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Steroid Injection Tendinopathy Evidence — SCE Rheumatology MCQ

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ModerateSoft Tissue RheumatologySteroid Injection Tendinopathy EvidenceSCE Rheumatology

A 50-year-old man has chronic lateral epicondylalgia despite 12 months of activity modification and an exercise-based rehabilitation programme. He asks about a local corticosteroid injection. Which pattern of clinical outcomes is best supported by randomised-trial evidence?

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Reveal the answer and explanation

Correct answer: E — Short-term improvement but higher recurrence and poorer intermediate- or long-term outcomes

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

Corticosteroid injection can provide relatively rapid symptomatic improvement in lateral epicondylalgia, so A is incorrect. This benefit is transient: systematic-review evidence shows reversal of benefit at intermediate and long-term follow-up. In a placebo-controlled trial, corticosteroid injection was associated with lower recovery at one year and markedly greater recurrence than placebo injection. Therefore D is correct. B and C incorrectly imply sustained benefit or no adverse effect on later outcomes. E is also incorrect: corticosteroids are not regenerative treatments and should not be presented as strengthening or healing the tendon. These findings are specific to lateral epicondylalgia and should not be applied indiscriminately to every anatomical tendinopathy.

Reference: Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376:1751–1767. https://pubmed.ncbi.nlm.nih.gov/20970844/