Clinical evidence library · October 2026
This selected evidence summary is for education, not an individual treatment recommendation. Findings are reported with limitations, including evidence that does not support routine injection use. Published dates are not clinical review dates.
NICE (2022) · National Institute for Health and Care Excellence · Guideline
Therapeutic exercise is central to care. Corticosteroid injections can be considered for short-term relief (2–10 weeks); intra-articular hyaluronan is not recommended.
Relevant to: Knee osteoarthritis; injection comparisons
Desmeules et al. (2025) · Journal of Orthopaedic & Sports Physical Therapy · Clinical practice guideline
Active rehabilitation is recommended as initial care. Steroid injection may reduce short-term pain but is not recommended as first-line treatment.
Relevant to: Shoulder; rotator cuff; ultrasound-guided injection
Pereira et al. (2022) · BMJ · Systematic review and meta-analysis
Across large placebo-controlled trials, average pain benefit was below the prespecified clinically important threshold; potential safety concerns were identified.
Relevant to: Knee osteoarthritis; hyaluronic acid
McAlindon et al. (2017) · JAMA · Randomised clinical trial
Repeated injections every 12 weeks for two years were associated with greater cartilage loss and no significant pain advantage versus saline. This does not assess occasional injections.
Relevant to: Knee osteoarthritis; repeat corticosteroid injections
Guidelines and high-quality comparative trials inform shared decision-making. Treatment suitability depends on the individual, contraindications and alternatives. An accurate ultrasound-guided needle placement does not automatically mean superior long-term patient outcomes.
Steroid injections · Hyaluronic acid evidence · Rotator cuff evidence