A Cochrane review (abstract , review [Abstract]) included 7 studies on subacromial steroid injection for rotator cuff disease, with a total of 284 subjects. In a meta-analysis of 2 studies (n=45), there was a small benefit of subacromial steroid injection over placebo at four weeks with respect to pain (SMD 0.83, 95% CI 0.39 to 1.26), function (SMD 0.63, 95% CI 0.20 to 1.06) and range of active abduction (SMD 0.82, 95% CI 0.39 to 1.25). Two further studies (n=90) reported some benefit of injection over placebo, whereas 2 other studies (n=109) reported no differences between the treatment groups. One trial (n=40) favoured the placebo group with respect to improvement in pain at three and 12 months although more participants in the steroid injection group resumed work at 12 months. In this trial, there was a large loss to follow up in both groups and the analysis included completers only. No benefit of subacromial steroid injection over NSAID with respect to improvement in pain, function or range of shoulder abduction at four or six weeks was demonstrated (3 trials, n=120). One trial (n=60) comparing a single intra-articular steroid injection (40mg methylprednisolone) to placebo for rotator cuff disease demonstrated no benefit of steroid injection at four weeks with respect to pain, range of abduction or success of therapy.
A systematic review 2 including 9 studies was abstracted in DARE. Four out of 6 RCTs reported a statistically significant improvement in pain on a visual analogue scale for patients receiving subacromial corticosteroid injections (CSI), relative to controls. One reported night-time pain relief at 1 month, but no differences at 3 months. Three out of 7 RCTs reporting range of motion found a statistically significant improvement, ranging from 14 to 45 degrees. Two RCTs found no difference between CSI and control groups on measures of function. Of the 2 RCTs that did find a significant difference, one reported that this was not significant at the 3- month follow-up.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
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