Use only short-course steroid injections
Corticosteroid injections should only be used to treat tendinopathy in the short term, suggests a study published in the Lancet.
"Our systematic review challenges continued use of corticosteroid injections by providing strong evidence that they are worse in the long term than are most conservative interventions for tendinopathy," report the authors, led by Professor Bill Vincenzino from University of Queensland in Brisbane, Australia.
In a review of 3824 trials involving 2672 participants, the team consistently found that corticosteroids reduced pain in the short term compared with other treatments but that this effect was reversed in the intermediate and long term.
Of note, corticosteroid injections for lateral epicondylalgia (tennis elbow) produced a large reduction in pain for up to 8 weeks, but were associated with increased pain when given for 6 months or 1 year, compared with no intervention.
Despite the apparent deleterious effect of steroids in the longer term, only one tendon rupture was reported. Benefits were found with some alternative injection therapies, but the authors stress that questions remain about their therapeutic efficacy and physiologic basis.
While the review is not "a nail in the corticosteroid coffin", evidence of benefit from specific exercise therapy is more encouraging than for corticosteroids, commented Dr Karim Khan and Dr Alexander Scott from the University of British Columbia.
"Specific exercise therapy might produce more cures at 6 and 12 months than one or more corticosteroid injections, and such was the case in [this] analysis," they wrote in a related editorial.
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By Caroline Price