Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

Background The ability of injection of corticosteroids into the subacromial space to relieve pain ascribed to rotator cuff tendinosis is debated. The number of patients who have an injection before one gets relief beyond what a placebo provides is uncertain. Questions/purposes We asked: (1) Do corti...

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Bibliographic Details
Published in:Clinical Orthopaedics and Related Research 2017-01, Vol.475 (1), p.232-243
Main Authors: Mohamadi, Amin, Chan, Jimmy J., Claessen, Femke M. A. P., Ring, David, Chen, Neal C.
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Conservative Orthopedics
Humans
Injections
Medicine
Medicine & Public Health
Meta-Analysis
Orthopedics
Pain Management
Rotator Cuff Injuries - drug therapy
Shoulder
Sports Medicine
Surgery
Surgical Orthopedics
Treatment Outcome
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Summary:Background The ability of injection of corticosteroids into the subacromial space to relieve pain ascribed to rotator cuff tendinosis is debated. The number of patients who have an injection before one gets relief beyond what a placebo provides is uncertain. Questions/purposes We asked: (1) Do corticosteroid injections reduce pain in patients with rotator cuff tendinosis 3 months after injection, and if so, what is the number needed to treat (NNT)? (2) Are multiple injections better than one single injection with respect to pain reduction at 3 months? Methods We systematically searched seven electronic databases for randomized controlled trials of corticosteroid injection for rotator cuff tendinosis compared with a placebo injection. Eligible studies had at least 10 adults and used pain intensity as an outcome measure. The Hedges’s g as adjusted pooled standardized mean difference (SMD) (which expresses the size of the intervention effect in each study relative to the total variability observed among pooled studies) and NNT were calculated at assessment points less than 1 month, 1–2 months, and 2–3 months. The protocol of this study was registered at the international prospective register of systematic reviews. Eleven studies of 726 patients satisfied our criteria for data pooling. Three studies containing 292 patients used repeat injections. A random effects model was used owing to substantial heterogeneity among studies. The funnel plot indicated the possibility of some missing studies, but Orwin’s fail-safe N and Duval and Tweedie’s trim and fill suggested that missing studies would not significantly affect the results. Results Corticosteroid injection did not reduce pain intensity in adult patients with rotator cuff tendinosis more than a placebo injection at the 3-month assessment. A small transient pain relief occurred at the assessment between 4 and 8 weeks with a SMD of 0.52 (range, 0.27–0.78) (p 
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-016-5002-1