LIMITED RECOMMENDATION Four high, four moderate and two low quality studies investigated the use of multiple steroid injections in treating rotator cuff rears (Abolhasani, 2019; Damjanov, 2018; Vaquerizo, 2023; Hsieh, 2021; Rabini, 2012; Sabaah, 2020; Hsieh, 2023, Eyigor, 2010; Sadeghifar, 2022; De Castro Correia, 2023). This recommendation was downgraded to limited strength for heterogeneity and inconclusive results. None of the reviewed studies provided evidence for or against repeated CS injections due to adverse events such as rotator cuff integrity.
Risks and Harms of Implementing this Recommendation
Corticosteroid injections in the setting of rotator cuff tears may be detrimental to the healing potential following rotator cuff repair. A single corticosteroid injection may be given to confirm the presence of rotator cuff pathology but may adversely affect outcomes if performed in temporal proximity to surgical intervention.
Future Research
Further research is recommended to determine the role of corticosteroid injections in the various settings of rotator cuff pathology.
- Eyigor, C., Eyigor, S., Kivilcim Korkmaz, O. 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 & rehabilitation medicine. 2010; 3: 315-24
- Sabaah, Hala M Abd Elsabour, Nassif, Mary A What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study. Egyptian Rheumatology and Rehabilitation 2020; 0: 1-7
- Sadeghifar, A., Saied, A., Abbaspour, V., Zandrahimi, F. Comparison of the efficacy of physiotherapy, subacromial corticosteroid, and subacromial hyaluronic acid injection in the treatment of subacromial impingement syndrome: A retrospective study. Current Orthopaedic Practice 2022; 5: 442-446
- Abolhasani, Hamed, Falsafi, Mani, Khafri, Soraya, Frydoni, Masoud Bahrami Comparison of efficacy of ketorolac, triamcinolone and betamethasone injections in the treatment of shoulder impingement syndrome. Journal of Evolution of Medical and Dental Sciences 2019; 26: 2050-2055
- Damjanov, N., Barac, B., Colic, J., Stevanovic, V., Zekovic, A., Tulic, G. The efficacy and safety of autologous conditioned serum (ACS) injections compared with betamethasone and placebo injections in the treatment of chronic shoulder joint pain due to supraspinatus tendinopathy: a prospective, randomized, double-blind, controlled study. Medical Ultrasonography 2018; 3: 335-341
- Vaquerizo, V., Garcia-Lopez, M., Mena-Roson, A., Prado, R., Padilla, S., Anitua, E. Plasma rich in growth factors versus corticosteroid injections for management of chronic rotator cuff tendinopathy: a prospective double-blind randomized controlled trial with 1 year of follow-up. Journal of Shoulder & Elbow Surgery 2023; 3: 555-564
- De Castro Correia, M., Oliveira, L., Moita Goncalves, E., Correia, R., Andrade, I., Borges, A., Rodrigues Lopes, T., Carvalho, J. L. Suprascapular Nerve Pulsed Radiofrequency as an Effective Pain Relief Strategy in Supraspinatus Muscle Tendon Tears. Cureus 2023; 10: e46936
- Rabini, A., Piazzini, D. B., Bertolini, C., Deriu, L., Saccomanno, M. F., Santagada, D. A., 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 randomized trial. Journal of Orthopaedic & Sports Physical Therapy 2012; 4: 363-70
- Hsieh, L. F., Kuo, Y. C., Huang, Y. H., Liu, Y. F., Hsieh, T. L. Comparison of corticosteroid injection, physiotherapy and combined treatment for patients with chronic subacromial bursitis - A randomised controlled trial. Clinical Rehabilitation 2023; 9: 1189-1200
- Hsieh, L. F., Lin, Y. J., Hsu, W. C., Kuo, Y. C., Liu, Y. C., Chiang, Y. P., Wang, C. P. Comparison of the corticosteroid injection and hyaluronate in the treatment of chronic subacromial bursitis: A randomized controlled trial. Clinical Rehabilitation 2021; 9: 1305-1316