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:
- 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.
