Bringing it back to clinical practice it is still a tricky we can see that the steroid injection into the subacromial space is definitely used as a sub machine gun approach to shoulder pain, firing indiscriminately in the hope of finding a mark. But I still encounter patients with cuff tendinopathy suffering from marked disruption to their sleep and a shoulder that seems hypersensitive to mechanical loading through the subacromial/rotator cuff region. This people I mention are failing to make progress with exercise rehabilitation, various manual therapies and oral/topical analgesics. I dare to say more than 1 in 5 of these people come back with a marked improvement. I do wonder if, with the abundance of mechanical receptors and nerve endings around the supraspinatus and subacromial bursa, if the area has some level of peripheral nerve sensitisation that is eased by either the corticosteroid and/or local anaesthetic (see the article mentioned in my previous post on rotator cuff pain ) or maybe my belief in the management I have suggested provides the best placebo ever! Oh no have I become the used car salesman of health!