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Myotoxicity of Injections for Acute Muscle Injuries: A Systematic Review

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Abstract

Background

Injection therapies are widely used for muscle injuries. As there is only limited evidence of their efficacy, physicians should be aware of the potential harmful effects of these injected preparations.

Objectives

The purpose of this review was to systematically review the literature on the myotoxic effects of intramuscular injection preparations commonly used for acute muscle injuries.

Data Sources

The databases of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and SportDiscus were searched in March 2013.

Study Eligibility Criteria

Studies reporting histological evaluation or creatine kinase activity after intramuscular injection with local anaesthetics, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), platelet-rich plasma (PRP), Traumeel® and Actovegin®, or combination preparations were eligible for inclusion.

Data Analysis

Two authors independently screened the search results and assessed the risk of bias. A best-evidence synthesis was used to identify the level of evidence.

Results

Forty-nine studies were included in this systematic review. There is strong to moderate evidence that intramuscularly injected local anaesthetics and NSAIDs are myotoxic, and there is conflicting evidence of the myotoxicity of PRP. There is limited evidence that single corticosteroid injections are not myotoxic but have a synergistic myotoxic effect when used together with local anaesthetics. There is no information to assess whether Actovegin® and Traumeel® are myotoxic.

Conclusion

Local anaesthetics and NSAID injections are not recommended for the treatment of muscle injuries in athletes, as they are myotoxic. The possible myotoxic effects of corticosteroids, PRP, Traumeel® and Actovegin® should be assessed in future research.

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Acknowledgments

No sources of funding were used in the preparation of this review. Gustaaf Reurink and Adam Weir reported receiving support from Arthrex Medizinsiche Instrumente GmbH for travel to a meeting about platelet-rich plasma. The other authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Room Hs-104, Department of Orthopedics, Erasmus Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Gustaaf Reurink & Jan A. N. Verhaar

  2. Department of Sports Medicine, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar

    Gert Jan Goudswaard, Adam Weir & Johannes L. Tol

  3. Department of Sports Medicine, Bergman Clinics, Naarden, The Netherlands

    Maarten H. Moen

  4. Sports Physician Group, Amsterdam, The Netherlands

    Maarten H. Moen

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  1. Gustaaf Reurink
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Reurink, G., Goudswaard, G.J., Moen, M.H. et al. Myotoxicity of Injections for Acute Muscle Injuries: A Systematic Review. Sports Med 44, 943–956 (2014). https://doi.org/10.1007/s40279-014-0186-6

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