title: Evidence-based radiology (part 2): Is there sufficient research to support the use of therapeutic injections into the peripheral joints?
abstract: BACKGROUND
  This review article addresses the best evidence currently available for the effectiveness of injection therapy for musculoskeletal conditions involving the peripheral joints. The research is presented by anatomical region and areas of controversy and the need for additional research are identified.
  
  
  CONCLUSIONS
  Randomized controlled trials, meta-analyses and systematic reviews are lacking that address the effectiveness of therapeutic injections to the sternoclavicular, acromioclavicular, ankle and foot joints. No research studies of any kind have been reported for therapeutic injections of the sternoclavicular joint. With the exception of the knee, possibly the hip and patients with inflammatory arthropathies, research does not unequivocally support the use of therapeutic joint injections for most of the peripheral joints, including the shoulder. Additionally, controversy exists in some areas as to whether or not corticosteroids provide better outcomes compared to local anesthetic injections alone.
  
  
  CONCLUSIONS
  When viscosupplementation injections are compared to corticosteroids in patients with osteoarthritis of the knee, the evidence supports the use of viscosupplementation for more prolonged improvement in outcomes, with corticosteroids being good for short-term relief.
authors.affiliation: Radiology, Orthopaedic University Hospital of Balgrist, Forchstrasse 340, 8008, Zürich, Switzerland. cynthia.peterson@balgrist.ch
authors.forename: Cynthia
authors.initials: C
authors.lastname: Peterson
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology* / Q000627:therapeutic use*; D001175:Arthrography; D019317:Evidence-Based Medicine; D006801:Humans; D007596:Joints / Q000187:drug effects*; D010147:Pain Measurement
chemical_list: D000305:Adrenal Cortex Hormones