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Musculoskeletal steroid injections in pregnancy: a review

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Abstract

Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.

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References

  1. Gross GA, George JW. Orthopedic injury in pregnancy. Clin Obstet Gynecol. 2016;59(3):629–38.

    Article  PubMed  Google Scholar 

  2. Smith MW, Marcus PS, Wurtz LD. Orthopedic issues in pregnancy. Obstet Gynecol Surv. 2008;63(2):103–11.

    Article  CAS  PubMed  Google Scholar 

  3. Fiat F, Merghes PE, Scurtu AD, AlmajanGuta B, Dehelean CA, Varan N, et al. The main changes in pregnancy—therapeutic approach to musculoskeletal pain. Medicina. 2022;58(8):1115.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang Y, Wu XB, Yang MH, Jiang Y, Zhao G, Zhang ZA. Pregnancy-related pelvic ring disease and its treatment. Beijing da xue xue bao Yi xue ban= J Peking Univ Health Sci. 2015;47(2):368–72.

    CAS  Google Scholar 

  5. Lujano-Negrete AY, Rodríguez-Ruiz MC, Skinner-Taylor CM, Perez-Barbosa L, Cardenas de la Garza JA, García-Hernández PA, et al. Bone metabolism and osteoporosis during pregnancy and lactation. Arch Osteoporos. 2022;17(1):1–6.

    Article  Google Scholar 

  6. Klein A. Peripheral nerve disease in pregnancy. Clin Obstet Gynecol. 2013;56(2):382–8.

    Article  PubMed  Google Scholar 

  7. Lam CM. Worsening back pain in pregnancy. Hong Kong Med J. 2007;13(5):409.

    CAS  PubMed  Google Scholar 

  8. De la Fuente FI, Ellitsgaard V. Hand symptoms and pregnancy. Ugeskr Laeger. 1998;160(40):5791–4.

    Google Scholar 

  9. Ehler E, Kost’ál M. Lesions of peripheral nerves in obstetrics and gynecology. A review Ceska Gynekologie. 2010;75(5):423–8.

    CAS  PubMed  Google Scholar 

  10. Awatef K, Salim G, Zahra MF. A rare case of dermatomyositis revealed during pregnancy with good outcome. Pan Afr Med J. 2016;23:117. https://doi.org/10.11604/pamj.2016.23.117.9198.

  11. McGUIGAN LO, Fleming AN. Osteonecrosis of the humerus related to pregnancy. Ann Rheum Dis. 1983;42(5):597–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Siva S, Liao Q, Abbas A, Periasamy K. Bilateral atraumatic femoral neck fractures resulting from transient osteoporosis of the hip. BMJ Case Rep CP. 2022;15(10): e247967.

    Article  Google Scholar 

  13. Laymon CW, Peterson WC. Glomangioma (glomus tumor): a clinicopathologic study with special reference to multiple lesions appearing during pregnancy. Arch Dermatol. 1965;92(5):509–14.

    Article  CAS  PubMed  Google Scholar 

  14. GoncuAyhan S, Ayhan E, Çaglar AT, Sahin D. Ultrasonography for carpal tunnel syndrome in pregnancy: a prospective cross-sectional study. J Obstet Gynaecol. 2022;8:1–6.

    Google Scholar 

  15. Ahern DP, Gibbons D, Johnson GP, Murphy TM, Schroeder GD, Vaccaro AR, Butler JS. Management of herniated lumbar disk disease and cauda equina syndrome in pregnancy. Clin Spine Surg. 2019;32(10):412–6.

    Article  PubMed  Google Scholar 

  16. Lin JS, Gimarc DC, Adler RS, Beltran LS, Merkle AN. Ultrasound-guided musculoskeletal injections. Sem Musculoskel Radiol. 2021;25(06):69–784 (Thieme Medical Publishers, Inc.).

    Google Scholar 

  17. Matthews LJ, McConda DB, Lalli TA, Daffner SD. Orthostetrics: management of orthopedic conditions in the pregnant patient. Orthopedics. 2015;38(10):e874–80.

