Systematic review of 41 randomised trials (2672 patients) evaluating injection therapies for tendinopathy. It asks whether corticosteroid and alternative injections actually help across short, intermediate, and long-term timepoints. Sites covered include lateral epicondylalgia, rotator cuff, Achilles, and patellar tendinopathy.
When a patient with tennis elbow asks for a steroid shot, this paper is the reason to have a longer conversation. The corticosteroid gives fast relief, but at 6 months and 1 year these patients do worse than those managed with a wait-and-see or physiotherapy approach. The short-term win comes with a long-term penalty and high recurrence.
The mechanistic teaching point: tendinopathy is degenerative, not inflammatory. An anti-inflammatory drug injected into non-inflamed, degenerating collagen may suppress the healing response, which fits the worse long-term data.
Do not generalize across sites. The reversal effect is clearest for lateral epicondylalgia. For rotator-cuff tendinopathy the evidence is conflicting and steroids show no edge over NSAIDs or physiotherapy. Safety is reassuring: serious harm is about 0·1%. The argument against routine steroid use is durability and recurrence, not rupture risk.
Systematic review of 41 randomised trials (2672 patients) evaluating injection therapies for tendinopathy. It asks whether corticosteroid and alternative injections actually help across short, intermediate, and long-term timepoints. Sites covered include lateral epicondylalgia, rotator cuff, Achilles, and patellar tendinopathy.
When a patient with tennis elbow asks for a steroid shot, this paper is the reason to have a longer conversation. The corticosteroid gives fast relief, but at 6 months and 1 year these patients do worse than those managed with a wait-and-see or physiotherapy approach. The short-term win comes with a long-term penalty and high recurrence.
The mechanistic teaching point: tendinopathy is degenerative, not inflammatory. An anti-inflammatory drug injected into non-inflamed, degenerating collagen may suppress the healing response, which fits the worse long-term data.
Do not generalize across sites. The reversal effect is clearest for lateral epicondylalgia. For rotator-cuff tendinopathy the evidence is conflicting and steroids show no edge over NSAIDs or physiotherapy. Safety is reassuring: serious harm is about 0·1%. The argument against routine steroid use is durability and recurrence, not rupture risk.