CORTICOSTEROID INJECTION

While many high-quality studies addressed efficacy of corticosteroid steroid injections (CSI), either as a primary intervention or comparison group, fewer included long term follow up. Three high quality studies with follow up ranging from 6 months to 5 years demonstrated no benefits (Hofer 2021, Salman 2018, Atroshi 2013). A study comparing CSI to nighttime immobilization found no significant differences at 1-2 years (Burton 2022) and an additional study comparing CSI to prolotherapy also showed no difference at 1 year (Aghaei 2021). Taken together, there is strong evidence that, while there may be short-term improvement in symptoms with CSI, there is no long-term benefit.

Benefits/Harms of Implementation
CSI may provide short term improvement in symptoms. A therapeutic injection may cause localized pain and swelling, rare allergic reactions, and a small possibility of nerve damage.

Outcome Importance
CSI are very common and popular interventions with high utilization in clinical practice, thus this recommendation informs standard treatment for many surgeons.

Cost Effectiveness/Resource Utilization
CSI are, individually, inexpensive interventions relative to many other treatments. Limited data address cost-effectiveness.

Acceptability
We expect this recommendation to be generally accepted, however, CSI for short term relief of symptoms may continue.

Feasibility
Minimizing use of CSI for any long-term benefit is readily available and feasible.

Future Research
Future investigation can focus on assessing the short-term benefits to patients, in relation to the cost, to evaluate the cost-effectiveness and value of CSI, given the lack of long-term effectiveness.