Corticosteroid injections for rotator cuff tendinosis
The wide use of corticosteroid injections into the subacromial space for symptomatic rotator cuff tendinosis may be attributable to habit or an incentive to satisfy the patient with a “quick fix” rather than discuss other options such as physiotherapy and exercise. This 2016 meta-analysis found corticosteroid injections provide, at best - minimal transient pain relief in one in five patients with rotator cuff tendinosis. They also found multiple injections were not more effective than a single injection at any time.
The authors noted the substantial heterogeneity of the 11 studies included in the analysis and limitations of bias. The study was also unable to calculate on a group level if the small transient improvements found would have been meaningful to the individual patients.
1 in 5 patients will experience a transient decrease in their pain to mild or less at 3 months follow up. That is a very limited and short-term plan for a long-term problem of rotator cuff tendinosis. Corticosteroid injections are uncomfortable for the patient and potentially harmful to the tendon, not to mention the cost and opportunity cost, it seems difficult to justify. The authors make a great point in that patients may not be getting complete information regarding their treatment options for this condition and they suggest a decision aid for the patient which might decrease the utility of corticosteroid injections.
> From: Mohamadi et al., Clin Orthop Relat Res 475 (2017) 232-243. All rights reserved to The Association of Bone and Joint Surgeons. Click here for the online summary.