Clinical benefits and drawbacks of local corticosteroids injections in tendinopathies

ABSTRACT

Introduction: local glucocorticoids injections are widely administered for the treatment of tendinopathies. positive results have been observed in some tendinopathies but not in others. moreover, worsening of symptoms, and even spontaneous tendon ruptures has been reported. the characteristics of the tendinopathies, the clinical peculiarities of the patient, and the technique used to administer glucocorticoids, can influence the therapeutic response.

Areas covered: After reviewing the pertinent literature on the clinical results, basic information, both on the pathogenesis of tendinopathies and the effects of glucocorticoids on tendons, is reported. The pharmacological properties of glucocorticoids are useful to counteract some pathogenetic mechanisms of tendinopathies. However, several experimental studies suggest that the direct action of glucocorticoids on tendons is detrimental. Loss of collagen organization, impaired viability of fibroblasts, depletion of stem cells pool, and reduced mechanical properties have been observed.

Expert opinion: Drawbacks of local glucocorticoids injections could be predicted on an individual basis, after a careful appraisal of patient characteristics and concomitant medications, along with the specific stage of tendon disease.

KEYWORDS:

• Ankle
• elbow
• foot
• knee
• shoulder
• tendons
• wrist
• glucocorticoids
• ultrasonography

Article highlights

• Local GCs injections provide positive results in some tendinopathies (trigger finger, De Quervain’s syndrome, plantar fascia disorders) but not in others (patellar and Achilles tendons, rotator cuff, elbow). Sometimes long term deleterious effects can be observed.

• The therapeutic response is influenced by different factors (type of tendinopathy, characteristics of patients, modalities of GCs administration).

• An accurate selection of the patients, and an optimal administration technique can improve the clinical results and minimize poor outcomes.

• The administration of PRP, immediately after GCs, could improve the clinical outcomes and is an area open to research.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper is not funded