In common with other corticosteroids, triamcinolone is metabolised largely hepatically but also by the kidney and is excreted in urine. The main metabolic route is 6-beta-hydroxylation; no significant hydrolytic cleavage of the acetonide occurs. In view of the hepatic metabolism and renal excretion of triamcinolone acetonide, functional impairments of the liver or kidney may affect the pharmacokinetics of the drug. This may become clinically significant if large or frequent doses of intradermal or intra-articular triamcinolone acetonide are given.
Study Design Case report. Background Intra-articular hip pathologies can be difficult to diagnose, and evidence to guide physical therapy interventions is lacking. The purpose of this case report is to describe a clinical pathway for conservative management of a patient with an acute acetabular labral tear and femoroacetabular impingement. Case Description The patient was an 18-year-old woman with recent onset of right groin pain who underwent intra-articular corticosteroid injection and therapeutic exercise for the management of an acute acetabular labral tear identified on radiographic imaging. Prior to physical therapy, the patient received an intra-articular hip injection for diagnostic purposes and pain relief. Upon initial evaluation, the patient presented with improved pain but with continued kinesthetic deficits, inflexibility, muscle imbalances, and reproduction of symptoms with end-range hip motions. A physical therapy plan was implemented using neuromuscular re-education to address her continued impairments. Outcomes Marked improvements were noted at discharge and 6-month follow-up for pain, strength, and function as demonstrated on the Patient-Specific Functional Scale, global rating of change scale, and International Hip Outcome Tool-33. Discussion This case demonstrates a clinical pathway for collaborative medical management of a patient with confirmed intra-articular pathology. Details illustrate the clinical reasoning and rationale used to guide the clinical decision-making process. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(11):965-975. Epub 29 Sep 2016. doi:/.
Intramuscular Injection: Provides an extended duration of therapeutic effect and fewer side effects of the kind associated with oral corticosteroid therapy, particularly gastro-intestinal reactions such as peptic ulceration. Studies indicate that, following a single intramuscular dose of 80 mg triamcinolone acetonide, adrenal suppression occurs within 24 - 48 hours and then gradually returns to normal, usually in approximately three weeks. This finding correlates closely with the extended duration of therapeutic action of triamcinolone acetonide.