PAIN+ CPN

Corticosteroid injections do not reduce pain from rotator cuff tendinosis at 3 months

This Evidence Summary is based on the following systematic review:

Mohamadi A, Chan JJ, Claessen FM, et al. Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis. Clin Orthop Relat Res. 2017 Jan;475(1):232-243. doi: 10.1007/s11999-016-5002-1. Epub 2016 Jul 28. PubMed

Review questions

In people who have rotator cuff tendinosis, do single or repeated corticosteroid injections relieve pain at 3 months after treatment compared with placebo?

Background

As they age, many people have shoulder pain that is caused by tendons that deteriorate over time but without any swelling. This is known as rotator cuff tendinosis but can also be called tendinopathy, tendinitis, or impingement. For many types of joint pain, corticosteroid injections are used to reduce swelling and pain.

How the review was done

The researchers did a systematic review, searching for studies that were published up to August 2015.

They found 11 high-quality randomized controlled trials including 726 people who were, on average, 54 years old.

People in the studies were adults who had rotator cuff tendinosis and had pain measured at least 1 week after the injections.

Corticosteroids were compared with placebo (normal saline or local anesthetic).

What the researchers found

3 months after having the injections, there were:

  • no differences in pain between groups who received a single corticosteroid injection compared with those who received a placebo injection; and
  • no differences in pain between groups who received repeated corticosteroid injections compared with those who received repeated placebo injections.

Small temporary pain relief (about half of a point on a 10-point pain scale) occurred in the corticosteroid group between 4 and 8 weeks after the injection. At least 5 patients would need to be treated for 1 patient to have their pain temporarily reduced.

Multiple, repeated injections were not better than a single injection at any time.

Conclusions

In people who have rotator cuff tendinosis, corticosteroid injections give short-term relief to 1 in 5 patients but do not reduce pain at 3 months compared with placebo. Multiple, repeated injections are not better than 1 or no injections.

Corticosteroid injections vs placebo for treatment of pain in people who have rotator cuff tendinosis

Comparison

Number of trials (number of people)

Effect of steroid injection on pain at 3 months

Single injection vs placebo

6 trials (number of people not reported)

Pain did not differ between groups

Multiple, repeated injections vs placebo

3 trials (number of people not reported)

Pain did not differ between groups

Either single or repeated injections vs placebo

8 trials (564 people)

Pain did not differ between groups

This Evidence Summary was originally prepared for the McMaster Optimal Aging Portal.

Published: Friday, July 28, 2017