Abstract
BackgroundCorticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up.MethodsElectronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach.ResultsSix studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term.ConclusionsThere are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions.PROSPERO registration numberCRD42020148650.
Highlights
Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective
Despite the low methodological quality, our results indicate that there is no significant difference between Corticosteroid injections (CSI) or dry needling (DN) for reducing pain at short-term follow-up (≤ 6 weeks) in individuals with greater trochanteric and myofascial pain/headache [26, 29]
In conclusion, there is very low quality of evidence that there is no significant difference between CSI or DN for pain or disability at short, medium- or long-term follow-up in people with myofascial pain and greater trochanteric pain syndrome
Summary
Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. Corticosteroid injections (CSI) have been widely used in the management of musculoskeletal conditions in order to reduce inflammation, pain and disability [1]. A randomized clinical trial (RCT) observed that an intra-articular corticosteroid injection caused loss of cartilage without reducing pain at two years follow-up [7]. These findings suggest that corticosteroid injections may be used with caution
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