Frequency of Shoulder Corticosteroid Injections for Pain and Stiffness After Shoulder Surgery and Their Potential to Enhance Outcomes with Physiotherapy: A Retrospective Study

Abstract

IntroductionWhat is the rate of injecting patients with shoulder corticosteroid injections to alleviate excessive stiffness and pain within 6 months after shoulder surgery?MethodsRetrospective 10-year review of a shoulder surgeon’s practice. Participants included 754 patients who had 945 non-arthroplasty shoulder surgeries. Outcome measures included the rate of injections, diagnoses, patient characteristics, and efficacy via questionnaire.ResultsApproximately one in five patients received a subacromial and/or glenohumeral corticosteroid injection. Over 95% of patients stated that the injections helped reduce shoulder pain and increased function 6 weeks post-injection. Twenty-two percent of cases (208/945) received glenohumeral and/or subacromial injections. The 208 injected cases had these diagnoses: rotator cuff tear (28% of injected patients), subacromial impingement (20%), glenohumeral instability (16%), subacromial impingement with acromioclavicular osteoarthritis (10%), adhesive capsulitis (7%), SLAP lesion (5%), biceps tendinopathy (3%), glenohumeral instability with subacromial impingement (3%), proximal humerus fracture (2%), calcific tendinitis (2%), and less common conditions (4%). Diagnoses among those with the highest rates of injected patients per diagnosis included: SLAP lesions (40%), calcific tendinitis (40%), adhesive capsulitis (29%), subacromial impingement (28%), proximal humerus fracture (24%), rotator cuff tear (19%), and glenohumeral instability (16%). Significant differences (p < 0.03) were found between patients who did and did not receive injections with respect to age (more likely younger patients with cuff tear) and sex (more likely female with subacromial impingement and instability) but not for diabetes or arthroscopic vs. open procedures.ConclusionThis is the first study to establish the rates of postoperative shoulder corticosteroid injections within the first 6 months after various non-arthroplasty shoulder surgeries for patients with high pain/stiffness. These data will be useful for establishing guidelines for using corticosteroid injections along with physiotherapy.

The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk

“…Corticosteroid injections are widely used in the postoperative period to alleviate pain and stiffness. 2,4,10 Skedros et al 27 reviewed the cases of 754 patients who underwent nonarthroplasty shoulder procedures and noted that 22% received corticosteroid injections within 6 months of the procedure, with 63% attributed to pain, 24% to stiffness, and 13% to inflammation/bursitis. These patients encompassed a variety of surgical procedures, including superior labrum anterior and posterior repair, biceps tenodesis, rotator cuff repair, adhesive capsulitis, and calcific tendinitis, and were found to have improvement in pain and function up to 6 weeks after the injection with improved participation in physical therapy.…”

“…Various modalities have been studied to recover range of motion, including nonsteroidal anti-inflammatory medications, oral steroids, aggressive physical therapy, and corticosteroid injections. 11,12 Skedros et al 27 noted the applicability of postoperative corticosteroid injections across a variety of arthroscopic shoulder procedures, and several studies also demonstrated improvement in pain and range of motion among patients with subacromial impingement and adhesive capsulitis. 4,9,27 These studies suggest that the use of corticosteroid injections is a safe intervention after shoulder arthroscopy; however, the development of infection was not specifically evaluated and would require much larger numbers to power.…”

MicroRNA-29a Mitigates Subacromial Bursa Fibrosis in Rotator Cuff Lesion with Shoulder Stiffness

“…put shoulders at the risk of the disease [27,28,29]. Rehabilitation [30], arthroscopic repair [31], and intra-articular injections of steroid [32] are common modalities. Hyaluronic acid [33] and platelet-rich plasma injections [34] improve rotator cuff lesions in experimental animals.…”

A novel taping therapy for pain after arthroscopic shoulder surgery: study protocol for a randomised controlled pilot trial

“…Minimally invasive arthroscopic shoulder surgery is beneficial for patients who desire less usage of analgesics and earlier return to work [ 23 ]. However, postoperative pain is often a concurrent problem that delays rehabilitation and lowers the quality of life [ 24 ]. Multimodal pain control, combining pharmaceutical and non-pharmaceutical techniques, is newly recommended to enhance recovery after surgery [ 25 , 26 ].…”