OLGU SUNUMLARI
Mediyal Epikondilitte Steroid Enjeksiyonu ile İlişkili Atrofi ve Hipopigmentasyon: Sıra Dışı Bir Olgu
Atrophy and Hypopigmentation Related to Steroid Injection in Medial Epicondylitis: An Extraordinary Case Report
Received Date : 24 Jun 2020
Accepted Date : 19 Oct 2020
Available Online : 18 Jan 2021
Fatma ÖZCANa, İlkay KARABAYa, Eda GÜRÇAYa
aSağlık Bilimleri Üniversitesi Gaziler Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi, Fiziksel Tıp ve Rehabilitasyon Kliniği,
Ankara, TÜRKİYE
Doi: 10.31609/jpmrs.2020-77452 - Makale Dili: TR
J PMR Sci. 2021;24(1):84-7
ÖZET
Kas-iskelet sistemi hastalıklarına bağlı ağrıyı azaltmak ve inflamasyonu
baskılamak amacıyla uygulanan lokal steroid enjeksiyonları,
konservatif tedavinin önemli bir bileşenidir, ancak ağrıda
alevlenme, yumuşak dokuda ekimoz/kalsifikasyon/atrofi, cilt pigmentasyonunda
azalma/artma gibi yan etkilere neden olabilir. Burada
mediyal epikondilit tedavisi için steroid enjeksiyonları
uygulanan, sonrasında doku atrofisi ve cilt hipopigmentasyonu gelişen
53 yaşındaki bir kadın hastayı sunmayı amaçladık. Yaklaşık 3
yıldır devam eden sağ dirsek iç kısmındaki ağrı yakınması için 6, 12
ve 24. aylarda steroid enjeksiyonları uygulanmış. En son yapılan enjeksiyondan
sonra mediyal epikondil çevresinde atrofi ve hipopigmentasyon
gelişmiş. Lokal steroid enjeksiyonlarını planlarken, olası
yan etkiler göz önünde bulundurulmalı ve preparatın etki süresi, çözünürlüğü,
uygulama tekniği ve gerekirse tekrarlanması optimal şekilde
düzenlenmelidir.
Anahtar Kelimeler: Mediyal epikondilit; steroid enjeksiyonu; atrofi; hipopigmentasyon
ABSTRACT
Local steroid injections administered to reduce pain and
suppress inflammation due to musculoskeletal diseases are an important
component of conservative treatment but may cause side effects
such as exacerbation of pain, soft tissue ecchymosis/calcification/atrophy,
decrease/increase in skin pigmentation. Here, we aimed to present
a 53-year-old woman who developed steroid atrophy and skin
hypopigmentation, followed by steroid injections for the treatment of
medial epicondylitis. Steroid injections were applied at the 6th, 12th,
and 24th months for the complaint of pain at the right elbow, which has
been going on for about 3 years. After the last injection, atrophy and
hypopigmentation occurred around the medial epicondyle. When
planning local steroid injections, possible side effects should be considered
and the duration of the preparation, solubility, application
technique, and, if necessary, its repetition should be optimally regulated.
Keywords: Medial epicondylitis; steroid injection; atrophy; hypopigmentation
REFERENCES
- Birtane M. [Causes and examination of elbow pain]. Beyazova M, Gökçe Kutsal Y, editörler. Fiziksel Tıp ve Rehabilitasyon. 2. Baskı. Ankara: Güneş Kitapevi; 2011. p.2019-35.
- Saliman JD, Beaulieu CF, McAdams TR. Ligament and tendon injury to the elbow: clinical, surgical, and imaging features. Top Magn Reson Imaging. 2006;17(5):327-36.[Crossref] [PubMed]
- Cantürk F. [Soft tissue rheumatism]. Beyazova M, Gökçe Kutsal Y, editörler. Fiziksel Tıp ve Rehabilitasyon. 2. Baskı. Ankara: Güneş Kitapevi; 2011. p.2335-65.
- The evidence base for injection therapy. In: Saunders S, Longworth S, eds. Injection Tecniques in Musculoskeletal Medicine: A Practical Manual for Clinicians in Primary and Secondary Care. 4th ed. China: Elsevier Churchill Livingstone, 2012. p.5-30.
- Aydın G. Glukokortikoidler. In: Beyazova M, Gökçe Kutsal Y, editörler. Fiziksel Tıp ve Rehabilitasyon. 2. Baskı. Ankara: Güneş Kitabevi; 2011. p.811-53
- Krames E. Using a pain treatment continuum: a logical and cost effective approach. In: Raj PP, ed. Practical Management of Pain. 3rd ed. St Louis, Missouri: Mosby; 2000. p.441-4.
- Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM. Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord. 2010;11:206.[Crossref] [PubMed] [PMC]
- Cantürk F, Cantürk T, Aydin F, Karagöz F, Sentürk N, Turanli AY. Cutaneous linear atrophy following intralesional corticosteroid injection in the treatment of tendonitis. Cutis. 2004;73(3):197-8.[PubMed]
- Beyzadeoglu T, Bekler H, Gokce A. Skin and subcutanous fat atrophy after corticosteroid injection for medial epicondylitis. Orthopedics. 2011;34(8):570.[Crossref] [PubMed]
- Dahl PR, Zalla MJ, Winkelmann RK. Localized involutional lipoatrophy: a clinicopathologic study of 16 patients. J Am Acad Dermatol. 1996;35(4):523-8.[Crossref] [PubMed]
- Friedman SJ, Butler DF, Pittelkow MR. Perilesional linear atrophy and hypopigmentation after intralesional corticosteroid therapy. Report of two cases and review of the literature. J Am Acad Dermatol. 1988;19(3):537-41.[Crossref] [PubMed]
- Kumar P, Adolph S. Hypopigmentation along subcutaneous veins following intrakeloid triamcinolone injection: a case report and review of literature. Burns. 1998;24(5):487-8.[Crossref] [PubMed]
- Firooz A, Tehranchi-Nia Z, Ahmed AR. Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases. Clin Exp Dermatol. 1995;20(5):363-70.[Crossref] [PubMed]
- Jang WS, Park J, Yoo KH, Han TY, Li K, Seo SJ, et al. Branch-shaped cutaneous hypopigmentation and atrophy after intralesional triamcinolone injection. Ann Dermatol. 2011;23(1):111-4.[Crossref] [PubMed] [PMC]
- Rull M, Clayburne G, Sieck M, Schumacher HR. Intra-articular corticosteroid preparations: different characteristics and their effect during inflammation induced by monosodium urate crystals in the rat subcutaneous air pouch. Rheumatology (Oxford). 2003;42(9):1093-100.[Crossref] [PubMed]
- Milani C, Lin C. Proximal linear extension of skin hypopigmentation after ultrasound-guided corticosteroid injection for de quervain tenosynovitis: a case presentation. PM R. 2018;10(8):873-6.[Crossref] [PubMed]
- Pariser H, Murray PF. Intralesional injections of triamcinolone. Effects of different concentrations on psoriatic lesions. Arch Dermatol. 1963;87:183-7.[Crossref] [PubMed]
- Schetman D, Hambrick GW Jr, Wilson CE. Cutaneous changes following local injection of triamcinolone. Arch Dermatol. 1963;88:820-8.[Crossref] [PubMed]