Thirteen patients who developed 15 ruptured tendons subsequent to injection of a depository steroid in or about the tendons are described. Eight were treated surgically. Ruptures were encountered in three Achilles tendons, two supraspinati, one lateral epicondylar attachment at the elbow, eight tendons of the long head of the biceps at the shoulder, and one anterior tibial tendon. Measures designed to lessen this complication are described. In most cases triamcinolone hexacetonide was used as the depository steroid, mixed with procaine or lidocaine. Patients with this complication who were not treated surgically were the older patients who had ruptures of the tendon of the long head of the biceps.
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back ( lumbar radiculopathy ), such as from lumbar spinal stenosis , cervical spinal stenosis, herniated disc , and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy , which causes pain.
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