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Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review
  1. Tim Cook1,
  2. Catherine Minns Lowe2,
  3. Mark Maybury3,
  4. Jeremy S Lewis2
  1. 1 Department of Physiotherapy, Bognor Regis War Memorial Hospital, Bognor Regis, West Sussex, UK
  2. 2 School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
  3. 3 Physiotherapy Department, Heart of England NHS Foundation Trust, Good Hope Hospital, Sutton Coldfield, Birmingham, UK
  1. Correspondence to Professor Jeremy S Lewis, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK; jeremy.lewis{at}LondonShoulderClinic.com

Abstract

Objective To compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP).

Design Systematic review with best evidence synthesis.

Data sources The 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 criteria Two 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.

Results Thirteen 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.

Conclusion Corticosteroid 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 number PROSPERO CRD42016033161.

  • rotator cuff
  • steroids
  • review

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Footnotes

  • Contributors TC was the primary reviewer, extracted and analysed the data and was the primary author. CML contributed to the design of the review, editing support and guidance for the final manuscript. MM was the second reviewer. JL contributed to the conception and design of the review and editing of the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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