Steroid injections are commonly used to treat rotator cuff tendinopathy, but controlled studies have demonstrated modest benefit, particularly in the long term. 34 Steroid injections should be reserved for patients who have discomfort that would limit them from engaging in rehabilitative exercises. Injections into the gluteal muscle versus guided injections into the subacromial bursa have demonstrated similar levels of pain relief. 35 Surgical options are available for patients with persistent symptoms, or for patients in whom function cannot be maintained.
1. Death AK, McGrath KC, Kazlauskas R, Handelsman DJ. Tetrahydrogestrinone is a potent androgen and progestin. J Clin Endocrinol Metab. 2004 May;89(5):2498-500
2. Catlin D. H., Sekera M. H., Ahrens B. D., Starcevic B., Chang Y. C., Hatton C. K. Tetrahydrogestrinone: discovery, synthesis, and detection in urine. Rapid Commun Mass Spectrom. 2004;18:1245049.
3. Yu-Chen Chang; Borislav Starcevic; Brian D. Ahrens; M. Jane Strouse; Don H. Catlin. Identification of a Urinary Metabolite of the Designer Steroid Tetrahydrogestrinone (THG). Drug Metab: Toxicology.
4. Fernand Labrie, Van Luu-The, Ezequiel Calvo, Cline Martel, Julie Cloutier, Sylvain Gauthier, Pascal Belleau, Jean Morissette, Marie-Hlne Lvesque, and Claude Labrie J. Endocrinol., Feb 2005; 184: 427 - 433.
Nineteen RCTs (820 children enrolled; 773 evaluated) were included. Most studies were small. Eleven studies were at low risk of bias for allocation concealment and only four studies were at low risk of performance bias . Fifteen, eight and 10 studies were at low risk of detection bias , attrition bias and reporting bias respectively. Cyclosporin when compared with placebo or no treatment significantly increased the number of children who achieved complete remission. However this was based on only eight children who achieved remission with cyclosporin compared with no children who achieved remission with placebo /no treatment in three small studies (49 children: RR , 95% CI to ). Calcineurin inhibitors significantly increased the number with complete or partial remission compared with IV cyclophosphamide (2 studies, 156 children: RR , 95% CI to ; I 2 = 20%). There was no significant differences in the number who achieved complete remission between tacrolimus versus cyclosporin (1 study , 41 children: RR , 95% CI to ), cyclosporin versus mycophenolate mofetil plus dexamethasone (1 study , 138 children: RR , 95% CI to ), oral cyclophosphamide with prednisone versus prednisone alone (2 studies, 91 children: RR , 95% CI to ), IV versus oral cyclophosphamide (1 study , 11 children: RR , 95% CI to ), IV cyclophosphamide versus oral cyclophosphamide plus IV dexamethasone (1 study , 49 children: RR , 95% CI to ), and azathioprine with prednisone versus prednisone alone (1 study , 31 children: RR , 95% CI to ). One study found no significant differences between three agents (cyclophosphamide, mycophenolate mofetil, leflunomide) used in combination with tacrolimus and prednisone. One study found no significant difference in the percentage reduction in proteinuria (31 children: -12; 95% CI -73 to 110) between rituximab with cyclosporin/prednisolone and cyclosporin/prednisolone alone. Two studies reported ACEi significantly reduced proteinuria.