Corticosteroid injections in tendon lesions

I think Dr McKenzie appears to feel unnecessarily threatened by this
article.

While, like him, over 24 years as a GP and clinical assistant in a
rheumatolgy out patient department, I have injected very large numbers of
tendinopathies, and I suspect in common with most practitioners using the
technique on a daily basis find the idea that sepsis is reported in up to
1 in 17 frankly unbelieveable, I do not see a problem with the conclusion
that there is insufficient evidence on which to base recommendations for
treatment. If there is no convincing evidence that a treatment is not
effective then those struggling to cope with the real world of patients
who cannot simply be discharged as they would be from a hospital clinic,
will continue to use treatments which they have observed to benefit many
of their patients.

I do believe incidentally that basic recussitation facilities should
be available, as anaphylactic reactions to local anaesthetics are by no
means unknown, and for this reason I will no longer carry out injections
in patient's homes.

With regard to the findings on tennis elbow - I suspect that most
patients would regard an almost 50% better relief of symptoms at four
weeks ample reason to accept any treatment even if they might be no better
after twelve months than those who had not received it.

I am somewhat surprised to note that having concluded that there is
no evidence as to the most appropriate dose of steroid, frequency of
injection or total number of injections to one site, the author proceeds
to publish suggestions on these points presumably based on gut feelings!

Clearly the correct conclusion is drawn - that more research is
needed before denying patients a treatment which has been in regular use
for at least a quarter of a century.