Biomechanical effects of steroid injections used to treat pyogenic flexor tenosynovitis

Journal of Orthopaedic Surgery and Research

Laurence E Dahners¹  Donald K Bynum¹  Reid W Draeger¹  Paul S Weinhold¹  Blake R Turvey¹ 

[1] University of North Carolina, School of Medicine, Department of Orthopaedics, Campus Box #7055, Bioinformatics Building, Chapel Hill, NC 27599-7055, USA

关键词: Closed-space infection;    Biomechanical properties;    Tensile strength;    Corticosteroids;    Pyogenic flexor tenosynovitis;   

Others  :  817853
DOI  :  10.1186/1749-799X-7-34

 received in 2012-03-06, accepted in 2012-10-05,  发布年份 2012

【 摘 要 】

Background

A recent study from our laboratory has demonstrated improved range of motion in the toes of broiler chickens afflicted with pyogenic flexor tenosynovitis when treated with local antibiotic and corticosteroid injections, without surgical drainage. However, the use of corticosteroids as an adjunct treatment raised peer concern, as steroids are thought to have deleterious effects on tendon strength. The purpose of this study was to compare the tensile strength of the aforementioned steroid treated tendons, to a group of tendons administered with the current standard treatment: systemic antibiotics, surgical drainage and no corticosteroids.

Methods

Twenty-three tendons’ structural and material properties were investigated (fifteen receiving the standard treatment, eight receiving the steroid treatment). The measurements from each group were interpreted via Student’s unpaired t-test and a post-hoc power analysis.

Results

The steroid treated tendons did demonstrate a trend toward decreased mechanical properties when compared with the standard treatment group, but the results were not statistically significant.

Conclusions

Treatment of septic tenosynovitis with local corticosteroid and local antibiotic injections resulted in better digital motion, without a significant loss of tendon strength, over a twenty-eight day recovery period.

【 授权许可】

   
2012 Turvey et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Boles SD, Schmidt CC: Pyogenic flexor tenosynovitis. Hand Clin 1998, 14:567-578.
• [2]Houshian S, Seyedipour S, Wedderkopp N: Epidemiology of bacterial hand infections. Int J Infect Dis 2006, 10:315-319.
• [3]Abrams RA, Botte MJ: Hand infections: treatment recommendations for specific types. J Am Acad Orthop Surg 1996, 4:219-230.
• [4]Pang HN, Teoh LC, Yam AK, Lee JY, Puhaindran ME, Tan AB: Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg Br 2007, 89:1742-1748.
• [5]Stern PJ, Staneck JL, McDonough JJ, Neale HW, Tyler G: Established hand infections: a controlled, prospective study. Journal of Hand Surgery 1983, 8:553-559.
• [6]Draeger RW, Singh B, Bynum DK, Dahners LE: Corticosteroids as an adjunct to antibiotics and surgical drainage for the treatment of pyogenic flexor tenosynovitis. J Bone Joint Surg Br 2010, 92:2653-2662.
• [7]Lee DH: Commentary on an article by R.W. Draeger, MD, et al.: “Corticosteroids as an adjunct to antibiotics and surgical drainage for the treatment of pyogenic flexor tenosynovitis”. J Bone Joint Surg Br 2010, 92:e30.
• [8]Kapetanos G: The effect of the local corticosteroids on the healing and biomechanical properties of the partially injured tendon. Clin Orthop Relat Res 1982, 163:170-179.
• [9]Noyes FR, Grood ES, Nussbaum NS, Cooper SM: Effect of intra-articular corticosteroids on ligament properties: a biomechanical and histological study in rhesus knees. Clin Orthop Relat Res 1977, 123:197-209.
• [10]Unverferth LJ, Olix ML: The effect of local steroid injections on tendon. Am J Sports Med 1973, 1:31-37.
• [11]Shrier I, Matheson GO, Kohl HW 3rd: Achilles tendonitis: are corticosteroid injections useful or harmful? Clin J Sport Med 1996, 6:245-250.
• [12]Kennedy JC, Willis RB: The effects of local steroid injections on tendons: a biomechanical and microscopic correlative study. Am J Sports Med 1976, 4:11-21.
• [13]Sakiniene E, Bremell T, Tarkowski A: Addition of corticosteroids to antibiotic treatment ameliorates the course of experimental Staphylococcus aureus arthritis. Arthritis Rheum 1996, 39:1596-1605.
• [14]Høgevold HE, Lyberg T, Reikerås O: Changes in leukocyte subpopulations following total hip replacement surgery. Effects of high doses of corticosteroids. Scand J Clin Lab Invest 1991, 51:443-451.
• [15]Woo SL, Orlando CA, Camp JF, Akeson WH: Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech 1986, 19:399-404.
• [16]Butler DL, Grood ES, Noyes FR, Zernicke RF, Brackett K: Effects of structure and strain measurement technique on the material properties of young human tendons and fascia. J Biomech 1984, 17:579-596.
• [17]Wysenbeek AJ, Volchek J, Amit M, Robinson D, Boldur I, Nevo Z: Treatment of staphylococcal septic arthritis in rabbits by systemic antibiotics and intra-articular corticosteroids. Ann Rheum Dis 1998, 57:687-690.
• [18]Odio CM, Ramirez T, Arias G, Abdelnour A, Hidalgo I, Herrera ML, Bolaños W, Alpízar J, Alvarez P: Double blind, randomized, placebo-controlled study of dexamethasone therapy for hematogenous septic arthritis in children. Pediatr Infect Dis J 2003, 22:883-888.
• [19]Ho G Jr, Su EY: Antibiotic therapy of septic bursitis. Its implication in the treatment of septic arthritis. Arthritis Rheum 1981, 24:905-911.
• [20]Verba V, Sakiniene E, Tarkowski A: Beneficial effect of glucocorticoids on the course of haematogenously acquired Staphylococcus aureus nephritis. Scand J Immunol 1997, 45:282-286.
• [21]van de Beek D, de Gans J, McIntyre P, Prasad K: Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2007, 1:CD004405.
• [22]Phelps D, Sonstegard DA, Matthews LS: Corticosteroid injection effects on the biomechanical properties of rabbit patellar tendons. Clin Orthop Relat Res 1974, 100:345-348.
• [23]Mackie JW, Goldin B, Foss ML, Cockrell JL: Mechanical properties of rabbit tendons after repeated anti-inflammatory steroid injections. Med Sci Sports 1974, 6:198-202.
• [24]Matthews LS, Sonstegard DA, Phelps DB: A biomechanical study of rabbit patellar tendon: effects of steroid injection. Am J Sports Med 1974, 2:349-357.