Corticosteroid Injections for Common Musculoskeletal Conditions

 


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Family physicians considering corticosteroid injections as part of a comprehensive treatment plan for musculoskeletal diagnoses will find few high-quality studies to assist with evidence-based decision making. Most studies of corticosteroid injections for the treatment of osteoarthritis, tendinopathy, bursitis, or neuropathy include only small numbers of patients and have inconsistent long-term follow-up. Corticosteroid injections for the treatment of adhesive capsulitis result in short-term improvements in pain and range of motion. For subacromial impingement syndrome, corticosteroid injections provide short-term pain relief and improvement in function. In medial and lateral epicondylitis, corticosteroid injections offer only short-term improvement of symptoms and have a high rate of symptom recurrence. Corticosteroid injections for carpal tunnel syndrome may help patients avoid or delay surgery. Trigger finger and de Quervain tenosynovitis may be treated effectively with corticosteroid injections. Patients with hip or knee osteoarthritis may have short-term symptom relief with corticosteroid injections.

Family physicians often treat patients with musculoskeletal conditions.1 In the United States, 8% of ambulatory visits are for musculoskeletal and soft tissue concerns, and more than 13% of these patients have arthritis as a comorbid chronic condition.2 Although many common musculoskeletal diagnoses can be successfully treated with conservative treatments such as rest, ice or heat, splinting, oral nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy, almost two-thirds of family physicians use corticosteroid injections as part of a treatment plan.3 Treatment of musculoskeletal conditions by a primary care physician can improve patient satisfaction4  and help avoid costly referrals. Discussion of the diagnostic benefits, techniques, and adverse effects of corticosteroid injections is beyond the scope of this article; however, given the reported rarity of adverse effects, physicians should consider them relatively safe. This article summarizes the research on corticosteroid injections to provide family physicians with evidence-based recommendations for their use (Table 1).

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Corticosteroid injections in the shoulder have only short-term benefits in adhesive capsulitis and subacromial impingement syndrome.

B

5, 79, 12, 14, 19

Corticosteroid injections for lateral and medial epicondylitis lead to short-term improvement but have a high rate of recurrence and are no better than other options in the long term.

B

21, 2630

Corticosteroid injections can be considered for patients with carpal tunnel syndrome who wish to avoid or delay surgical treatment.

B

35, 36, 40

Corticosteroid injections for de Quervain tenosynovitis and trigger finger are effective early in therapy.

B

44, 46, 48, 50

Corticosteroid injections provide short-term relief from symptoms of knee and hip osteoarthritis in patients who wish to delay surgery.

B

57, 6063


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Corticosteroid injections in the shoulder have only short-term benefits in adhesive capsulitis and subacromial impingement syndrome.

B

5, 79, 12, 14, 19

Corticosteroid injections for lateral and medial epicondylitis lead to short-term improvement but have a high rate of recurrence and are no better than other options in the long term.

B

21, 2630

Corticosteroid injections can be considered for patients with carpal tunnel syndrome who wish to avoid or delay surgical treatment.

B

35, 36, 40

Corticosteroid injections for de Quervain tenosynovitis and trigger finger are effective early in therapy.

B

44, 46, 48, 50

Corticosteroid injections provide short-term relief from symptoms of knee and hip osteoarthritis in patients who wish to delay surgery.

B

57, 6063


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

Table 1.

Corticosteroid Injections for Common Musculoskeletal Conditions: Relative Success and Duration of Pain Relief

ConditionShort-term reliefLong-term reliefStrength of evidenceSuccess of therapy

Adhesive capsulitis

++ to +++

++ to +++

++

Faster pain relief and improved range of motion and function in short term; equivalent to other options in long term

Carpal tunnel syndrome

+++

+

+

Short-term improvements in pain and function, with up to one-half of patients having

The Authors

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ZOË J. FOSTER, MD, is a faculty physician at St. Joseph Mercy Livingston Family Medicine Residency, Brighton, Mich., and for the University of Michigan Primary Care Sports Medicine Fellowship Program, Ann Arbor. She is also a team physician for the University of Michigan; Eastern Michigan University, Ypsilanti; and Pinckney (Mich.) Community High School....

TYLER T. VOSS, DO, is a primary care sports medicine fellow at St. John Providence Health System, Brighton. At the time the article was written, he was a third-year resident at St. Joseph Mercy Livingston Family Medicine Residency.

JACQUELYNN HATCH, DO, is a third-year resident at St. Joseph Mercy Livingston Family Medicine Residency.

ADAM FRIMODIG, DO, is a third-year resident at St. Joseph Mercy Livingston Family Medicine Residency.

Address correspondence to Zoë J. Foster, MD, St. Joseph Mercy Hospital, 7575 Grand River, Ste. 210, Brighton, MI 48114 (e-mail: zoe_foster@ihacares.com). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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