Twelve randomised trials were unearthed, five comparing steroid plus local anaesthetic injection with injection of local anaesthetic or saline, two comparing different steroid doses or formulations, and five comparing steroid with other treatment. The Dutch are tough reviewers, and found fault with most of the trials. They did go on to try to pool the results from the various trials. Not surprisingly pooling apples with pears produced evidence of heterogeneity in the results within the trials which compared steroid versus local anaesthetic or saline there was variation in the number of injections studied Results Bandolier has tried to tease out the results for the trials comparing steroid with local anaesthetic or saline. The best we can do is to count votes.
References are in the systematic review.
So, three of four trials with available data showed an effect of steroid injection compared with local anaesthetic alone or saline at authors' most important follow-up time. The report shows how difficult it is for all of us to pick out the problems. When you read you need to have your critical faculties honed. Elbow joint injections may do better short term but don't look different from shoulder injections beyond six weeks. Once again the WD40 approach of injecting steroid is not a long term solution to the problem.