The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon

Dean, Benjamin; Lostis, Emilie; Oakley, Thomas; Rombach, Ines; Morrey, Mark E.; Carr, Andrew

doi:10.1016/j.semarthrit.2013.08.006

Cited by 187 publications

(123 citation statements)

References 78 publications

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“…Ninth, the clinical trials were too small to provide information regarding safety. We know that corticosteroids are catabolic and likely to accelerate tendon degeneration [17]. Finally, there were insufficient data to conduct a meta-analysis for functional outcomes such as ROM or patient-reported outcome measures such as the DASH score.…”

Section: Discussionmentioning

confidence: 99%

“…In tendinopathies, neuropeptides, calcitonin gene-related peptide, and substance P are found to increase, so perhaps corticosteroid effects are mediated primarily by analgesic pathways [14,20]. In light of this, there may be a threshold where the analgesic effects are outweighed by the deleterious effects of corticosteroids on the tendon tissue, which include collagen disorganization, decreased mechanical properties of tendon, and longterm harm to tendon tissue and cells [17]. The relationship of injection dosage to clinical benefit or harm is not well understood, and this uncertainty warrants further study.…”

Section: Discussionmentioning

confidence: 99%

“…1). We also found five more studies using additional data sources: one by contacting authors and four from previous systematic reviews [15,17]. After review of full text, 72 articles did not fulfill the inclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

Mohamadi

Chan

Claessen

et al. 2017

Clinical Orthopaedics &Amp; Related Research

120

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

Mohamadi

Chan

Claessen

et al. 2017

Clinical Orthopaedics &Amp; Related Research

120

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“…9 Additionally, there are some negative effects of glucocorticoid injections on cellular characteristics and mechanical properties of tendons, especially when used for long-term treatment. 10 Patients pursuing treatment for shoulder pain seek care from manual therapy (MT) providers such as physical therapists, chiropractic practitioners, and others who use conservative interventions such as mobilization and manipulation. A study conducted in the Netherlands reported that shoulder complaints constituted 9.8% of physical therapy (PT) patients, 11 and in a survey of chiropractic practice in Australia, 12% of patients presented with shoulder pain.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

Hawk

Minkalis

Khorsan

et al. 2017

Journal of Manipulative and Physiological Therapeutics

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Objective: The purpose of this review was to evaluate the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder. Methods: The review was conducted from March 2016 to November 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered with PROSPERO. Eligibility criteria included randomized controlled trials (RCTs), systematic reviews, or meta-analyses studying adult patients with a shoulder diagnosis. Interventions qualified if they did not involve prescription medication or surgical procedures, although these could be used in the comparison group or groups. At least 2 independent reviewers assessed the quality of each study using the Scottish Intercollegiate Guidelines Network checklists. Shoulder conditions addressed were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain. Results: Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low-to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions. Conclusion: The findings of this literature review may help inform practitioners who use conservative methods (eg, doctors of chiropractic, physical therapists, and other manual therapists) regarding the levels of evidence for modalities used for common shoulder conditions. (J Manipulative Physiol Ther 2017;40:293-319)

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“…This is due to their anti-inflammatory effects and suppression of collagen synthesis, fibroblast proliferation, and extracellular matrix formation as well as showing reduced proliferation, viability, and migration of tenocytes [46][47][48][49] . Few studies report a positive effect of local corticosteroid treatment on intact tendons [50][51][52][53] , whereas others showed no effect of corticosteroids on mechanical properties [54][55][56][57] .…”

Section: Corticosteroidsmentioning

confidence: 99%

Inflammation and tendon healing

Blomgran¹

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Tendons heal through three different overlapping phases; the inflammatory, proliferative and remodeling phase. Many studies have investigated what factors influence healing of tendons. However, little was known about inflammation and the immune cells present during Achilles tendon healing by the time this thesis started. We developed a flow cytometry method for our rat model of tendon healing, which enabled us to study different leukocyte subpopulations during Achilles tendon healing. The general aim of this thesis was to understand more about inflammation and the immune cell populations present during tendon healing and how the immune cell composition changes during normal tendon healing. Moreover, we investigated how different factors that are known to influence tendon healing affected the composition of the immune cell population. First, we described the immune cells during the time course of tendon healing focusing on different subpopulations of macrophages and T cells. Then, we studied how these cells were influenced by reduced mechanical loading. Mechanical loading prolonged the presence of M1 macrophages and delayed the switch to regulatory T cells and M2 macrophages compared to reduced mechanical loading. Next, the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the leukocyte composition revealed that, even though NSAIDs influence the mechanical properties of healing tendon, this effect was not mediated via changes in the leukocyte sub-populations during early and mid-time tendon healing. Further, the effect of corticosteroids during the inflammatory and remodeling phases of tendon healing was an improved healing of tendons and a reduction of CD8a T cells when corticosteroid was administered after the inflammatory phase. Lastly, we investigated if impairment of tendon healing by NSAIDs was related to mechanotransduction or microdamage during mechanical loading and showed that NSAIDs impair tendon healing by reducing the response to microdamage. In conclusion, these studies show that inflammation plays an important role during Achilles tendon healing, and factors that influence healing can also alter the presence or polarization of immune cell populations.

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The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon

Cited by 187 publications

References 78 publications

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

Inflammation and tendon healing

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