Severe temporomandibular dysfunction and joint destruction after intra-articular injection of triamcinolone.
BACKGROUND
Steroid injections into joints are frequently used to control symptomatic pain. Risks associated with intra-articular steroid injections are not well documented.


METHODS
We report the case of a 29-year-old woman who was referred to a dental surgeon because of a suspected relationship between persisting chronic back pain and an arthrosis of the temporomandibular joint (TMJ).


RESULTS
The dental surgeon diagnosed capsulitis of the right TMJ and injected 40 mg triamcinolone into the joint. Within 4 months the patient developed progressive pain and trismus of the right TMJ and the intra-articular injection was repeated. An occlusal splint slightly improved the patients' symptoms but induced crepitus. Magnetic resonance imaging revealed a disk dislocation in the right TMJ and severe necrosis of the condyle. The patient had persisting pain and ankylosis. Surgical restoration of the TMJ revealed a bony apposition in the fossa deformed with the socket of the joint, extensive medial erosion of the condyle and complete destruction of the disk.


CONCLUSIONS
This case report supports earlier observations that intra-articular glucocorticoid injections, if used in a wrong way, may cause severe destruction of a joint.
Schindler
C
C
Institute of Clinical Pharmacology, Medical Faculty, University of Technology, Dresden, Germany. christoph.schindler@mailbox.tu-dresden.de
Paessler
L
L
Eckelt
U
U
Kirch
W
W
D000328:Adult; D000844:Ankylosis / Q000139:chemically induced; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002358:Cartilage, Articular / Q000187:drug effects; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007270:Injections, Intra-Articular; D004204:Joint Dislocations / Q000139:chemically induced; D008335:Mandibular Condyle / Q000187:drug effects; D009336:Necrosis; D019224:Temporomandibular Joint Disc / Q000187:drug effects; D013705:Temporomandibular Joint Disorders / Q000139:chemically induced*; D014221:Triamcinolone / Q000008:administration & dosage / Q000009:adverse effects*; D014313:Trismus / Q000139:chemically induced
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014221:Triamcinolone