Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review

Rotator cuff-related shoulder pain (RCRSP) is a subacromial pain syndrome resulted in altered processing and output of the central nervous system. Although corticosteroid (CS) injections were prescribed for RCRSP, the definitive mechanism of action is uncertain, and no previous review has directly compared CS alone with local anesthetic-alone injections in the treatment of RCRSP. Therefore, the results of this study revealed that CS injections might have a short-term benefit (up to 8 weeks) over local anesthetic injections alone in the management of RCRSP.

To evaluate the comparison of the efficacy of corticosteroid injections to local anaesthetic injections in the treatment of RCRSP.

The search engines like CINAHL Plus,  EMBASE, PubMed, Cochrane, and PEDro were searched from inception to 8 June 2017. The reference lists of related studies were also searched manually. The eligibility was evaluated by two reviewers independently. The randomised controlled trials (RCTs) involved comparison of subacromial injections of corticosteroid with anaesthetic injections were selected for the analysis. Two reviewers individually derived the information regarding short-term, midterm and long-term results for pain, patient-perceived improvement, range of motion, and self-reported function.

A total of 13 RCTs were selected, out of which the four trials were found to have a low risk of bias.  The use of corticosteroid over anaesthetic-only injections in the short term was favoured by three studies having a low risk of bias. Substantial evidence was noticed regarding the similarity between the midterm outcomes of both the injection types. However, evidence regarding the similarity between the long-term results of both the injection types was minimal.

As per findings, Corticosteroid injections alone exert short-term advantages over local anaesthetic injections during RCRSP management and no evidence of corticosteroid advantage over local anaesthetic injections was seen beyond eight weeks.