Lazzarini Stefano Giuseppe, Buraschi Riccardo, Pollet Joel, Bettariga Francesco, Pancera Simone, Pedersini Paolo
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
Phys Ther. 2025 Mar 3;105(3). doi: 10.1093/ptj/pzaf006.
Rotator cuff tendinopathy represents the most prevalent cause of shoulder pain, the third most common musculoskeletal disorder after low back pain and knee pain.
The objective of this study was to determine the effectiveness of corticosteroid injection(s), alone or in combination with anesthetic injection or any other physical therapist interventions, compared to physical therapist interventions alone in adults with rotator cuff tendinopathy.
This study was a systematic review and meta-analysis of randomized controlled trials. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Physiotherapy Evidence Database were searched from inception to March 2023. Meta-analysis using a random-effects model was performed. Risk of bias and certainty of the evidence for the primary outcomes were assessed using the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation approach, respectively. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021240882).
Participants were adults with rotator cuff tendinopathy.
Corticosteroid injection(s), alone or in combination with anesthetic injection or with any other physical therapist interventions, was compared to physical therapist interventions alone.
Pain, function, quality of life, patient-rated overall improvement, and adverse events were the main outcomes.
Fifteen randomized controlled trials (1785 participants) met the inclusion criteria. At short term, corticosteroid injection coupled with physical therapist interventions and compared to the same interventions alone might have resulted in some small to moderate improvements in pain and function. Conversely, corticosteroid injection alone seemed not to be more effective than physical therapist interventions in improving pain and function in most of the studies included. At mid- and long-term follow-up assessments corticosteroid injection seemed not to be more effective than any physical therapist interventions.
This study highlights the potential effectiveness of corticosteroid injection(s) in rotator cuff tendinopathy for pain and function at short term at best, especially in combination with physical therapist interventions. However, the evidence is of moderate to mostly very low certainty. Additional high-quality research considering core outcomes, therefore, is needed.
Corticosteroid injection(s) seems not to be superior to physical therapist interventions, other than resulting in some transient improvements at short term if provided together with other physical therapist interventions, in adults with rotator cuff tendinopathy. Furthermore, considering the potential adverse events associated with the injections, physical therapist interventions may be an important stand-alone treatment option.
肩袖肌腱病是肩痛最常见的原因，是继腰痛和膝关节疼痛之后第三常见的肌肉骨骼疾病。
本研究的目的是确定与单独的物理治疗师干预相比，皮质类固醇注射单独使用、与麻醉剂注射联合使用或与任何其他物理治疗师干预措施联合使用，对患有肩袖肌腱病的成年人的有效性。
本研究是对随机对照试验的系统评价和荟萃分析。从创刊到2023年3月，检索了PubMed、EMBASE、护理及相关健康文献累积索引、Cochrane对照试验中央注册库、Scopus、科学网和物理治疗证据数据库。使用随机效应模型进行荟萃分析。分别使用Cochrane偏倚风险工具和推荐分级、评估、制定和评价方法评估主要结局的偏倚风险和证据的确定性。该方案已在国际前瞻性系统评价注册库（CRD42021240882）中注册。
参与者为患有肩袖肌腱病的成年人。
将皮质类固醇注射单独使用、与麻醉剂注射联合使用或与任何其他物理治疗师干预措施联合使用，与单独的物理治疗师干预措施进行比较。
疼痛、功能、生活质量、患者评定的总体改善情况和不良事件是主要结局。
15项随机对照试验（1785名参与者）符合纳入标准。在短期内，与单独的相同干预措施相比，皮质类固醇注射联合物理治疗师干预措施可能会使疼痛和功能有一些轻度到中度的改善。相反，在大多数纳入的研究中，单独的皮质类固醇注射在改善疼痛和功能方面似乎并不比物理治疗师干预措施更有效。在中长期随访评估中，皮质类固醇注射似乎并不比任何物理治疗师干预措施更有效。
本研究强调了皮质类固醇注射在肩袖肌腱病中对疼痛和功能的潜在有效性，至多在短期内有效，尤其是与物理治疗师干预措施联合使用时。然而，证据的确定性从中度到大多非常低。因此，需要进行更多考虑核心结局的高质量研究。
在患有肩袖肌腱病的成年人中，皮质类固醇注射似乎并不优于物理治疗师干预措施，除非与其他物理治疗师干预措施一起使用时在短期内会有一些短暂的改善。此外，考虑到与注射相关的潜在不良事件，物理治疗师干预措施可能是一种重要的独立治疗选择。
