I read with interest Bruce Arroll and Felicity Goodyear-Smith's article in the March edition of the BJGP, ‘Corticosteroid injections for painful shoulder: a meta analysis’.1 This welcome research provides further evidence that subacromial injections with corticosteroid can provide a rapid and effective response to patients suffering from rotator cuff tendonitis. However, I have reservations about the authors' comments that by calculating ‘the small numbers needed to treat may make GPs more likely to use subacromial steroids for rotator cuff syndrome, as it is a relatively easy procedure to perform’. There are many barriers in applying evidence into practice. In a survey of GPs perceived barriers to performing injections in the community, the majority of responders felt that the lack of evidence regarding the effectiveness of corticosteroid injections was not a significant barrier to performing injections in the community.2 Inability to maintain their injection skill base and fear of complications and litigation were perceived as the main barriers. While evidence of treatment effectiveness is fundamental — there are many other steps to consider in translating evidence from the bench to the bedside of patients with this common condition.
- © British Journal of General Practice, 2005.
