In our Lafayette Physical Therapy and Boulder Physical Therapy clinics we often have my patients ask whether a steroid injection is appropriate for managing their symptoms of tendon pain. This question does not have a simple answer. While corticosteroids can be effective for pain relief and inflammation control there are underlying physiological changes that happen with these types of injections that we should consider.
A recent review titled “Adverse Impact of Corticosteroids on Rotator Cuff Tendon Health and Repair: A Systematic Review of Basic Science Studies” published in the journal Arthroscopy systematically reviewed basic science studies investigating the impact of corticosteroid use on rotator cuff tendon health and repair. Corticosteroids are commonly used to treat rotator cuff tendon injuries due to their anti-inflammatory effects. However, the authors of this article argue that corticosteroids have adverse effects on tendon health and repair.
The authors of the article reviewed 24 basic science studies that investigated the impact of corticosteroid use on rotator cuff tendon health and repair. The authors found that corticosteroids have a detrimental effect on tendon health and repair by reducing the amount of collagen synthesis and increasing the rate of collagen degradation. This results in a decrease in tendon strength and an increased risk of tendon rupture. The authors also found that corticosteroids inhibit the production of tenocytes, which are cells that play a key role in tendon healing and repair.
The authors of the article concluded that corticosteroid use has a negative impact on rotator cuff tendon health and repair. They suggest that corticosteroids should be used with caution in the treatment of rotator cuff tendon injuries, and that alternative treatments should be considered. The authors also suggest that further research is needed to better understand the impact of corticosteroids on tendon health and repair and to develop alternative treatments for rotator cuff tendon injuries.
With my patients I try to consider the above risks as well as each person’s level of function and how much the pain is affecting their daily activities. As physical therapists we have many tools to help address tendon pain including hands-on work (manual therapy), dry needling, and graded exercises. We also work to solve the root cause behind why the tendon became over-stressed to begin with. There are certainly times when an injection is merited but I find it prudent to exhaust all conservative options first because of the impact of tendon health following injections.
What should you consider if you have a rotator cuff injury? Read more here
Wondering how physical therapy can help with tendon pain? Check out some of our blog posts on exercise and tendon health: here and here
Interested in leaning more about exercise in general? We have lots more information on our blog here and here
References
1. Puzzitiello RN, Patel BH, Forlenza EM, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Adverse Impact of Corticosteroids on Rotator Cuff Tendon Health and Repair: A Systematic Review of Basic Science Studies. Arthrosc Sports Med Rehabil. 2020 Apr 8;2(2):e161-e169. doi: 10.1016/j.asmr.2020.01.002. PMID: 32368753; PMCID: PMC7190543.