Clinical Review Fortnightly review

Corticosteroid injections in tendon lesions

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7309.382 (Published 18 August 2001) Cite this as: BMJ 2001;323:382
  1. C A Speed, senior research associate (cas50@medschl.cam.ac.uk)
  1. Rheumatology Unit, Department of Medicine, University of Cambridge, Cambridge CB2 2QQ
  • Accepted 5 June 2001

Periarticular soft tissue rheumatic complaints include localised disorders of tendons, ligaments, muscles, fascia, and joint capsules. Such complaints account for up to 59% of new patient referrals to a rheumatology practice1 and up to 15% of consultations in primary care.2 Tendon lesions (tendinopathies) represent a large proportion of these complaints and are often the most difficult to treat. Their high incidence of chronicity and recurrence 3 4 result in appreciable morbidity and loss of productivity, representing a major socioeconomic burden.5

Corticosteroid injections are one of the most commonly used treatments for chronic tendon lesions.1 Despite their popularity, the rationale for use of corticosteroid injections is contentious, the evidence for benefit is lacking, and they have potential adverse effects. This article describes the nature of tendon lesions, the basis for the use of local corticosteroids, and current evidence for beneficial and adverse effects.

Summary points

Tendon lesions are a varied group of common complaints

Various treatments are available

There is no good evidence to support the use of local corticosteroid injections in chronic tendon lesions

The lack of evidence is due to a true lack of effect or a lack of good trials

Accuracy of diagnosis and injection are important.

Methods

I searched the Cochrane Library, Medline, and Embase to identify studies of common pathological findings in tendinopathies and treatment with corticosteroids. I also looked for good systematic reviews of randomised controlled trials, and good randomised controlled trials published since the search date of identified reviews, relating to the evidence for effect, guidelines for use, and potential adverse effects of corticosteroid injections in tendinopathies. When no systematic review was available, I used data from individual randomised controlled trials, applying Sackett et al's quality criteria.6

Tendon structure and pathology

Tendons are collagenous structures with additional tenocytes, water, and other matrix components. Tendons are surrounded …

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