Corticosteroid Injections: Glass half-full, half-empty or full then empty?

Dr. John Orchard is a highly experienced Sports Physician who has worked in professional Australian Football, Soccer and Rugby League to mention a few.

I have little doubt he has administered his fair share of corticosteroid injections, and witnessed many more.

In the current issue of The British Journal of Sports Medicine, he writes a thoughtful and much needed editorial on the topic.  BJSM 2020, Volume 54, Issue 10

I have been reasonably vocal in my opinion that the evidence for infiltration of corticosteroid for plantar heel pain has little long term benefit, and may fly in the face of potential harm.

Here are a couple of excerpts from John’s editorial.. seems he might agree…??

The abstract may be read here 

“Cortisone is the most common class of injection in musculoskeletal medicine. Expert guidelines, such as the 2017 edition of Therapeutic Guidelines: Rheumatology (Australia), generally recommend corticosteroid injections (CSI) as a treatment for most tendon and joint pain conditions.

I quote, ‘local corticosteroid injections should only be given by, or under the supervision of, clinicians with appropriate training and experience’

I find it remarkable that the guidelines do not spell out that cortisone injections should only be given where high-quality evidence shows that benefits outweigh the harms; that is, the widespread recommendations to use CSI for multiple joints and multiple tendons are ‘eminence-based’ (who should give them) rather than ‘evidence-based’ (when they should be given).

The question remains: can we clinicians assume that CSI is benign and that there is no long-term deleterious effect for the majority of indications?

It might depend on whether you have a glass-half full or a glass-half empty mentality, or whether, after looking at the data, it looks more like the glass starts off full and ends up empty—the patient ends up worse off.”

 

So.. as always.. do the risk/benefit analysis and let your treatment be guided by that, and more importantly, the evidence!

 

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