Injecting TMJ with Steroid Not Better Than Saline Inject

40 mg Depo Medrol into tender TMJ was no better off a month later than saline injection. The crystals of the steroid made 5 subjects temporarily worse which they pegged as very bad “adverse events”.

J Oral Rehabil. 2019 Jan;46(1):5-13. doi: 10.1111/joor.12718
Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia-A multicentre randomised controlled trial.
Isacsson G. et al

  • swedish study
  • 27 in each group
  • 4 week followup

Technique:

  • “The   intervention   was   initiated   by   blocking   the   auriculotemporal   nerve    with    1.8 mL   of  prilocaine-   felypressin   30 + 0.54 mg/mL “
  • “The   lateral    condylar   pole   of  the   TMJ   was   identified,   and   the   patient   was   asked    to  open    his/her   jaw.   The   injection   needle   (gauge   0.7 mm)   was   moved   towards   the   articular   tubercle   until    contact   was   made   with   cartilage/bone,   thereby   identifying   the  upper   compartment    of  the   joint.    The   test   solution   was   injected   prior    to  an  aspiration attempt and removal of any exudate.”

Results re pain before and 1 month after:

tmj_steroid_inj

  • They talked big about the side effects of steroids but it was mainly 5 subjects that had temporary worsening of pain which you see from the initial crystal irritation of the steroid before it dissolves.

Comment –  It was painful for me to see because I always thought you could do one shot (more would damage the disc) . Now it doesn’t look like that is useful. Fact that there was still pain 1 month later makes me wonder if there was significant myofascial problems that were not dealt with…

I had found joint lavage was helpful (2 needles in – one an exit butterfly, other the saline inject in) – wonder if that would be better than just saline in.

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