Editor—Speed discussed corticosteroid injections in tendon lesions.1 We agree that there is a lack of good randomised trials in this field, but we disagree with his conclusion that in rotator cuff tendinopathy, range of movement but not pain is improved by steroid injection.
Speed comments that analysis of the pooled data in two prospective randomised trials showed an improvement in abduction but not pain after steroid injections. It is not clear if this is compared with anti-inflammatory treatment or placebo. When examined individually, however, these papers concluded that triamcinolone significantly improved pain at four weeks compared with placebo and showed non-significant benefits compared with naproxen or diclofenac.2,3
Furthermore, in our experience, steroid injections provide pain relief sufficient to obviate surgical treatment in a proportion of patients with tendinopathy without rotator cuff tears. This is supported by a prospective randomised controlled double blind clinical study from the Hospital for Joint Diseases in New York that shows the efficacy of steroid injections in providing pain relief for the subacromial impingement syndrome.4 In this study, 40 patients with confirmed signs of impingement in the absence of a rotator cuff tear, pain, and range of movement improved noticeably during up to six months of follow up when compared with local anaesthetic alone.
We think that in the case of rotator cuff tendinopathy steroid injections are a worthwhile addition to the physician's list of options.
References
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