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Centre for Evidence-
Based Medicine

Rotator cuff tendonitis - Subacromial corticosteroids decreases pain

Clinical Bottom Line

Subacromial injection of corticosteroids in patients with rotator cuff tendonitis has modest benefits on pain and range of motion.

Citation

Green S, Buchbinder R, Glazier R, Forbes A. Interventions for shoulder pain (Cochrane Review). In: The Cochrane Library, Issue 1, 1999. Oxford: Update Software.

Clinical Question

Are corticosteroid injections or physiotherapy effective in rotator cuff tendinitis?

Search Terms

"shoulder pain" in title - Cochrane Library

The Study

This review used an extenstive search strategy to identify 58 studies of treatment of painful shoulder; 27 trials were excluded because of non-randomization or lack of blinding. The 31 included studies had a variety of interventions including: NSAIDs (17 trials), intra-articular and subacromial corticosteroids (10 trials), physiotherapy (5 trials), and oral glucocorticoids (2 trials). Most measured pain and range of movement as outcomes. On a quality scale of 0 to 40, the mean trial quality was 16.8, with the highest being 22.

The Evidence

Data from two trials was pooled to determine the efficacy of subacromial steroid injection versus placebo in rotator cuff tendinitis. The Weighted Mean Difference suggested injection was superior to placebo in improving range of abduction (WMD = 35; 95%CI 14 to 55), and in pain (on a visual analogue scale).

Comments

The studies were generally small, of variable and low quality, and used very different populations and methods. However, there appears to be a consistent trend in favour of anti-inflammatory treatment, in particular, subacromial corticosteroids.

Appraised By

Paul Glasziou, 27 May 2000

Expiry Date

2 years from last review update