Katherine L Margo, MD
What are the short-, intermediate-, and long-term clinical effects of peritendinous injections for tendinopathy?
Included studies compared ≥ 1 peritendinous injection with placebo or nonsurgical interventions in patients who had tendinopathy; and had quality scores > 50% on the modified Physiotherapy Evidence Database (PEDro) scale (maximum score = 13). Studies with a high proportion of patients with adhesive capsulitis, rheumatologic disease, or full-thickness tears were excluded. Outcomes included study-defined pain scores and function.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, Cochrane Controlled Trials Register, Web of Knowledge, Allied and Complementary Medicine, SPORTDiscus, and Physiotherapy Evidence Database (in Mar 2010); and reference lists were searched for randomized controlled trials (RCTs). 41 RCTs (n = 2672) met the selection criteria: 34 reported short-term outcomes (0 to 12 wk), 18 intermediate-term outcomes (13 to 26 wk), and 11 long-term outcomes (≥ 52 wk). 17 RCTs involved patients with lateral epicondylalgia, 16 rotator cuff tendinopathy, 6 Achilles tendinopathy, 2 patellar tendinopathy, 1 both Achilles and patellar tendinopathy, and 1 medial epicondylalgia. Injections used and comparisons evaluated varied. Different scales were used to measure pain and function.
The main results of pooled analyses of corticosteroids for reducing pain are shown in the Table. Results were similar for improving function. Limited data exist to evaluate other peritendinous injections and other conditions.
Corticosteroids improve short-term outcomes but are worse than no intervention or physiotherapy for intermediate- and long-term outcomes for some types of tendinopathy. Evidence is insufficient to evaluate effectiveness of other types of injection.
Corticosteroid injections for reducing pain in tendinopathy*
*NSAID = nonsteroidal antiinflammatory drug; SMD = standardized mean difference; other abbreviations defined in Glossary. Only comparisons including > 1 study are reported here.
†Short = 0 to 12 wk, intermediate = 13 to 26 wk, long = ≥ 52 wk.
‡Random-effects model. Difference > 0 indicates benefit with corticosteroids. SMD of 1 = difference in mean effect between groups of 1 pooled standard deviation: SMD < 0.5 = small effect, 0.5 to 0.8 = medium effect, and > 0.8 = large effect.
§All 3 studies showed benefit in favor of corticosteroids.
Margo KL. Review: Corticosteroids improve short-term outcomes but worsen longer-term outcomes in some types of tendinopathy. Ann Intern Med. 2011;154:JC2–5. doi: 10.7326/0003-4819-154-4-201102150-02005
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Published: Ann Intern Med. 2011;154(4):JC2-5.
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