ABSTRACT
This chapter reviews the literature and provides a practical approach to their use according to the evidence-base if it exists or to normal practice. Local injection into peripheral joints and soft tissues are a central part of management of many musculoskeletal diseases and pain syndromes. Intra-articular and local soft tissue administration was first undertaken in the 1950s and remains important in the treatment of inflammatory arthritis and local soft tissue lesions including bursitis, tendonosis, and peripheral nerve entrapment syndromes. Intra-articular or intralesional injections into infected lesions are absolutely contraindicated and may lead to severe local infections and occasionally to septicemia. A combined intra-articular and subacromial injection plus physiotherapy is more effective at six weeks in reducing pain and improving range of movement than either a subacromial or an intra-articular injection plus physiotherapy. A caution about injecting into superficial soft-tissue lesions is that the steroid can produce local subcutaneous atrophy and depigmentation, which is more noticeable in those with dark skin.
