Injections of Corticosteroids vs Local Anesthetic in Rotator Cuff-Related Shoulder Pain

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For this analysis, 2 investigators independently reviewed 13 randomized controlled trials.
For this analysis, 2 investigators independently reviewed 13 randomized controlled trials.

Corticosteroid injections may be associated with greater efficacy in the short-term compared with local anesthetic injections in the treatment of rotator cuff-related shoulder pain (RCRSP), according to a systematic review published in the British Journal of Sports Medicine.

For this analysis, 2 investigators independently reviewed 13 randomized controlled trials that compared single or repeated injections of local anesthetic injections without corticosteroids vs subacromial corticosteroid injections with or without local anesthetic in the treatment of RCRSP.

Pain, function, range of motion, and patient-reported improvements were assessed at 3 months, 3 to 12 months, and ≥1 year.

The trials included in the review had a total of 1013 patients, with three of four studies considered at low risk for bias and indicating a greater improvement in patient outcomes with corticosteroid vs anesthetic-only injections for up to 8 weeks. No significant difference was observed between the 2 patient groups at the 3- to 12-month follow-up. In addition, the available data did not allow assessment of the benefits of one type of injection over the other in the longer term (≥1 year).

To assess the risk for bias, the researchers used the domain-based Cochrane tool for randomized controlled trials, which is often associated with modest inter-rater agreement and a limited ability to assess for bias associated with conflicts of interest. Another limitation of the systematic review lies in the publication bias resulting from the omission of grey literature sources such as government reports and conference papers.

 “If local anesthetics prove safe and effective in future research, significant cost savings could be achieved,” concluded the investigators.

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Reference

Cook T, Minns Lowe C, Maybury M, Lewis JS. Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review [published online January 5, 2018]. Br J Sports Med. doi:10.1136/bjsports-2016-097444

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