Steroid injections for arthropathy, tendinopathy and myopathy in the pediatric population: a systematic review.

Abstract

Objective: To assess the effectiveness and safety of corticosteroid injections (CSI) for pediatric patients with non-rheumatologic peripheral musculoskeletal pain conditions.

Design: Systematic review.

Methods: A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Central was performed through August 2024 in alignment with PRISMA 2020 guidelines. Eligible studies included pediatric patients receiving CSI for peripheral musculoskeletal pain unrelated to rheumatologic disease. Primary outcomes were pain relief and functional improvement; secondary outcomes consisted of safety and adverse events. MASTER and GRADE scales evaluated risk of bias and certainty of evidence.

Results: In brief, 1061 studies were identified, six of which met inclusion criteria, encompassing 267 pediatric patients. Interventions targeted hip pain related to dislocation or femoroacetabular impingement (n = 4 studies), sacroiliac pain (n = 1), and acute anterior cruciate ligament tears (n = 1). Across most studies, CSI provided short-term pain relief and functional improvement, with post-injection follow-up ranging from 5 days to 5 years. However, the randomized controlled trial in ACL tear patients found no significant difference between CSI and saline placebo. Rare adverse events were reported, including localized swelling, pain flare, and one transient sciatic nerve block post-SI joint injection. There were no long-term complications reported. Evidence certainty was rated "very low" due to small sample sizes, heterogeneity, and risk of bias.

Conclusions: CSI may provide temporary pain relief for select pediatric peripheral musculoskeletal conditions, albeit with limited and low quality supporting evidence. Despite current data suggesting a favorable short-term safety profile, longer-term effects and standardized dosing guidelines are insufficient. Larger, higher-quality trials with more varied pediatric pathologies are required in order to elucidate the role of CSI in non-rheumatologic pediatric pain management.