Oral Prednisone for Shoulder Tendinitis
Oral prednisone is NOT recommended for shoulder tendinitis. The evidence strongly advises against systemic corticosteroids for tendon conditions, and when corticosteroids are considered at all, they should only be administered via local injection (peritendinous, not intratendinous) rather than oral systemic therapy.
Why Systemic Corticosteroids Should Be Avoided
Systemic glucocorticoids are strongly recommended against for inflammatory musculoskeletal conditions affecting tendons and entheses 1.
The American College of Rheumatology guidelines explicitly state a strong recommendation against systemic glucocorticoid treatment, noting that while short-term use with rapid tapering could be considered in very limited circumstances (such as polyarticular flares or pregnancy), these exceptions do not apply to isolated tendinitis 1.
Corticosteroids may inhibit tendon healing and reduce tensile strength, potentially predisposing to spontaneous rupture 2.
The role of inflammation in tendinopathies remains unclear, which undermines the theoretical rationale for anti-inflammatory corticosteroid therapy 2.
What Should Be Used Instead
First-Line Conservative Management (3-6 months)
Begin with relative rest, eccentric strengthening exercises, NSAIDs, and cryotherapy as the foundation of treatment, which results in complete recovery in approximately 80% of patients within 3-6 months 3, 4.
Topical NSAIDs are preferred over oral NSAIDs because they effectively reduce tendon pain without interfering with healing and eliminate the gastrointestinal hemorrhage risk associated with oral formulations 3, 4.
Eccentric strengthening exercises are the cornerstone of treatment and have proven beneficial across multiple tendinopathies 4.
Apply ice through a wet towel for 10-minute periods for short-term pain relief 4.
Second-Line Options If Conservative Treatment Fails
Local corticosteroid injections (subacromial or peritendinous) may be considered if conservative treatment fails, but the evidence is mixed 1, 2.
Subacromial corticosteroid injections for rotator cuff tendinitis show effectiveness for improvement up to 9 months, with a number needed to treat of 3.3 patients 5.
Critical safety warning: Never inject corticosteroids directly into the tendon substance - only peritendinous injections should be considered, as intratendinous injections can weaken the tendon 2, 4.
Avoid peritendinous injections around Achilles, patellar, and quadriceps tendons due to higher rupture risk 1, 2.
One level II study found no statistically significant difference between corticosteroid with lidocaine versus lidocaine alone in acute rotator cuff tendinitis 1, 6.
Evidence Quality and Nuances
The American Academy of Orthopaedic Surgeons states they "cannot recommend for or against subacromial injections for patients with rotator cuff tears" due to inconclusive evidence based on conflicting studies 1.
While local injections have some support, corticosteroids provide only short-term pain relief and do not alter long-term outcomes 2, 7.
Recent research suggests little or no inflammation is present in chronic tendinopathies, making anti-inflammatory treatments like corticosteroids theoretically less appropriate 7.
Clinical Algorithm
Start with 3-6 months of conservative treatment: relative rest, eccentric exercises, topical NSAIDs, and cryotherapy 3, 4
If inadequate response after 3-6 months: Consider ultrasound-guided peritendinous corticosteroid injection (avoiding Achilles, patellar, quadriceps tendons) 2, 4
If pain persists despite conservative treatment and local injection: Refer for surgical evaluation 4
Never use oral systemic corticosteroids like prednisone for isolated shoulder tendinitis 1