Coombes, Lancet 2010 - Efficacy and Safety of Corticosteroid Injections and Other Injections for Management of Tendinopathy: A Systematic Review of Randomised Controlled Trials
|
Efficacy and Safety of Corticosteroid Injections and Other Injections for Management of Tendinopathy: A Systematic Review of Randomised Controlled Trials
Coombes, Vicenzino, et al.·Lancet·2010·857 citations·Meta-analysis
Coombes and colleagues pooled randomized trials to measure how well corticosteroid and other injections relieve tendinopathy pain, and how often they cause harm.
Systematic review with random‑effects meta‑analysis of 41 randomized trials (2672 participants), searched in March 2010.
Methods
Design
Systematic review of randomized controlled trials
Random‑effects meta‑analysis using SMDs and relative risks
Reported per Cochrane and PRISMA guidance
Search
Eight databases, March 2010
No limits on language, publication status or date
Reference lists also searched
Included
41 of 3824 identified trials
Peritendinous injection vs placebo or non‑surgical care
Modified PEDro score above 50%
Intramuscular and intra‑articular injections excluded
Population
2672 participants with tendinopathy
Sites included lateral elbow, rotator cuff and Achilles tendon
Comparison
Corticosteroid injection vs no intervention, placebo or other non‑surgical care
Non‑corticosteroid injectates such as platelet‑rich plasma and sodium hyaluronate
Outcomes
Pain at short term (4 weeks, range 0 to 12)
Pain at intermediate term (26 weeks, range 13 to 26)
Pain at long term (52 weeks or later)
Adverse events
Key Findings
Across many high‑quality trials, corticosteroid injection eased pain early more than other treatments, but by intermediate and long‑term follow‑up the advantage had reversed.
For lateral epicondylalgia, corticosteroid beat no intervention at short term (SMD 1.44, 95% CI 1.17 to 1.71), but no intervention was favored at 26 weeks (−0.40, p < 0.003) and 52 weeks (−0.31, p = 0.05).
In one lateral epicondylalgia trial, repeated corticosteroid injections (mean 4.3 over 18 months) were associated with worse long‑term pain than a single injection.
Whether corticosteroid injection relieves rotator‑cuff tendinopathy pain in the short term remained unclear.
Serious harm was rare, with 1 of 991 corticosteroid recipients (0.1%) in trials reporting adverse events sustaining a tendon rupture.
Board pearl
Tendinopathy histology shows angiofibroblastic hyperplasia without inflammation, which the authors cited as one reason corticosteroid injection was being questioned.
Authors' conclusion
Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy.
Efficacy and Safety of Corticosteroid Injections and Other Injections for Management of Tendinopathy: A Systematic Review of Randomised Controlled Trials
Coombes, Vicenzino, et al.·Lancet·2010·857 citations·Meta-analysis
Coombes and colleagues pooled randomized trials to measure how well corticosteroid and other injections relieve tendinopathy pain, and how often they cause harm.
Systematic review with random‑effects meta‑analysis of 41 randomized trials (2672 participants), searched in March 2010.
Methods
Design
Systematic review of randomized controlled trials
Random‑effects meta‑analysis using SMDs and relative risks
Reported per Cochrane and PRISMA guidance
Search
Eight databases, March 2010
No limits on language, publication status or date
Reference lists also searched
Included
41 of 3824 identified trials
Peritendinous injection vs placebo or non‑surgical care
Modified PEDro score above 50%
Intramuscular and intra‑articular injections excluded
Population
2672 participants with tendinopathy
Sites included lateral elbow, rotator cuff and Achilles tendon
Comparison
Corticosteroid injection vs no intervention, placebo or other non‑surgical care
Non‑corticosteroid injectates such as platelet‑rich plasma and sodium hyaluronate
Outcomes
Pain at short term (4 weeks, range 0 to 12)
Pain at intermediate term (26 weeks, range 13 to 26)
Pain at long term (52 weeks or later)
Adverse events
Key Findings
Across many high‑quality trials, corticosteroid injection eased pain early more than other treatments, but by intermediate and long‑term follow‑up the advantage had reversed.
For lateral epicondylalgia, corticosteroid beat no intervention at short term (SMD 1.44, 95% CI 1.17 to 1.71), but no intervention was favored at 26 weeks (−0.40, p < 0.003) and 52 weeks (−0.31, p = 0.05).
In one lateral epicondylalgia trial, repeated corticosteroid injections (mean 4.3 over 18 months) were associated with worse long‑term pain than a single injection.
Whether corticosteroid injection relieves rotator‑cuff tendinopathy pain in the short term remained unclear.
Serious harm was rare, with 1 of 991 corticosteroid recipients (0.1%) in trials reporting adverse events sustaining a tendon rupture.
Board pearl
Tendinopathy histology shows angiofibroblastic hyperplasia without inflammation, which the authors cited as one reason corticosteroid injection was being questioned.
Authors' conclusion
Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy.