Moderate evidence supports the use of a single injection of corticosteroids with local anesthetic for short-term improvement in both pain and function for patients with shoulder pain.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Moderate Evidence MODERATE EVIDENCE
Rationale
One high quality study (Eyigor, C., 2010) compared corticosteroid injections with transcutaneous electrical nerve stimulator (TENS) treatment for the treatment of rotator cuff tendinitis. It showed an advantage in favor of injections with improvement in pain and functional scores for up to 12 weeks following the injection.

One high quality study (Rabini, A, 2012) compared corticosteroid injections with hyperthermia via localized microwave diathermy for rotator cuff tendinopathy with a follow up of 24 weeks. Both treatment groups showed equivalent improvement in functional scores but steroid injections showed better pain scores.

One high quality study (Penning, L. I. F., 2012) compared subacromial corticosteroid injections with hyaluronic acid injections or lidocaine (placebo injections in patients with subacromial impingement. There was no convincing benefit detected from hyaluronic acid injections compared with corticosteroid or placebo injections, whereas corticosteroid injections produced a better reduction in pain compared with placebo at 12 weeks but not at 26 weeks.

One high quality study (Alvarez, C. M., 2005) compared subacromial injection of corticosteroid injection to placebo (xylocaine) in chronic rotator cuff tendinosis. They were no more effective in improving the quality of life, range of motion, or impingement sign than xylocaine alone in patients with chronic rotator cuff tendinosis for all follow-up time intervals evaluated.

One high quality study (Kang, H., 2016) compared the efficacy of subacromial injection with sodium bicarbonate versus corticosteroid in patients with chronic subacromial bursitis: Both injections were equivalent in functional and pain scores for up to 4 weeks.

Despite the high quality of the above studies, the strength of the recommendation was downgraded to moderate due to variability of study findings.

Risks and Harms of Implementing this Recommendation
Corticosteroid injections in the setting of rotator cuff tears may be detrimental to the healing potential following cuff repair. Considering that rotator cuff diagnoses are clinical, a single corticosteroid injection may be given to confirm the presence of a symptomatic rotator cuff tear, but may adversely affect surgical outcomes.

Future Research
Further research is recommended to determine the role of corticosteroid injections in the various settings of rotator cuff pathology. Currently there is no high quality studies specifically addressing the role of corticosteroid injections in partial and / or full thickness cuff tears.
  1. (63) Alvarez CM, Litchfield R, Jackowski D, Griffin S, Kirkley A. A prospective, double-blind, randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendinosis. Am J Sports Med 2005;33(2):255-262.
  2. Eyigor, C., Eyigor, S., Korkmaz, O. K. Are intra-articular corticosteroid injections better than conventional TENS in treatment of rotator cuff tendinitis in the short run? A randomized study. European Journal of Physical and Rehabilitation Medicine 2010; 3: 315-324
  3. Kang, H., Jiang, H., Chai, D., Lin, Y., Li, Q. Comparison of the efficacy of subacromial injection with sodium bicarbonate versus corticosteroid in patients with chronic subacromial bursitis: A prospective, randomized and controlled study. International journal of clinical and experimental medicine 2016; 10: 18972-18980
  4. Penning, L. I. F., De Bie, R. A., Walenkamp, G. H. I. M. The effectiveness of injections of hyaluronic acid or corticosteroid in patients with subacromial impingement: A three-arm randomised controlled trial. Journal of Bone and Joint Surgery - Series B 2012; 9: 1246-1252
  5. Rabini, A, Piazzini, Db, Bertolini, C, Deriu, L, Saccomanno, Mf, Santagada, Da, Sgadari, A, Bernabei, R, Fabbriciani, C, Marzetti, E, Milano, G Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind andomized trial. The Journal of orthopaedic and sports physical therapy 2012; 4: 363-70
  6. Rabini, A, Piazzini, Db, Bertolini, C, Deriu, L, Saccomanno, Mf, Santagada, Da, Sgadari, A, Bernabei, R, Fabbriciani, C, Marzetti, E, Milano, G Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind andomized trial. The Journal of orthopaedic and sports physical therapy 2012; 4: 363-70