Intended for healthcare professionals

Rapid response to:

Clinical Review

Shoulder pain: diagnosis and management in primary care

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7525.1124 (Published 10 November 2005) Cite this as: BMJ 2005;331:1124

Rapid Response:

corticosteroids are effective for rotator cuff disorders

The authors report that the evidence for corticosteroids in shoulder
disorders is weak. This is perhaps because they only examined the Cochrane
reviews which did not report numbers needed to treat. I was part of a
review "Arroll B, Goodyear-smith F. Corticosteroid injections for painful
shoulder a meta-analysis. Br J Gen Pract 2005;55:224-8." where the the
relative risk (RR) for improvement for subacromial corticosteroid
injection for rotator cuff tendonitis was 3.1 (95%CI 1.9-4.9). This
translated to a numbers needed to treat of 3.3 to get an improvement which
is better than almost any thing we do in clinical medicine. The experience
of myself and some of my colleagues that this NNT translates in to
everyday clinical practice. There is an absence of data on harm but plenty
on effectiveness. Thus if we are cautious we can improve the situation for
our patients.

Competing interests:
None declared

Competing interests: No competing interests

27 November 2005
Bruce ARROLL
Professor of General Practice and Primary Health Care
University of Auckland