02/14/2025
TL;DR: Cortisone injections may provide short term relief and functional improvements with rotator cuff tendinopathy, but at mid- and long-term follow ups show no additional benefits and may have potential for adverse effects.
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On this research Friday we’re going to dig into this study by Lazzarini et al in the Physical Therapy & Rehabilitation Journal. In this systematic review and meta analysis, this team looked to compare the effectiveness of subacromial corticosteroid injections (or cortisone as you may know it) in combination with anesthetic injection or any other PT interventions to just physical therapy interventions alone in patients with rotator cuff tendinopathy. This is a pretty big study. In total, they looked at 15 randomized controlled trials which added up to over 1700 participants included. In terms of outcomes, they looked at pain, level of function, quality of life and patient-rated improvement. As far as results, they found that at short term, the corticosteroid injections coupled with PT may result in small to moderate pain and functional improvements compared to PT alone. This isn’t that surprising and lines up with what we already know. Cortisone is a powerful anti inflammatory, and when you quickly drop their inflammation they feel better quickly. Conversely, corticosteroid injection alone compared to PT did not seem more effective at improving pain and function in most of the studies. Furthermore, at mid and long term follow ups, corticosteroid injections did not seem more effective than any other PT interventions. We love studies like this because it highlights the power of physical therapy, but also gives us more information to help our patients make informed decisions about injections. There may be a time and place where injections are recommended or even necessary, but they are often a great example of a situation where the short term gain is not worth the long term cost, as more studies come out that highlight the potential negative effects on tissue health as well as the lack of long term benefits.
