Detrimental Effect of Repeated and Single Subacromial Corticosteroid Injections on the Intact and Injured Rotator Cuff

Maman, Eran; Yehuda, Chaim; Pritsch, Tamir; Morag, Guy; Brosh, Tamar; Sharfman, Zachary T.; Dolkart, Oleg

doi:10.1177/0363546515591266

Cited by 59 publications

(66 citation statements)

References 21 publications

(19 reference statements)

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“…Subacromial corticosteroid injections (CSI's) are a common non-surgical treatment for rotator cuff tears (RCT's) and other shoulder pathologies. While the science behind the use of CSI's is currently inconclusive [3][4][5][6][7][8][9][10] , they are typically employed along with other non-surgical measures like physical therapy, activity modification, and non-steroidal anti-inflammatory medications (NSAIDs), in order to reduce pain and increase functionality in patients with RCT's. When a combination of these therapies does not relieve patients' symptoms sufficiently, surgical repair is typically the next treatment.…”

Section: Introductionmentioning

confidence: 99%

Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer

Cautiero

Russo

Pietto

et al. 2019

Muscle Ligaments and Tendons J

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Background: Subacromial corticosteroid injections (CSI's) are a common non-surgical treatment for rotator cuff tears. Few studies have assessed the effects of pre-operative CSI's on postoperative functional outcomes. Methods: A retrospective analysis was conducted of 132 patients with high-grade, partial-thickness rotator cuff tears (PTRCT's). The subjects were divided into two groups based on whether they received a CSI or not. The CSI group was further divided into three subgroups based on when they received a pre-operative injection: 0-3 months, 3-6 months, >6 months before surgery. The Visual Analog Scores (VAS), American Shoulder and Elbow Surgeon scores (ASES), and Constant scores were recorded prior to surgery and at a one-year post-operative follow-up appointment for each subject. stant score (p=0.019 and 0.014, respectively) compared to the other two subgroups, but the VAS score decrease only trended toward significance (p=0.091). The sample as a whole experienced significant improvement in all three outcome measures. Conclusion: Patients undergoing arthroscopic re-pair of a high-grade PTRCT may benefit from a pre-operative CSI 0-3 months before surgery. Level of evidence: IIb. Results: Patients who received a pre-operative CSI (n=92) improved significantly more than the non-injection group (n=40) in all outcome measures. The 0-3 months injection subgroup experienced a significant increase in ASES and Con

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Section: Introductionmentioning

confidence: 99%

Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer

Cautiero

Russo

Pietto

et al. 2019

Muscle Ligaments and Tendons J

View full text Add to dashboard Cite

show abstract

“…The results of several systematic reviews and meta-analyses over decades suggest there may be short-term symptomatic relief after CSI, but these results are often difficult to reproduce [4][5][6][7][8] . In addition, case reports from the past have suggested a correlation of CSI and tendon rupture [19][20][21] , which has been confirmed in multiple animal models 6,9,10,22 . Previous studies have also shown an increase in post-operative infection rates in patients who received pre-or peri-operative CSI's [23][24][25] , but recent systematic reviews and meta-analyses have challenged these claims 11,13,26,28 .…”

Section: Discussionmentioning

confidence: 77%

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Donohue

Prisco

Grindel

2017

MLTJ

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SummaryBackground: Subacromial corticosteroid injections (CSI's) are a common non-surgical treatment for rotator cuff tears. Few studies have assessed the effects of pre-operative CSI's on postoperative functional outcomes. Methods: A retrospective analysis was conducted of 132 patients with high-grade, partial-thickness rotator cuff tears (PTRCT's). The subjects were divided into two groups based on whether they received a CSI or not. The CSI group was further divided into three subgroups based on when they received a pre-operative injection: 0-3 months, 3-6 months, >6 months before surgery. The Visual Analog Scores (VAS), American Shoulder and Elbow Surgeon scores (ASES), and Constant scores were recorded prior to surgery and at a one-year post-operative follow-up appointment for each subject. Results: Patients who received a pre-operative CSI (n=92) improved significantly more than the non-injection group (n=40) in all outcome measures. The 0-3 months injection subgroup experienced a significant increase in ASES and Constant score (p=0.019 and 0.014, respectively) compared to the other two subgroups, but the VAS score decrease only trended toward significance (p=0.091). The sample as a whole experienced significant improvement in all three outcome measures. Conclusion: Patients undergoing arthroscopic repair of a high-grade PTRCT may benefit from a pre-operative CSI 0-3 months before surgery. Level of evidence: IIb.

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“…Concerns about a local corticosteroid injection for tendinopathy arise from its potential side effects, including tendon degeneration, the weakening of the injected tendon, decreasing biomechanical strength at the injected site, and ruptures [16][17][18][19][20][21][22][23]. Intra-articular treatment with corticosteroids also increases apoptosis in human rotator cuff tears and the tendency was similar in all rupture sites [24].…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Facilitates NF-��B Signal Pathway in TNF-�� Stimulated Rotator Cuff Tenocytes

Kim

Patel

et al. 2019

Journal of Microbiology and Biotechnology

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Corticosteroids are commonly used for pain control in rotator cuff tear. Deregulated NF-κB activation is a hallmark of chronic inflammatory diseases and has been responsible for the pathogenesis of rotator cuff tear. The Dexamethasone(DEXA) is a synthetic corticosteroid. The purpose of this study was to examine the exact effect of dexamethasone on NF-κB signaling in rotator cuff tear. We measured NF-κB expression in four groups: control, TNF-α-treated, DEXA-treated, and combined treatment with TNF-α and DEXA. Tenocytes were isolated from patients with rotator cuff tears and pre-incubated with TNF-α (10 ng/ml), DEXA (1 μM), or both of them for 10 min, 1 h, and 2 h. Expression of p65, p50, and p52 in the nuclei and cytosol was analyzed by western blotting and immunofluorescence imaging using confocal microscopy. We also evaluated nucleus/cytosol (N/C) ratios of p65, p50, and p52. In our study, the combined treatment with DEXA and TNF-α showed increased N/C ratios of p65, p50, and p52 compared with those in the TNF-α group at all time points. Additionally, in the DEXA group, N/C ratios of p65, p50, and p52 gradually increased from 10 min to 2 h. In conclusion, DEXA promoted the nuclear localization of p65, p50, and p52, but was not effective in inhibiting the inflammatory response of TNF-α-stimulated rotator cuff tear.

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Detrimental Effect of Repeated and Single Subacromial Corticosteroid Injections on the Intact and Injured Rotator Cuff

Abstract: The potential benefit and detrimental effects of corticosteroid injection should be thoroughly considered before it is administered subacromially in patients with RC injuries.

Cited by 59 publications

References 21 publications

Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer

Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Dexamethasone Facilitates NF-��B Signal Pathway in TNF-�� Stimulated Rotator Cuff Tenocytes

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