-old male complains of 5 years of heel pain while running. Initially the pain was relieved with Achilles tendon stretching, orthotics, and open-backed shoe wear. Over the past year these modalities are no longer helpful and he is beginning to have pain with walking. Clinical photograph and radiograph are provided in figures A and B. Which of the following treatment options is the best choice to relieve pain and improve function? Review Topic

Intratendinous steroid injection

intratendinous steroid injection

() A 48-year-old male complains of 5 years of heel pain while running. Initially the pain was relieved with Achilles tendon stretching, orthotics, and open-backed shoe wear. Over the past year these modalities are no longer helpful and he is beginning to have pain with walking. Clinical photograph and radiograph are provided in figures A and B. Which of the following treatment options is the best choice to relieve pain and improve function? Review Topic

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