Efficacy and safety of corticosteroid injections for management of tendinopathy

January 01, 0001

Efficacy and safety of corticosteroid injections for management of tendinopathy

Few evidence-based treatment guidelines for tendinopathy exist. The researchers from Queensland, Australia undertook a systematic review of randomised trials to establish clinical efficacy and risk of adverse events for treatment by injection. They searched eight databases without language, publication, or date restrictions. They included randomised trials assessing efficacy of one or more peritendinous injections with placebo or non-surgical interventions for tendinopathy, scoring more than 50% on the modified physiotherapy evidence database scale. 3824 trials were identified and 41 met inclusion criteria, providing data for 2672 participants.

They found consistent findings between many high-quality randomised controlled trials that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms. For example, in pooled analysis of treatment for lateral epicondylalgia, corticosteroid injection had a large effect (defined as standardised mean differences, SMD greater than 0.8) on reduction of pain compared with no intervention in the short term (SMD 1.44, significant), but no intervention was favoured at intermediate term and long term. Short-term efficacy of corticosteroid injections for rotator-cuff tendinopathy is not clear. Of 991 participants who received corticosteroid injections in studies that reported adverse events, only one (0.1%) had a serious adverse event (tendon rupture). By comparison with placebo, reductions in pain were reported after injections of sodium hyaluronate (short, intermediate and long terms), botulinum toxin (short term) and prolotherapy (intermediate term) for treatment of lateral epicondylalgia. Lauromacrogol (polidocanol), aprotinin, and platelet-rich plasma were not more efficacious than was placebo for Achilles tendinopathy, while prolotherapy was not more effective than was eccentric exercise.

The researchers concluded: "Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy."

Different areas of the body may well benefit from individualized approaches. Confirmation of diagnosis is also important.

For the full abstract, click here.

The Lancet published online 22 October 2010
© 2010 Elsevier Ltd
Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Brooke K Coombes, Leanne Bisset and Bill Vicenzino. Correspondence to Prof Bill Vicenzino: [email protected]

Category: M. Musculoskeletal. Keywords: efficacy, safety, corticosteroid, injections, management, tendinopathy, systematic review of randomised trials, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 5 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.