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Treating tendinopathy with steroid injections

Issue 32 Synovium (Spring 2011)

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Sore tendons have been treated with steroid injections in primary care for many years, particularly at the lateral elbow. Recently we have reported studies suggesting that patients have better outcomes when referred to physiotherapy. The notion that injected steroids are effective treatments for sore tendons is probably based on the assumption (now known to be incorrect) that an inflammatory process is occurring in symptomatic tendons.

A recent systematic review in The Lancet1 examined the evidence for benefits and risks of steroid injections in randomised controlled trials. Of 3824 studies identified from 8 databases only 41 met the entry criteria, providing a total of 2672 subjects for a meta-analysis. 12 studies were of lateral elbow pain (tennis elbow) and provided 1171 patients. The findings confirm that steroid injections provide effective short-term pain relief but that other treatments provide better outcomes over the medium and longer term. However, the effect size varied from one tendon site to another, being greatest for lateral elbow pain. Other more effective treatments providing better longer-term outcomes included hyaluronate, botulinum toxin and sclerosant injections and eccentric loading exercises – again, effect sizes varied from one site to another. Adverse effects were uncommon with steroid injections, however, and there was only one tendon rupture – after injection of the Achilles tendon.

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