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Review
. 2024 Feb 17;13(4):1132.
doi: 10.3390/jcm13041132.

Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis

Hye Chang Rhim  1   2 , Joseph Ruiz  1 , Atta Taseh  2 , Wilma Afunugo  1 , Zack Crockett  1 , Jason Schon  1 , Xiaoyu Pan  3   4 , Jaehyung Shin  2 , Sean Schowalter  5 , Ki-Mo Jang  6 , David M Robinson  1
Affiliations
Review

Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis

Hye Chang Rhim et al. J Clin Med. .

Abstract

Background: Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions.

Methods: Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed.

Results: A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) -0.244; 95% CI, -1.232 to 0.745; I2, 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, -0.413 to 1.921; I2, 90.2%) and 3 months (WMD-0.089; 95% CI, -0.345 to 0.166; I2, 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups.

Conclusion: NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis.

Keywords: hip osteoarthritis; ketorolac; knee osteoarthritis; methylprednisolone; shoulder impingement syndrome; triamcinolone; trigger finger.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) diagram showing selection of articles for this meta-analysis.
Figure 2
Figure 2
Risk of bias of included in randomized clinical trials.
Figure 3
Figure 3
Meta-analyses comparing NSAID injection with steroid injection in pain visual analogue scale (VAS) for shoulder impingement syndrome. (A) VAS at 1 month; (B) VAS at 3 months.
Figure 3
Figure 3
Meta-analyses comparing NSAID injection with steroid injection in pain visual analogue scale (VAS) for shoulder impingement syndrome. (A) VAS at 1 month; (B) VAS at 3 months.
Figure 4
Figure 4
Meta-analyses comparing NSAID injection with steroid injection in pain visual analogue scale (VAS) for knee osteoarthritis. (A) VAS at 1 month; (B) VAS at 3 months.
Figure 4
Figure 4
Meta-analyses comparing NSAID injection with steroid injection in pain visual analogue scale (VAS) for knee osteoarthritis. (A) VAS at 1 month; (B) VAS at 3 months.
See this image and copyright information in PMC

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