Is there an optimal amount of Glucocorticoids that should be injected into a joint bursa or tendon sheath

Is there an optimal amount of Glucocorticoids that should be injected into a joint bursa or tendon sheath?

It is generally recommended that short-acting or longer-acting GCs be injected into tendon sheaths because they are more soluble and cause less soft tissue atrophy or chance of tendon rupture.

The longest-acting, least-soluble GC preparations are typically injected into inflamed joints because they tend to be more effective.

Recently, an extended release triamcinolone acetonide (Zilretta, 32 mg/5 mL) has been FDA-approved specifically for joint injections. It costs $600 compared with $18 to $34 for triamcinolone acetonide (Kenalog, 40 mg/mL).

The dose and volume of GCs that can be safely injected depends on the size of the joint.

The provider must be aware of the volume to be injected and attempts should be made to avoid overdistention of the surrounding joint capsule.

This is especially important for small joints (e.g., metacarpals, etc) that should receive <0.5 mL with an injection.

Guidelines for the Appropriate Dose of Glucocorticoid to be Injected

SitePrednisone Equivalent Dose (mg)
Bursa10–20
Tendon sheath10–20
Small joints of hands and feet5–15
Medium-sized joints (wrist, elbow)15–25
Large joints (knee, shoulder, ankle)20–50

The dose for injection into a child’s knee is 1 mg/kg.

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