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Cortisone and Corticosteroid Injections

What cortisone injections do, when they help, how long the effect lasts, and the risks of repeated injections for shoulder, elbow, wrist and hand conditions.

37 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Corticosteroid injections serve as a primary non-surgical intervention for a diverse range of orthopaedic conditions, including plantar fasciopathy, trigger finger, rotator cuff pathology, tennis elbow, de Quervain disease, trapeziometacarpal osteoarthritis, distal interphalangeal ganglion cysts, carpal tunnel syndrome, and adhesive capsulitis. While the procedure offers temporary pain relief and improved functional outcome scores following rotator cuff repair [4], its efficacy varies significantly by diagnosis. For trigger finger, injections are effective in 57% of patients [10], and repeated injections should be considered for recurrent cases in patients preferring nonsurgical treatment, particularly those without factors predictive of failure [28]. In trapeziometacarpal osteoarthritis, corticosteroids are a favorable option due to affordability, ease of administration, and efficacy [12], providing potentially significant although short-term benefits [13]. For carpal tunnel syndrome, injections provide safe and effective temporary relief, though most patients will eventually require surgery for long-term control [15].

The clinical utility of corticosteroid injections is often limited by short-term benefits that reverse over time or by inferiority to alternative therapies. In tennis elbow, significant short-term benefits are reversed after six weeks with high recurrence rates [9], and injections should not be used for patients with symptom duration of less than 12 months [8]. A single, blinded injection is associated with poorer long-term outcomes and higher recurrence rates one year after treatment in unilateral lateral epicondylalgia [27]. Furthermore, platelet-rich plasma is superior to corticosteroid injections at both 3 and 6 months for lateral epicondylitis, though it has no advantage within the first month [17]. Combining a corticosteroid injection with exercise is not superior to exercise alone or no exercise for patients with plantar fasciopathy [1].

Safety profiles and specific administration protocols are critical to minimizing adverse events. Steroid injections are significantly associated with soft-tissue calcification in lateral epicondylitis, suggesting this calcification is likely an iatrogenic complication [11]. However, corticosteroid and hyaluronic acid injections remain a safe treatment option regarding the risk of severe adverse events requiring hospitalization [18]. No complications were observed for 4 mg triamcinolone injections administered at intervals of at least 1 month for trigger finger [16]. For rotator cuff repair, there are no conclusive data to suggest an increased risk of retear or infection with corticosteroid injection use before or after primary repair [6]; however, injections should be administered only after the first postoperative month to minimize the potential risk for adverse events [3]. An interval of at least three months is recommended between corticosteroid injection and shoulder arthroplasty [31].

How It Works

Efficacy and Outcomes by Condition

Corticosteroid injections provide condition-specific benefits across various orthopaedic pathologies. In rotator cuff repair, injections relieve pain and improve functional outcome scores [4]. For carpal tunnel syndrome, local corticosteroid injection offers safe, temporary symptom relief [15], providing greater clinical improvement than placebo at one month [19]. Local injection also yields significantly greater improvement than oral corticosteroids for up to three months in carpal tunnel syndrome [19]; however, it does not significantly improve outcomes compared with anti-inflammatory treatment, splinting, or laser treatment beyond eight weeks [19]. In trapeziometacarpal osteoarthritis, injections are a favorable management option due to their affordability, ease of administration, and efficacy [12]. For subacromial impingement with significant symptoms, physical therapy combined with corticosteroid injection is recommended as first-line treatment [32]. When treating adhesive capsulitis, clinicians may select either intra-articular or subacromial injection sites [21]. Conversely, combining corticosteroid injection with exercise is not superior to exercise or no exercise for patients with plantar fasciopathy [1].

Comparative Efficacy and Timing

The relative efficacy of corticosteroids depends on the condition and the timeframe of assessment. In lateral epicondylitis, corticosteroid injections are superior to platelet-rich plasma at one month [17], whereas platelet-rich plasma is superior to corticosteroid injections at both three and six months [17]. A single, blinded corticosteroid injection is associated with poorer long-term outcomes and higher recurrence rates one year after treatment in patients with unilateral lateral epicondylalgia [27]. In rotator cuff disease, corticosteroids demonstrate better short-term efficacy, while platelet-rich plasma is more beneficial for long-term recovery [25].

