The INCORRECT Statement is D
Statement D is incorrect: Local corticosteroid injection is NOT contraindicated in rotator cuff bursitis/tendonitis, and while theoretical concerns about tendon rupture exist, guidelines explicitly state that corticosteroid injections can be used for this condition.
Why Statement D is Wrong
The American Academy of Orthopaedic Surgeons (AAOS) guidelines explicitly address this issue. While they acknowledge "logical concerns" about potential adverse effects of corticosteroid injection on rotator cuff tendon biology, they found "no quality evidence to guide recommendations" against their use 1. In fact, the 2020 AAOS guidelines state that "moderate evidence supports the use of a single injection of corticosteroid with local anesthetic for short-term improvement in both pain and function for patients with shoulder pain" 2.
The Canadian Stroke Best Practice guidelines (2016) further support this, explicitly recommending that "subacromial corticosteroid injections can be used in patients when pain is thought to be related to injury or inflammation of the subacromial region (rotator cuff or bursa)" 3.
Key Nuances About Corticosteroid Injections:
- They are NOT contraindicated - multiple guidelines support their use
- Benefits are modest and transient - primarily providing short-term pain relief (4-8 weeks) 4, 5
- Theoretical tendon rupture risk exists but lacks quality evidence to support absolute contraindication 1
- Single injection preferred - multiple injections show no additional benefit 4
- Best used judiciously - as part of conservative management, not as standalone treatment 5, 6
Why the Other Statements Are CORRECT
Statement A (Pain on passive shoulder elevation): Correct - this is a classic finding in rotator cuff pathology, reflected in the Neer's test which elicits pain with full forward flexion 7.
Statement B (Pain on internal rotation when dressing): Correct - internal rotation with the arm at the side (like putting on a jacket) commonly reproduces pain in rotator cuff tendonitis/bursitis 7.
Statement C (Tenderness to palpation of subacromial bursa): Correct - direct palpation of the inflamed subacromial bursa typically elicits tenderness, and recent evidence shows that subacromial bursitis is associated with better short-term response to treatment 8, 9.
Statement E (MRI can reveal tendonitis or tears): Correct - MRI is the preferred imaging modality for evaluating rotator cuff pathology, including tendonitis, partial-thickness tears, and full-thickness tears 10, 11.
Clinical Bottom Line
The statement about corticosteroid injections being contraindicated is outdated and contradicted by current guidelines. While these injections provide only modest, transient benefit and should not be overused, they remain a reasonable option for short-term symptom management when combined with other conservative measures like physical therapy 2, 5, 6.