Context

Cortisone injections have been an accepted and recommended treatment for chronic tendinopathies for many years, including tennis elbow (lateral epicondylitis), Achilles tendinopathy and rotator cuff tendinopathy. Most of the recommendations to use cortisone injections are based on case series or controlled studies with short-term follow-up. However, theoretical objections have been raised against the use of cortisone, particularly that tendinopathy is not generally an inflammatory disorder. There have been reported associations of tendon weakening and rupture after cortisone injections. Tendinopathy experts have argued for years that, since inflammation is not a major part of the pathology, anti-inflammatory treatment such as cortisone injections may not be ideal management.1,–,4