Steroid Type and Dosing

Selection of steroid type and dose impacts clinical outcomes. For primary trigger finger injection, betamethasone results in a significantly shorter time to failure than triamcinolone [2]. In soft tissue pathology of the hand, high-dose triamcinolone injections outperform low-dose injections across most metrics, including estimated time of relief, rate of repeat injection, and rate of surgery [26]. For de Quervain disease, targeting the extensor pollicis brevis subcompartment alone can reduce the total dose of steroids used [7].

Safety and Complications

Safety profiles vary by anatomical site and patient comorbidities. Following rotator cuff repair, corticosteroid injections should be administered only after the first postoperative month to minimize the potential risk for adverse events [3]. Subjective synthesis of ranges provides no conclusive data suggesting an increased risk of retear or infection with corticosteroid injection use [6]. Preoperative corticosteroid injection at all studied timepoints is not associated with an increased risk of postoperative deep infection after carpal tunnel release [22]. For trigger finger, no complications were observed for 4 mg triamcinolone injections administered at intervals of at least one month [16]. While there is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone for trigger finger, this difference may not be clinically relevant [24]. In patients with type 2 diabetes not treated with insulin, local corticosteroid injection to the shoulder can create a significant, short-term increase in systemic glucose levels [29]. Furthermore, the significant association of steroid injections with soft-tissue calcification in lateral epicondylitis suggests that this calcification is likely an iatrogenic complication of steroid injection [11].

Technique and Management

Specific techniques address delivery accuracy and manage potential side effects. Volar corticosteroid injection for distal interphalangeal ganglion cysts allows for ease and consistency of needle placement for intra-articular delivery while minimizing potential soft tissue and infection concerns [14]. Serial saline solution injections serve as a promising, cost-effective, and low-risk treatment option for subcutaneous lipoatrophy and skin depigmentation following cortisone injection in the elbow [23]. Currently, there is a lack of robust evidence to support the use of image guidance to improve accuracy and clinical effectiveness of steroid injection for thumb carpometacarpal joint osteoarthritis [20].

What the Evidence Shows

Plantar Fasciopathy

No specific evidence regarding corticosteroid injection outcomes for plantar fasciopathy is provided in the current evidence base.

Trigger Finger

Betamethasone injections result in a significantly shorter time to failure than triamcinolone injections for primary trigger finger [2].

Lateral Epicondylitis (Tennis Elbow)

Corticosteroid injections should not be used to treat most patients with tennis elbow with symptom duration of less than 12 months [8]. The significant short-term benefits of corticosteroid injection for tennis elbow are paradoxically reversed after six weeks, with high recurrence rates [9]. Platelet-rich plasma has no advantage over steroid injections within the first month of treatment for lateral epicondylitis, but it is superior to steroids at both 3 and 6 months [17]. Ketorolac injection is non-inferior to triamcinolone acetonide for the treatment of lateral epicondylitis over 52 weeks [36].

Rotator Cuff

There were no conclusive data to suggest an increased risk of retear or infection with corticosteroid injection use based on a subjective synthesis of ranges for rotator cuff repair [6]. Corticosteroids have better efficacy in short term, whereas platelet-rich plasma is more beneficial for longterm recovery in rotator cuff disease [25]. Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength [34].

Shoulder (General)

No specific evidence regarding general shoulder indications is provided in the current evidence base.

Adhesive Capsulitis (Frozen Shoulder)

Intra-articular steroid injection is effective and safe for frozen shoulder, relieving pain, improving functional performance, and increasing range of motion [33].

De Quervain Disease

An injection targeting the extensor pollicis brevis subcompartment alone can reduce the dose of steroids used, perhaps thereby decreasing complications related to steroid injections for de Quervain disease [7]. Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease [37]. Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients, but the effectiveness of each additional injection does not appear to diminish [35].

Carpal Tunnel Syndrome

Corticosteroid injection is safe and effective for the temporary relief of carpal tunnel syndrome symptoms, but most patients will eventually require surgery for long-term control of their symptoms [15]. Local corticosteroid injection provides greater clinical improvement in symptoms 1 month after injection compared with placebo and significantly greater improvement than oral corticosteroid for up to 3 months, but does not significantly improve outcomes compared with anti-inflammatory treatment, splinting, or laser treatment beyond 8 weeks for carpal tunnel syndrome [19]. Repeated corticosteroid injections were found to be safe in the treatment of carpal tunnel syndrome and did not affect the morbidity of subsequent release [30].

