Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis.

Area of Science:

• Orthopedics
• Pain Management
• Rheumatology

Background:

• The efficacy of subacromial corticosteroid injections for rotator cuff tendinosis pain relief is controversial.
• The number of patients requiring treatment for meaningful pain reduction beyond placebo is unclear.

Purpose of the Study:

• To determine if corticosteroid injections reduce pain in rotator cuff tendinosis patients at 3 months and calculate the number needed to treat (NNT).
• To assess if multiple injections are superior to a single injection for pain reduction at 3 months.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing corticosteroid injections to placebo for rotator cuff tendinosis.
• Eleven studies (726 patients) were included; three studies (292 patients) analyzed repeat injections.
• Pooled standardized mean difference (SMD) and NNT were calculated using a random effects model due to heterogeneity.

Main Results:

• Corticosteroid injections did not significantly reduce pain compared to placebo at 3 months.
• A small, transient pain relief was observed between 4-8 weeks (SMD 0.52), requiring treatment of at least five patients for one to experience mild relief.
• Multiple injections showed no added benefit over single injections.

Conclusions:

• Corticosteroid injections provide minimal, transient pain relief for a limited number of rotator cuff tendinosis patients.
• These injections do not alter the disease's natural course and have limited therapeutic appeal due to side effects and costs.
• Widespread use may stem from placebo effect underestimation, patient preference, or financial incentives rather than clinical utility.