Steroid Injections
We cannot recommend for or against subacromial injections for patients with rotator cuff tears.
Rationale
One level II study55 found no statistically significant difference in pain or tenderness up to six weeks after injection of steroid with lidocaine compared to lidocaine injection alone.
In contrast, three Level IV56, 57, 58studies noted short term improvement with corticosteroid injection compared to baseline status, without comparison to a placebo control. We found no specific, compelling evidence to provide evidence-based recommendations concerning an ideal / absolute / safe number or frequency of subacromial corticosteroid injections in the setting of a rotator cuff tear. While it is logical for clinicians to consider potential adverse effects of corticosteroid injection upon rotator cuff tendon biology and healing capacity with rotator cuff repair (based upon general concerns across other areas of orthopaedic practice), there was no quality evidence to guide recommendations in this regard. Because the evidence that addresses this recommendation is limited and conflicting, the strength of this recommendation is Inconclusive.
In contrast, three Level IV56, 57, 58studies noted short term improvement with corticosteroid injection compared to baseline status, without comparison to a placebo control. We found no specific, compelling evidence to provide evidence-based recommendations concerning an ideal / absolute / safe number or frequency of subacromial corticosteroid injections in the setting of a rotator cuff tear. While it is logical for clinicians to consider potential adverse effects of corticosteroid injection upon rotator cuff tendon biology and healing capacity with rotator cuff repair (based upon general concerns across other areas of orthopaedic practice), there was no quality evidence to guide recommendations in this regard. Because the evidence that addresses this recommendation is limited and conflicting, the strength of this recommendation is Inconclusive.
- (55) Darlington L, Coomes E. The effects of local steroid injection for supraspinatus tears. Rheumatology Rehabilitation 1977;16:172-179.
- (56) Shibata Y, Midorikawa K, Emoto G, Naito M. Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg 2001;10(3):209-216.
- (57) Fearnley ME, Vadasz I. Factors influencing the response of lesions of the rotator cuff of the shoulder to local steroid injection. Ann Phys Med 1969;10(2):53-63.
- (58) Weiss JJ. Intra-articular steroids in the treatment of rotator cuff tear: reappraisal by arthrography. Arch Phys Med Rehabil 1981;62(11):555-557.