Trapeziometacarpal Osteoarthritis

Corticosteroids are a favorable option when considering the choice of intra-articular injection for the management of trapeziometacarpal osteoarthritis given their affordability, ease of administration, and efficacy [12]. There are potentially significant although short-term benefits to be gained from steroid injections into the trapeziometacarpal joint [13]. There is lack of robust evidence to support use of image guidance to improve accuracy and clinical effectiveness of steroid injection for thumb carpometacarpal joint osteoarthritis [20].

Other Indications

Volar corticosteroid injection allows for ease and consistency of needle placement for intra-articular corticosteroid delivery while minimizing the potential soft tissue and infection concerns described with other techniques for distal interphalangeal ganglion cysts [14].

Practical Considerations

Efficacy and Comparative Outcomes

Corticosteroid injections demonstrate superior efficacy compared to platelet-rich plasma at one month for lateral epicondylitis; however, platelet-rich plasma proves more effective at six months [17]. In the management of trapeziometacarpal osteoarthritis, intra-articular corticosteroid injections represent a favorable option due to their affordability, ease of administration, and efficacy [12].

Steroid Selection and Dosing

Targeting the extensor pollicis brevis subcompartment alone in de Quervain disease allows for a reduction in the dose of steroids used, which may thereby decrease complications related to steroid injections [7].

Safety, Complications, and Adverse Events

Repeated injections have been found to be safe in the treatment of carpal tunnel syndrome and do not affect the morbidity of subsequent release [30].

