From the Guidelines
For a rotator cuff tendinitis, corticosteroid infiltration is generally considered the most effective option, but its use should be approached with caution due to potential deleterious effects on the tendon, as noted in studies such as 1 and 1.
Key Considerations
- The optimal drugs, dosages, techniques, intervals, and post-injection care for corticosteroid injections remain unknown, highlighting the need for careful consideration and personalized treatment plans.
- The effects of peritendinous corticosteroid injections are unknown, and they should be used with caution, as they may inhibit healing and reduce the tensile strength of the tissue, predisposing to spontaneous rupture, as discussed in 1.
- Ultrasound guidance is recommended to ensure precise placement in the subacromial space rather than directly into the tendon, which can help minimize potential risks.
Treatment Recommendations
- A single injection of methylprednisolone (40-80mg) or triamcinolone (20-40mg) mixed with lidocaine 1% may be considered, but the decision should be made on a case-by-case basis, taking into account the patient's specific condition and medical history.
- Corticosteroid injections should be limited to 2-3 per year to avoid potential tendon weakening, as excessive use can lead to adverse effects, as hinted at in 1.
- For patients with contraindications to steroids or those seeking alternatives, platelet-rich plasma (PRP) injections may be considered, though evidence for their effectiveness is less robust, and more research is needed to fully understand their benefits and risks.
Additional Therapies
- Physical therapy should accompany any infiltration treatment to address underlying biomechanical issues and strengthen the rotator cuff muscles for long-term improvement, as this can help promote healing and reduce the risk of further injury.
- Rest, ice, and analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may also be recommended to help manage pain and reduce inflammation, as discussed in 1.
From the FDA Drug Label
For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus Intra-Articular The intra-articular or soft tissue administration of triamcinolone acetonide injectable suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.
The best type of injection for rotator cuff tendinitis is an intra-articular injection of triamcinolone acetonide.
- The dose is usually between 2.5 mg to 5 mg for smaller joints and from 5 mg to 15 mg for larger joints, depending on the specific disease entity being treated.
- Strict aseptic technique is mandatory when administering the injection.
- The injection should be made into the joint space, avoiding the surrounding tissues to prevent atrophy. 2 2
From the Research
Types of Injections for Rotator Cuff Tendinitis
- Corticosteroid injections: These injections have been shown to provide short-term pain relief for rotator cuff tendinitis, but their long-term effectiveness is debated 3, 4, 5.
- Platelet-rich plasma (PRP) injections: PRP injections have been found to be effective in providing long-term pain relief and improving function in patients with rotator cuff lesions 4.
- Prolotherapy injections: Prolotherapy injections have been used to treat rotator cuff tendinitis, but their effectiveness is not well established 4.
- Intramuscular tetracosactide injections: These injections have been compared to subacromial triamcinolone injections and found to be less effective in reducing pain and improving function in patients with rotator cuff tendinitis 6.
- Ultrasound-guided barbotage for calcific tendinitis: This injection therapy has been mentioned as a treatment option for rotator cuff disease, but its effectiveness is not well established 7.
Comparison of Injection Therapies
- A study comparing subacromial injection of triamcinolone acetonide to oral indomethacin therapy found no significant difference in short-term efficacy between the two treatments 3.
- A study comparing intramuscular tetracosactide injection to subacromial triamcinolone injection found that the latter was more effective in reducing pain and improving function in patients with rotator cuff tendinitis 6.
- A study comparing PRP, corticosteroid, and prolotherapy injections found that corticosteroid injections provided short-term pain relief, while PRP injections provided long-term benefits 4.
- A meta-analysis found that corticosteroid injections provided small and transient pain relief in patients with rotator cuff tendinosis, with a number needed to treat of at least five patients for one patient to experience pain reduction 5.