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Oct. 21, 2010 -- Corticosteroid injections, better known as cortisone shots, provide short-term pain relief for tendon problems such as tennis elbow?but may be worse than other treatments later on, according to a new analysis.
"We have shown strong evidence that corticosteroid injection is beneficial in the short term for treatment of tendinopathy, but is worse than other treatment options in the intermediate and long terms," says researcher Bill Vicenzino, PhD, professor of sports physiotherapy at the University of Queensland in St. Lucia, Australia.
''The strong immediate effects [of pain relief] in a high proportion of patients have led to the notion that they are the miracle treatment," Vicenzino tells WebMD.
But he suspected otherwise, since the treatment is sometimes accompanied by poor long-term outcomes. Some experts had begun to question the use of corticosteroids, which reduce inflammation, for overuse disorders of the tendon, which are not accompanied by inflammation.
Tendons are tough, fibrous tissues that connect muscles to bones; in tendinopathy, the tendon becomes painful or torn.
To get some answers, Vicenzino and his colleagues reviewed the results of 41 previously published studies, including 2,672 patients with various tendon problems.
In the 41 published studies, the tendinopathy sites primarily included the elbow and the rotator cuff in the shoulder.
Some studies used corticosteroids for injections, while others used non-steroid-based treatments such as Botox, platelet-rich plasma, sodium hyaluronate, and other substances.
The researchers looked at pain reduction in the short term (about four weeks), intermediate term (about 26 weeks), and long term (one year).
Benefits differed by site, the researchers found.
For tennis elbow, corticosteroid injections provided relief at eight weeks but had negative outcomes at six months and one year.
For rotator cuff tendinopathy, corticosteroid injections provided inconsistent effects, but some of the studies showed a medium beneficial effect compared to placebo.
All studies using non-corticosteroid injections reported adverse events, but only 82% of the 28 using corticosteroids did.
And the adverse effects were generally minor, such as pain and loss of pigment. "We could not find much evidence to indicate that there are many adverse effects of a serious nature," he tells WebMD, speaking of the corticosteroid injections. However, he adds, "the caveat on this is that it is unknown to what extent adverse events are reported or not."