Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review

• Published in: British journal of sports medicine Vol. 52; no. 8; pp. 497 - 504
• Main Authors: Cook, Tim, Minns Lowe, Catherine, Maybury, Mark, Lewis, Jeremy S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2018
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Anesthetics - therapeutic use; Bursitis; Clinical trials; Humans; Injections, Intra-Articular; Medical treatment; Pain; Randomized Controlled Trials as Topic; Range of Motion, Articular; Rheumatology; Rotator cuff; Rotator Cuff - physiopathology; Shoulder; Shoulder Pain - drug therapy; Steroids; Systematic review; United Kingdom > UK; rotator cuff; review; steroids
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2016-097444

ObjectiveTo compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP).DesignSystematic review with best evidence synthesis.Data sourcesThe Cochrane, PubMed, CINAHL Plus, PEDro and EMBASE electronic databases were searched (inception until 8 June 2017). Reference lists of included articles were also hand searched.Eligibility criteriaTwo reviewers independently evaluated eligibility. Randomised controlled trials (RCTs) were included if they compared subacromial injections of corticosteroid with anaesthetic injections. Two reviewers independently extracted data regarding short-term, midterm and long-term outcomes for pain, self-reported function, range of motion and patient-perceived improvement.ResultsThirteen RCTs (n=1013) were included. Four trials (n=475) were judged as being at low risk of bias. Three studies of low risk of bias favoured the use of corticosteroid over anaesthetic-only injections in the short term (up to 8 weeks). There was strong evidence of no significant difference between injection types in midterm outcomes (12–26 weeks). There was limited evidence of no significant difference between injection types in long-term outcomes.ConclusionCorticosteroid injections may have a short-term benefit (up to 8 weeks) over local anaesthetic injections alone in the management of RCRSP. Beyond 8 weeks, there was no evidence to suggest a benefit of corticosteroid over local anaesthetic injections.Trial registration numberPROSPERO CRD42016033161.