    Article  PubMed  Google Scholar 

  18. Vakos A, Dean K, Reeder C, Louis-Jacques A. Management of cauda equina syndrome during pregnancy and postpartum. BMJ Case Rep CP. 2022;15(4): e238793.

    Article  Google Scholar 

  19. Connolly TM, Nadav D, Gungor S. Ultrasound-guided caudal epidural steroid injection for successful treatment of radiculopathy during pregnancy. Pain Manag. 2020;10(2):67–71.

    Article  PubMed  Google Scholar 

  20. Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain’s disease of pregnancy and lactation. J hand Surg. 2002;27(2):322–4.

    Article  Google Scholar 

  21. Skovbjerg BK, Hartig-Andreasen C, Sædder EA. Local anaesthesia and steroid blockades for carpal tunnel syndrome in pregnancy. Ugeskr Laeger. 2021;183(22):V12200932.

  22. Niempoog S, Sanguanjit P, Waitayawinyu T, Angthong C. Local injection of dexamethasone for the treatment of carpal tunnel syndrome in pregnancy. Med J Med Assoc Thail. 2007;90(12):2669.

    Google Scholar 

  23. Miracle X, Di Renzo GC, Stark A, Fanaroff A, Carbonell-Estrany X, Saling E. Guideline for the use of antenatal corticosteroids for fetal maturation. J Perinat Med. 2008;36(3):191–6.

    Article  PubMed  Google Scholar 

  24. Ince-Askan H, van den Akker EL, de Rijke YB, van Rossum EF, Hazes JM, Dolhain RJ. Associations between antenatal prednisone exposure and long-term cortisol and cortisone concentrations in children born to women with rheumatoid arthritis: results from a nationwide prospective cohort study. RMD Open. 2019;5(1): e000852.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Levy RA, de Jesús GR, de Jesús NR, Klumb EM. Critical review of the current recommendations for the treatment of systemic inflammatory rheumatic diseases during pregnancy and lactation. Autoimmun Rev. 2016;15(10):955–63.

    Article  PubMed  Google Scholar 

  26. Committee on Obstetric Practice. Committee Opinion No. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2017;130(2):e102-9.

    Article  Google Scholar 

  27. Wise J. Rheumatic diseases should be actively treated in pregnancy, new guidelines say. BMJ. 2016;532:i312. https://doi.org/10.1136/bmj.i312.

  28. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med. 2011;9(1):1–5.

    Article  Google Scholar 

  29. Borg-Stein J, Dugan SA, Gruber J. Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil. 2005;84(3):180–92.

    Article  PubMed  Google Scholar 

  30. Berthelot JM, Douane F, Ploteau S, Le Goff B, Darrieutort-Laffite C. Venous congestion as a central mechanism of radiculopathies. Joint Bone Spine. 2022;89(2): 105291.

    Article  PubMed  Google Scholar 

  31. Akgun AS, Ertan G, Ulus S. Acute carpal tunnel syndrome caused by thrombosed persistent median artery associated with bifurcated median nerve in a pregnant woman. Case Rep. 2017;2017:bcr-2017.

    Google Scholar 

  32. Pflibsen LR, McCormick BA, Noland SS, Kouloumberis PE. What came first—the chicken or the egg? Carpal tunnel syndrome and pregnancy. J Womens Health. 2020;29(7):896–8.

    Article  Google Scholar 

  33. Turgay T, Aydeniz A. Avascular necrosis of the bilateral femoral head with pregnancy: a case report. Ağrı. 2020;32(4):228–31.

    PubMed  Google Scholar 

  34. Shah A, Mak D, Davies AM, James SL, Botchu R. Musculoskeletal corticosteroid administration: current concepts. Can Assoc Radiol J. 2019;70(1):29–36.

    Article  PubMed  Google Scholar 

  35. Wittich CM, Ficalora RD, Mason TG, Beckman TJ. Musculoskeletal injection. Mayo Clin Proc. 2009;84(9):831–7 (Elsevier).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Freire V, Bureau NJ. Injectable corticosteroids: take precautions and use caution. Semin Musculoskel Radiol. 2016;20(05):401–8 (Thieme Medical Publishers).