Key Evidence

  • [L1] The results indicate that combining a corticosteroid injection with exercise is not superior to exercise or no exercise. [1] (10.1136/bjsports-2023-106948)
  • [L3] Betamethasone injections resulted in a significantly shorter time to failure than triamcinolone injections. [2] (10.1016/j.jhsa.2026.03.011)
  • [L1] Corticosteroid injections should be administered only after the first postoperative month to minimize the potential risk for adverse events. [3] (10.1016/j.asmr.2021.10.010)
  • [L4] Corticosteroid injections provide benefit by relieving pain and improving functional outcome scores. [4] (10.1016/j.arthro.2020.04.044)
  • [L2] This study supports TA as a more viable corticosteroid option for shoulder injection. [5] (10.1016/j.jse.2023.05.023)
  • [L3] There were no conclusive data to suggest an increased risk of retear or infection with corticosteroid injection use based on a subjective synthesis of ranges. [6] (10.1016/j.arthro.2020.01.039)
  • [L1] An injection targeting the EPB subcompartment alone can reduce the dose of steroids used, perhaps thereby decreasing complications related to steroid injections. [7] (10.1097/corr.0000000000002018)
  • [Paper] Corticosteroid injections should not be used to treat most patients with tennis elbow with symptom duration of less than 12 months. [8] (10.1016/j.jsams.2009.09.009)
  • [L1] The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow. [9] (10.1136/bmj.38961.584653.ae)
  • [L1] Corticosteroid injections are effective in 57% of patients with trigger finger. [10] (10.5435/00124635-200703000-00006)
  • [L3] The significant association of steroid injections with soft-tissue calcification in LE suggests that this calcification is likely to be an iatrogenic complication of steroid injection. [11] (10.1016/j.jse.2018.10.009)
  • [L1] Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA. [12] (10.1016/j.jhsa.2024.02.001)
  • [L2] This study demonstrates that there are potentially significant although short-term benefits to be gained from steroid injections into the TMJ. [13] (10.1007/s11552-015-9778-3)
  • [L4] This technique allows for ease and consistency of needle placement for intra-articular corticosteroid delivery while minimizing the potential soft tissue and infection concerns described with other techniques. [14] (10.1177/1558944717744336)
  • [L5] Corticosteroid injection is safe and effective for the temporary relief of carpal tunnel syndrome symptoms, but most patients will eventually require surgery for long-term control of their symptoms. [15] (10.1016/j.jhsa.2008.06.023)
  • [L4] No complications were observed for 4 mg triamcinolone injections when administered at intervals of at least 1 month. [16] (10.1016/j.jhsg.2025.01.005)
  • [L1] PRP has no advantage over steroid injections within the first month of treatment, but it is superior to steroids at both 3 and 6 months. [17] (10.1016/j.jse.2023.04.018)
  • [L2] Corticosteroid and hyaluronic acid injections remain a safe treatment option regarding the risk of severe adverse events requiring hospitalization. [18] (10.1186/s12891-026-09752-7)
  • [L1] Local corticosteroid injection provides greater clinical improvement in symptoms 1 month after injection compared with placebo and significantly greater improvement than oral corticosteroid for up to 3 months, but does not significantly improve outcomes compared with anti-inflammatory treatment, splinting, or laser treatment beyond 8 weeks. [19] (10.1177/1753193413490848)
  • [L4] However, there is lack of robust evidence to support use of image guidance to improve accuracy and clinical effectiveness of steroid injection for thumb CMCJ and warrants further research. [20] (10.1177/17589983261430876)
  • [L1] When corticosteroid injection is used to treat adhesive capsulitis, both injection sites can be selected. [21] (10.1155/2019/1274790)
  • [L3] Preoperative corticosteroid injection at all studied timepoints was not associated with an increased risk of postoperative deep infection, a divergence from existing literature. [22] (10.5435/jaaos-d-25-00317)
  • [L4] Serial saline solution injections are a promising, cost-effective, and low-risk treatment option for subcutaneous lipoatrophy and skin depigmentation following cortisone injection in the elbow. [23] (10.1016/j.jseint.2020.08.009)
  • [L2] There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone, but that difference may not be clinically relevant. [24] (10.1016/j.jhsa.2024.05.016)
  • [L1] Current analysis showed that corticosteroids have better efficacy in short term, whereas PRP is more beneficial for longterm recovery. [25] (10.1016/j.jse.2023.01.037)
  • [L4] High-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery. [26] (10.1016/j.jhsa.2025.09.014)
  • [L1] A single, blinded injection of corticosteroid medication was associated with poorer long-term outcomes and higher recurrence rates 1 year after receiving an injection in patients with unilateral lateral epicondylalgia. [27] (10.1001/jama.2013.129)
  • [L2] Repeated corticosteroid injections for recurrent trigger finger should be considered in patients who prefer nonsurgical treatment, especially in those without factors predictive of failure. [28] (10.1016/j.jhsa.2023.12.002)
  • [L2] Local corticosteroid injection to the shoulder can create a significant, short-term increase in systemic glucose levels in patients with type 2 diabetes not treated with insulin. [29] (10.1016/j.jseint.2022.05.016)
  • [L3] Repeated injections were found to be safe in the treatment of carpal tunnel syndrome and did not affect the morbidity of subsequent release. [30] (10.1177/17531934251396629)
  • [L1] Thus, an interval of at least three months is recommended between injection and arthroplasty. [31] (10.1177/17585732241261659)
  • [L1] For patients with significant symptoms, the authors recommend physical therapy with corticosteroid injection as a first-line treatment, followed by acromioplasty and physical therapy if conservative treatment fails. [32] (10.1016/j.arthro.2022.02.008)
  • [L1] Intra-articular steroid injection is effective and safe for frozen shoulder, relieving pain, improving functional performance, and increasing range of motion. [33] (10.1177/0363546516669944)
  • [L2] Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength, suggesting that one injection before repair does not strongly influence outcomes. [34] (10.1016/j.jseint.2026.101632)
  • [L4] Patients with diabetes mellitus have a decreased probability of success following a single corticosteroid injection for de Quervain tenosynovitis in comparison to nondiabetic patients, but the effectiveness of each additional injection does not appear to diminish. [35] (10.1016/j.jhsa.2022.02.018)
  • [L1] This randomized controlled non-inferiority trial demonstrates that ketorolac injection is non-inferior to triamcinolone acetonide for the treatment of lateral epicondylitis over 52 weeks. [36] (10.1016/j.jse.2025.11.012)
  • [L1] Pain and clinical outcomes significantly improved after corticosteroid injection in de Quervain's disease. [37] (10.1016/j.otsr.2019.11.015)

See Also

  • Osteoarthritis

References

[1] Does a corticosteroid injection plus exercise or exercise alone add to the effect of patient advice and a heel cup for patients with plantar fasciopathy? A randomised clinical trial. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2023-106948

[2] The Effect of Corticosteroid Type on Failure Following Primary Trigger Finger Injection. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.03.011

[3] Corticosteroid Injections After Rotator Cuff Repair Improve Function, Reduce Pain, and Are Safe: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.10.010

[4] Corticosteroid Injections May Increase Retear and Revision Rates of Rotator Cuff Repair: A Systematic Review. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.04.044

[5] Comparison of triamcinolone and methylprednisolone efficacy and steroid flare reaction rates after shoulder corticosteroid injection: a prospective interrupted time series study. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.05.023

[6] Do Corticosteroid Injections Before or After Primary Rotator Cuff Repair Influence the Incidence of Adverse Events? A Subjective Synthesis. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.01.039

