• corticosteroids
• osteoarthritis
• tendinopathy

Cortisone is the most common class of injection in musculoskeletal medicine. Expert guidelines, such as the 2017 edition of Therapeutic Guidelines: Rheumatology (Australia),1 generally recommend corticosteroid injections (CSI) as a treatment for most tendon and joint pain conditions (including those listed in table 1). I quote, ‘local corticosteroid injections should only be given by, or under the supervision of, clinicians with appropriate training and experience’.1 I find it remarkable that the guidelines do not spell out that cortisone injections should only be given where high-quality evidence shows that benefits outweigh the harms; that is, the widespread recommendations to use CSI for multiple joints and multiple tendons are ‘eminence-based’ (who should give them) rather than ‘evidence-based’ (when they should be given).

To be fair, I see that ‘appropriate training’ could cover ‘knowing the indications’ for a treatment but at a time where medical overtreatment is incontrovertible—it exists and no one denies it exists—I argue that the case for ‘indication-based treatment’ should be explicit.