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Sports Medicine
Published in: Sports Medicine 7/2014

01-07-2014 | Systematic Review

Myotoxicity of Injections for Acute Muscle Injuries: A Systematic Review

Authors: Gustaaf Reurink, Gert Jan Goudswaard, Maarten H. Moen, Adam Weir, Jan A. N. Verhaar, Johannes L. Tol

Published in: Sports Medicine | Issue 7/2014

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Abstract

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.
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Metadata
Title
Myotoxicity of Injections for Acute Muscle Injuries: A Systematic Review
Authors
Gustaaf Reurink
Gert Jan Goudswaard
Maarten H. Moen
Adam Weir
Jan A. N. Verhaar
Johannes L. Tol
Publication date
01-07-2014
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 7/2014
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-014-0186-6

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