    Article  Google Scholar 

  37. Šimurina T, Mraović B, Župčić M, Graf Župčić S, Vulin M. Local anesthetics and steroids: contraindications and complications-clinical update. Acta Clin Croat. 2019;58(Supplement 1):53–61.

    PubMed  PubMed Central  Google Scholar 

  38. Garmel SH, Guzelian GA, D’Alton JG, D’Alton ME. Lumbar disk disease in pregnancy. Obstet Gynecol. 1997;89(5):821–2.

    Article  CAS  PubMed  Google Scholar 

  39. Al-Khodairy AW, Bovay P, Gobelet C. Sciatica in the female patient: anatomical considerations, aetiology and review of the literature. Eur Spine J. 2007;16(6):721–31.

    Article  PubMed  Google Scholar 

  40. Shah S, Banh ET, Koury K, Bhatia G, Nandi R, Gulur P. Pain management in pregnancy: multimodal approaches. Pain Res Treat. 2015;2015:987483. https://doi.org/10.1155/2015/987483.

  41. Vincent R, Blackburn J, Wienecke G, Bautista A. Sacroiliac joint pain in pregnancy: a case report. A&A Practice. 2019;13(2):51–3.

    Article  Google Scholar 

  42. Hurdle MF, McHugh R, Schwendemann W, Psimos C, Smith J. Poster 128: ultrasound guided sacroiliac joint injection in pregnancy: a case series. Arch Phys Med Rehabil. 2007;88(9):E45–6.

    Article  Google Scholar 

  43. Heckman JD, Sassard R. Musculoskeletal considerations in pregnancy. JBJS. 1994;76(11):1720–30.

    Article  CAS  Google Scholar 

  44. Yazdanpanah P, Aramesh ST, Malekzadeh JM, Rahimipour SH. Comparison efficacy of triamcinolone and wrist splint in severe carpal tunnel syndrome in pregnancy. Gynecol Obstet. 2012;2(134):2161–932.

    Google Scholar 

  45. Stolp-Smith KA, Pascoe MK, Ogburn PL Jr. Carpal tunnel syndrome in pregnancy: frequency, severity, and prognosis. Arch Phys Med Rehabil. 1998;79(10):1285–7.

    Article  CAS  PubMed  Google Scholar 

  46. Moghtaderi AR, Moghtaderi N, Loghmani A. Evaluating the effectiveness of local dexamethasone injection in pregnant women with carpal tunnel syndrome. J Res Med Sci. 2011;16(5):687.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Chesterton LS, Blagojevic-Bucknall M, Burton C, Dziedzic KS, Davenport G, Jowett SM, Myers HL, Oppong R, Rathod-Mistry T, van der Windt DA, Hay EM. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. The Lancet. 2018;392(10156):1423–33.

    Article  Google Scholar 

  48. Van Slobbe AM, Bohnen AM, Bernsen RM, Koes BW, Bierma-Zeinstra SM. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. 2004;251(3):294–7.

    Article  PubMed  Google Scholar 

  49. Ferra Verdera M, Ribera Leclerc H, Garrido Pastor JP. Dos casos de meralgia parestésica del nervio femorocutáneo [2 cases of paresthetic meralgia of the femoral cutaneous nerve]. Rev Esp Anestesiol Reanim. 2003;50(30):154–6. Spanish.

  50. Mabie WC. Peripheral neuropathies during pregnancy. Clin Obstet Gynecol. 2005;48(1):57–66.

    Article  PubMed  Google Scholar 

  51. Borg-Stein J, Dugan SA. Musculoskeletal disorders of pregnancy, delivery and postpartum. Phys Med Rehabil Clin N Am. 2007;18(3):459–76.

    Article  PubMed  Google Scholar 

  52. Cronin RS, Chelimo C, Mitchell EA, Okesene-Gafa K, Thompson J, Taylor RS, Hutchison BL, McCowan LM. Survey of maternal sleep practices in late pregnancy in a multi-ethnic sample in South Auckland. N Z BMC Pregnancy Childbirth. 2017;17(1):1–7.

