The Shoulder

Infiltrations

Triamcinoloneacetonide

Side Effects

General Side Effects

These are even less than with the IA injections of 20 mg triamcinolone.

However, the following side effects are possible:

Hyperglycaemia. Glucocorticoids have an important influence on the intermediary metabolism. They increase circulatory glucose via stimulation of gluconeogenesis and decrease the intracellular use of glucose.
Therefore it is wise to warn diabetic patients for an increase of their blood sugar during the first few days after the local injection of triamcinolone.
Slight suppression of the adrenal cortex after prolonged administration of corticosteroids. Some cortical suppression seems to occur not only when steroids are administered orally but also after intra-articular injections. Prolonged administration renders the adrenals atrophic and provokes suprarenal insufficiency with symptoms such as hypotension, anorexia, fever and generalized joint or muscular pain.
Interference with the menstrual cycle. In female patients repeated injections with steroid may lead to dysfunctional uterine bleeding. Steroids may also interfere with hormonal contraceptives. There is no evidence for a teratogenic effect
Flushing. In the first few days after an intra-articular injection, some patients suffer from erythema and warmth in face, neck and chest. This is a totally benign but rather frequent sensation which is more common after the use of triamcinolone.
Allergic and anaphylactic reactions are extremely rare: rash, or bronchospasm and hypotension are the warning signs. Usually the additive carboxymethylcellulose and not the triamcinolone is responsible for the reaction. Sodium carboxymethylcellulose is widely used in the food and pharmaceutical industry as a suspending agent for insoluble powders in aqueous preparations.
Fat necrosis and skin atrophy. These side effects are due to a faulty injection technique or to leakage of the product after an intra-articular injection.

Local side effects

Corticosteroids impair the proliferation of fibroblasts and decrease the rate of production of matrix and mature collagen. The connective tissue will be (temporarily) of inferior quality.
There will be a decrease in ligamentous stiffness and in load and energy absorption.
It follows that there is more risk for tendon ruptures.
Although this risk is minimal when the infiltration technique is optimal and the recommendations on dose (1cc) and concentration (10 mg/ml) are followed, a possible tendon rupture should always be kept in mind, especially in sportsmen and self-employed workers.
After an infiltration there is usually a swift improvement in pain. Motivated by this apparent cure the sporter resumes his/her training and overloads the (weak) tendon, which may lead to further overuse injuries and ruptures.

Recommendations

The following recommendations should be given to the patient, in order to diminish the risk of tendinous damage after local infiltrations:

Relative rest for at least two weeks.
Progressive start of activities and training leading to a maximal load after one month.

A prudent therapist will:

give no more than three consecutive infiltrations.
refer the patient for deep transverse frictions in case of recurrences.