Efficacy and safety of steroid injections for shoulder and elbow tendonitis: A meta-analysis of randomized controlled trials

Cécile Gaujoux-Viala ^1*, Maxime Dougados ¹ and Laure Gossec ¹

¹ Paris Descartes University, Medicine Faculty; APHP, Rheumatology B Department, Cochin Hospital, France

^* To whom correspondence should be addressed. E-mail: cecilegaujouxviala{at}yahoo.fr.

Accepted 23 November 2008

Abstract

Objectives: To assess efficacy and safety of steroid injections for patients with tendonitis of the shoulder or elbow.

Methods: A systematic review of the literature using PUBMED, EMBASE, Cochrane library and hand searches was performed until April 2008. All randomized controlled trials (RCTs) reporting the efficacy on pain or functional disability, and/or the safety of steroid injections, versus placebo, non steroidal anti-inflammatory drugs (NSAID) or physiotherapy in patients with tendonitis were selected. Pooled effect size (ES) was calculated by metaanalysis, using the Mantel-Haenszel method.

Results: 20 RCTs were analyzed i.e. 744 patients treated by injections and 987 patients treated by controls; 618 shoulders and 1113 elbows. The pooled analysis indicated only short-term effectiveness of steroids versus the pooled controls both for pain and function e.g. pain at week 1-3 ES=1.18 (95%CI 0.27 to 2.09), pain at week 4-8 ES=1.30 (95%CI 0.55 to 2.04), pain at week 12-24 ES= -0.38 (95%CI -0.85 to 0.08) and pain at week 48 ES= 0.07 (95%CI -0.60 to 0.75). Sensitivity analyses indicated similar results whatever the localization, type of steroid and type of comparator except for NSAIDs: steroid injections were not significantly better than NSAIDs in the short-term. Steroid injections appeared more effective than pooled other treatments in acute or sub-acute tendonitis. Main side effects were transient pain after injection (10.7% of corticosteroid injections) and skin modification (4.0%).

Conclusions: Steroid injections are well tolerated and more effective for tendonitis in the short-term than pooled other treatments, though similar to NSAIDs. No long-term benefit was evidenced.