BACKGROUND: Injection therapies are widely used for muscle injuries. As there is only limited evidence of their efficacy, physicians should be aware of the potential harmful effects of these injected preparations. OBJECTIVES: The purpose of this review was to systematically review the literature on the myotoxic effects of intramuscular injection preparations commonly used for acute muscle injuries. DATA SOURCES: The databases of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and SportDiscus were searched in March 2013. STUDY ELIGIBILITY CRITERIA: Studies reporting histological evaluation or creatine kinase activity after intramuscular injection with local anaesthetics, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), platelet-rich plasma (PRP), Traumeel(®) and Actovegin(®), or combination preparations were eligible for inclusion. DATA ANALYSIS: Two authors independently screened the search results and assessed the risk of bias. A best-evidence synthesis was used to identify the level of evidence. RESULTS: Forty-nine studies were included in this systematic review. There is strong to moderate evidence that intramuscularly injected local anaesthetics and NSAIDs are myotoxic, and there is conflicting evidence of the myotoxicity of PRP. There is limited evidence that single corticosteroid injections are not myotoxic but have a synergistic myotoxic effect when used together with local anaesthetics. There is no information to assess whether Actovegin(®) and Traumeel(®) are myotoxic. CONCLUSION: Local anaesthetics and NSAID injections are not recommended for the treatment of muscle injuries in athletes, as they are myotoxic. The possible myotoxic effects of corticosteroids, PRP, Traumeel(®) and Actovegin(®) should be assessed in future research.
BACKGROUND: Injection therapies are widely used for muscle injuries. As there is only limited evidence of their efficacy, physicians should be aware of the potential harmful effects of these injected preparations. OBJECTIVES: The purpose of this review was to systematically review the literature on the myotoxic effects of intramuscular injection preparations commonly used for acute muscle injuries. DATA SOURCES: The databases of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and SportDiscus were searched in March 2013. STUDY ELIGIBILITY CRITERIA: Studies reporting histological evaluation or creatine kinase activity after intramuscular injection with local anaesthetics, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), platelet-rich plasma (PRP), Traumeel(®) and Actovegin(®), or combination preparations were eligible for inclusion. DATA ANALYSIS: Two authors independently screened the search results and assessed the risk of bias. A best-evidence synthesis was used to identify the level of evidence. RESULTS: Forty-nine studies were included in this systematic review. There is strong to moderate evidence that intramuscularly injected local anaesthetics and NSAIDs are myotoxic, and there is conflicting evidence of the myotoxicity of PRP. There is limited evidence that single corticosteroid injections are not myotoxic but have a synergistic myotoxic effect when used together with local anaesthetics. There is no information to assess whether Actovegin(®) and Traumeel(®) are myotoxic. CONCLUSION: Local anaesthetics and NSAID injections are not recommended for the treatment of muscle injuries in athletes, as they are myotoxic. The possible myotoxic effects of corticosteroids, PRP, Traumeel(®) and Actovegin(®) should be assessed in future research.
Authors: Sheila Jean McNeill Ingham; Alberto de Castro Pochini; Daniel Antonio de Oliveira; Bianca Cristina Garcia Lisboa; Abram Beutel; Valderez Bastos Valero-Lapchik; Ana Maria Ferreira; Rene Jorge Abdalla; Moisés Cohen; Sang Won Han Journal: PM R Date: 2011-10-05 Impact factor: 2.298
Authors: André Gismonti Garcia; Renato Andrade; José Afonso; José Luíz Runco; Antonio Maestro; João Espregueira-Mendes Journal: J Orthop Date: 2022-04-11
Authors: Stefan G Mattyasovszky; Eva K Langendorf; Ulrike Ritz; Christoph Schmitz; Irene Schmidtmann; Tobias E Nowak; Daniel Wagner; Alexander Hofmann; Pol M Rommens; Philipp Drees Journal: J Orthop Surg Res Date: 2018-04-06 Impact factor: 2.359
Authors: T Hotfiel; R Seil; W Bily; W Bloch; A Gokeler; R M Krifter; F Mayer; P Ueblacker; L Weisskopf; M Engelhardt Journal: J Exp Orthop Date: 2018-06-22
Authors: Patrick Belikan; Lisa Nauth; Lars-Christopher Färber; Frédéric Abel; Eva Langendorf; Philipp Drees; Pol Maria Rommens; Ulrike Ritz; Stefan G Mattyasovszky Journal: Int J Mol Sci Date: 2020-03-19 Impact factor: 5.923