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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:

Is Steroid Injection The Best Option ?

Pofessor Arroll is undoubtedly correct in his assessment of the
efficacy of corticosteroid injections for rotator cuff syndrome.

This efficay however, reflects symptomatic relief, as I am reminded
that cortisone acts by altering the tissue response and does nothing to
treat the cause.

Yes, Cyriax was a proponent of steroid injections as well, it seems
like such a cop-out though.

Manual manipulation as applied by osteopaths or chiropractors often
obtains objective improvement in a reasonable time span, thus I would
always consider this the treatment of choice.

Also, we ought not forget that many people who present with symptoms
that point toward RCS are in reality suffering from a problem in the
cervical spine and are misdiagnosed and given the easy treatment of
steroid injection.

When results fail to materialize it adds to the perception that the
evidence for this kind of management is weak.

Competing interests:
None declared

Competing interests: No competing interests

28 November 2005
Dr. Herbert H. Nehrlich
Private Practice
Bribie Island, Australia 4507