[7] Is a Steroid Injection in Both Compartments More Effective than an Injection in the Extensor Pollicis Brevis Subcompartment Alone in Patients with de Quervain Disease? A Randomized, Controlled Trial. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000002018

[8] Stop injecting corticosteroid into patients with tennis elbow, they are much more likely to get better by themselves!. Journal of Science and Medicine in Sport. 2010. DOI: 10.1016/j.jsams.2009.09.009

[9] Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006. DOI: 10.1136/bmj.38961.584653.ae

[10] Corticosteroid Injections in the Treatment of Trigger Finger: A Level I and II Systematic Review. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200703000-00006

[11] Association of steroid injection with soft-tissue calcification in lateral epicondylitis. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.10.009

[12] Efficacy of Intra-Articular Corticosteroid Injection for Nonsurgical Management of Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.02.001

[13] Intra-Articular Corticosteroid Injections to Manage Trapeziometacarpal Osteoarthritis—a Systematic Review. HAND. 2015. DOI: 10.1007/s11552-015-9778-3

[14] Treatment of Distal Interphalangeal Ganglion Cysts by Volar Corticosteroid Injection. HAND. 2017. DOI: 10.1177/1558944717744336

[15] Corticosteroid Injection for Carpal Tunnel Syndrome. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.06.023

[16] Safety and Efficacy of Low-Dose Triamcinolone Injection without Injection Frequency Limitation for Trigger Finger. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.01.005

[17] Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet-rich plasma at 1 month but platelet-rich plasma is more effective at 6 months: an updated systematic review and meta-analysis of level 1 and 2 studies. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.04.018

[18] Safety of intra-articular corticosteroid and hyaluronic acid injections: a 14-year population-based cohort study of 404,797 patients. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09752-7

[19] Cochrane corner: local corticosteroid injection for carpal tunnel syndrome. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413490848

[20] Guided steroid injection for thumb carpometacarpal joint (CMCJ) osteoarthritis: A scoping review. Hand Therapy. 2026. DOI: 10.1177/17589983261430876

[21] Intra-Articular versus Subacromial Corticosteroid Injection for the Treatment of Adhesive Capsulitis: A Meta-Analysis and Systematic Review. BioMed Research International. 2019. DOI: 10.1155/2019/1274790

[22] Ipsilateral Preoperative Corticosteroid Injection and Timing Not Associated With Postoperative Deep Infection After Carpal Tunnel Release. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00317

[23] Serial saline solution injections for the treatment of lipoatrophy and depigmentation after corticosteroid injection for medial epicondylitis. JSES International. 2020. DOI: 10.1016/j.jseint.2020.08.009

[24] Corticosteroid Injection With and Without Local Anesthetic for the Treatment of Trigger Finger: A Randomized Clinical Trial. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.05.016

[25] Comparison of the effects of platelet-rich plasma and corticosteroid injection in rotator cuff disease treatment: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.01.037

[26] Efficacy of Low-Dose Versus High-Dose Corticosteroid Injections for Soft Tissue Pathology of the Hand. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.09.014

[27] Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia. JAMA. 2013. DOI: 10.1001/jama.2013.129

[28] Factors Influencing the Successful Treatment of Recurrent Trigger Finger With Repeated Corticosteroid Injections: A Prospective Cohort Study. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.12.002

[29] The effect of steroid injection into the shoulder on glycemia in patients with type 2 diabetes. JSES International. 2022. DOI: 10.1016/j.jseint.2022.05.016

[30] The safety and cost of repeated corticosteroid injections for carpal tunnel syndrome. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251396629

[31] The safety of corticosteroid injection prior to shoulder arthroplasty: A systematic review. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241261659

[32] Physical Therapy Combined With Subacromial Cortisone Injection Is a First‐Line Treatment Whereas Acromioplasty With Physical Therapy Is Best if Nonoperative Interventions Fail for the Management of Subacromial Impingement: A Systematic Review and Network Meta‐Analysis. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.02.008

[33] Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516669944

[34] Timing of corticosteroid injection within 1 year prior to rotator cuff repair was not associated with increased risk of repair failure. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101632

[35] Effectiveness of Corticosteroid Injections in Diabetic Patients With De Quervain Tenosynovitis. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.02.018

[36] The KINDLE trial: ketorolac vs. triamcinolone injections for lateral epicondylitis- a non-inferiority randomized controlled multicentric trial. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.11.012

[37] Prospective randomized comparison of ultrasonography-guided and blind corticosteroid injection for de Quervain's disease. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2019.11.015

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Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.