Steroid Taper for Tendonitis
Systemic corticosteroids are not routinely recommended for tendonitis, and there is no established oral steroid taper regimen for this condition. The evidence supports local corticosteroid injections for short-term pain relief only, not systemic steroids.
Key Treatment Principles
Local Injection vs. Systemic Steroids
Local corticosteroid injections may provide short-term pain relief (better than oral NSAIDs acutely) but do not alter long-term outcomes and should be used cautiously 1, 2.
Systemic oral corticosteroids are not part of standard tendonitis management—the provided guidelines addressing steroid tapers are for inflammatory myopathies and juvenile arthritis, not tendonitis 3.
If Local Injection is Considered
Injection technique and location are critical:
Use peritendinous injections only—never inject directly into the tendon substance, as this increases rupture risk 1.
Absolutely avoid peritendinous corticosteroid injections in Achilles, patellar, and quadriceps tendons due to high rupture risk 1, 2.
Ultrasound guidance significantly improves accuracy (87% vs. lower rates with landmark techniques) 1.
Evidence for Injection Efficacy
Short-term benefits only:
Corticosteroid injections provide better short-term pain relief than placebo for lateral epicondylalgia and rotator cuff tendinopathy, but intermediate and long-term outcomes are worse than other treatments 4.
For De Quervain's tenosynovitis specifically, methylprednisolone acetate injection controlled symptoms in 90% of cases (58% with single injection, 33% requiring multiple injections) 5.
Long-term concerns:
Corticosteroids may inhibit healing, reduce tensile strength, and predispose to spontaneous rupture 1, 2.
The role of inflammation in tendinopathies is unclear, which undermines the theoretical basis for anti-inflammatory treatment 1.
Compared to platelet-rich plasma, corticosteroids showed better short-term but worse long-term outcomes 4.
Recommended Treatment Algorithm
First-line management:
NSAIDs (oral or topical) for short periods as initial treatment 2.
Consider COX-2 selective inhibitors in patients with gastrointestinal risk 2.
Relative rest, activity modification, and ice application (10-minute periods) for acute pain 2.
Second-line for persistent localized pain:
- Local corticosteroid injection (peritendinous only, avoiding high-risk tendons) with limited number of injections due to tendon weakening risk 2.
Adjunctive and alternative therapies:
Eccentric strengthening exercises can reverse degenerative changes 2.
Acetaminophen or other simple analgesics if NSAIDs are contraindicated or insufficient 2.
Critical Pitfalls to Avoid
Never inject corticosteroids directly into tendon substance—only peritendinous 1.
Never inject Achilles, patellar, or quadriceps tendons 1, 2.
Do not expect long-term benefit from corticosteroid injections—they provide temporary pain relief only 1, 2, 4.
Limit the number of injections due to cumulative tendon weakening effects 2.
Recognize that actual tendon inflammation (true "tendonitis") is rarely demonstrated pathologically—most cases are degenerative tendinosis 6, 7.