    Google Scholar 

  53. Stephens MB, Beutler A, O’Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician. 2008;78(8):971–6.

    PubMed  Google Scholar 

  54. Rowland P, Phelan N, Gardiner S, Linton KN, Galvin R. The effectiveness of corticosteroid injection for de Quervain’s stenosing tenosynovitis (DQST): a systematic review and meta-analysis. Open Orthop J. 2015;9:437.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Vuillemin V, Guerini H, Bard H, Morvan G. Stenosing tenosynovitis. J Ultrasound. 2012;15(1):20–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Cosgrove JL, Welch DA, Richardson GS, Nicholas JJ. Diaper doer’s hand: stenosing tenosynovitis in the postpartum period. Clin Rehabil. 1987;1(3):219–23.

    Article  Google Scholar 

  57. Bodor M, Flossman T. Ultrasound-guided first annular pulley injection for trigger finger. J Ultrasound Med. 2009;28(6):737–43.

    Article  PubMed  Google Scholar 

  58. Chopin C, Le Guillou A, Salmon JH, Lellouche H, Richette P, Maillet J. Treatment of trigger finger by ultrasound-guided needle release of a1 pulley: a series of 105 cases. Joint Bone Spine. 2022;89(6): 105433.

    Article  PubMed  Google Scholar 

  59. Wu YY, Chen K, He FD, Quan JR, Guo XY. Ultrasound-guided needle release of A1 pulley combined with corticosteroid injection is more effective than ultrasound-guided needle release alone in the treatment of trigger finger. BMC Surg. 2022;22(1):1–7.

    Article  Google Scholar 

  60. Ericson-Neilsen W, Kaye AD. Steroids: pharmacology, complications, and practice delivery issues. Ochsner J. 2014;14(2):203–7.

    PubMed  PubMed Central  Google Scholar 

  61. Begg EJ, Atkinson HC, Gianarakis N. The pharmacokinetics of corticosteroid agents. Med J Aust. 1987;146(1):37–41.

    Article  CAS  PubMed  Google Scholar 

  62. Caldwell JR. Intra-articular corticosteroids. Drugs. 1996;52(4):507–14.

    Article  CAS  PubMed  Google Scholar 

  63. Pyne D, Ioannou Y, Mootoo R, Bhanji A. Intra-articular steroids in knee osteoarthritis: a comparative study of triamcinolone hexacetonide and methylprednisolone acetate. Clin Rheumatol. 2004;23(2):116–20.

    Article  PubMed  Google Scholar 

  64. Lansang MC, Hustak LK. Glucocorticoid-induced diabetes and adrenal suppression: how to detect and manage them. Cleve Clin J Med. 2011;78(11):748–56. https://doi.org/10.3949/ccjm.78a.10180.

  65. Myrex P, Harper L, Gould S. Corticosteroid Injection for an orthopedic complaint in a female with gestational diabetes. Sports Medicine-Open. 2018;4(1):1–3.

    Article  Google Scholar 

  66. Mariotti V, Marconi AM, Pardi G. Undesired effects of steroids during pregnancy. J Matern Fetal Neonatal Med. 2004;16(2):5–7.

    Article  CAS  PubMed  Google Scholar 

  67. French NP, Hagan R, Evans SF, Godfrey M, Newnham JP. Repeated antenatal corticosteroids: size at birth and subsequent development. Am J Obstet Gynecol. 1999;180(1):114–21.

    Article  CAS  PubMed  Google Scholar 

  68. Asztalos EV, Murphy KE, Willan AR, Matthews SG, Ohlsson A, Saigal S, Armson BA, Kelly EN, Delisle MF, Gafni A, Lee SK. Multiple courses of antenatal corticosteroids for preterm birth study: outcomes in children at 5 years of age (MACS-5). JAMA Pediatr. 2013;167(12):1102–10.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK

    Claire Filippini

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Sonal Saran

  3. Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK

    Basavaraj Chari

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  1. Claire Filippini
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Filippini, C., Saran, S. & Chari, B. Musculoskeletal steroid injections in pregnancy: a review. Skeletal Radiol 52, 1465–1473 (2023). https://doi.org/10.1007/s00256-023-04320-9

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