Corticosteroid and Local Anesthetic Use Trends for Large Joint and Bursa Injections: Results of a Survey of Sports Medicine Physicians.
Daniel M Cushman, Masaru Teramoto, Alexandra Asay and 2 others
PMID 32969178WHAT IT FOUND
Sports medicine physicians mostly inject triamcinolone or methylprednisolone at 21-40mg with lidocaine.
However, one-third use doses above 40mg, and few use ropivacaine, despite literature suggesting lower doses are equally effective and ropivacaine may be safer for tissue.
Key findings
01Triamcinolone and methylprednisolone are the most commonly used corticosteroids, with most physicians administering 21-40mg.
02Approximately one-third of physicians use corticosteroid doses greater than 40mg, which the authors note may exceed evidence-based recommendations.
03Lidocaine is the predominant local anesthetic, used by 79-87% of respondents, while ropivacaine is used by fewer than 10%.
STILL TO COME
How it was doneWhat they found
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What it does not show
The survey was limited to sports medicine physicians, so results may not reflect the practices of other musculoskeletal providers like physiatrists or primary care physicians. The response rate was 20%, raising the possibility of non-response bias where those with specific practice patterns may have been more or less likely to reply. Rationales for injection choices were limited to multiple-choice options, preventing free-text explanations that might reveal deeper clinical reasoning.
The easy way to misread this
Do not interpret the high usage of >40mg doses as evidence that higher doses are superior. The authors explicitly state that doses above 40mg are unlikely to provide additional benefit for most large joints and may increase complication risks, yet one-third of physicians still use them.