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Double whammy for steroid injections in shoulder pain

Issue 26 Synovium (Spring 2009)

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We have previously reported (Synovium 20) that local steroid injections appear to offer only short-term pain relief in tennis elbow and in the longer term are inferior to physiotherapy interventions. It now seems that the benefits are not extensive in shoulder pain either. The SAPPHIRE study1 randomised 91 practices in the UK to receive additional training in diagnosing and injecting rotator cuff problems or no additional training. Thereafter 200 patients consulting their GPs with shoulder pain were randomised to receive either a steroid or local anaesthetic injection. Sadly it appears that patient outcomes (pain and disability) 1 year later were not improved by training GPs in the diagnosis and treatment of shoulder disorders. Neither was there any advantage to injecting steroid in patients diagnosed with predominant rotator cuff disorder.

In another randomised double-blind trial involving 106 patients with rotator cuff disease and comparing ultrasound-guided subacromial steroid injection with intrasmuscular (gluteal) steroid injections,2 no significant differences in short-term outcomes between the two treatments was demonstrated. Rotator cuff disorder is likely to be the end product of a variable combination of factors that may include adverse biomechanics – instability or impingement – trauma and overuse, none of which steroids would address whichever route of administration was chosen. Unfortunately in the latter study no placebo injection was included – perhaps that would have been interesting.

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