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Post-Surgical Residual Symptom Injections

Diagnostic and therapeutic post-operative injections for residual symptoms. Timing, indications, prognostic value of response. Distinguishing scar-related inflammation from structural failure.

Overview

Image-guided corticosteroid injections provide statistically and clinically relevant improvements in shoulder function and pain for glenohumeral arthritis up to 4 months post-injection [1]. Ultrasound guidance yields significantly greater improvement in pain and function at 6 weeks compared to blind injections [12]. For adhesive capsulitis, multiple-site injections offer a clinical advantage over placebo for short- and intermediate-term composite outcomes, although short-term benefits dissipate over time [2]. In snapping scapula syndrome, patients achieving a good transient response to preoperative ultrasound-guided subscapular cortisone injection obtain significantly better recovery than those who do not [6].

Therapeutic effects of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections are best observed after the first and second injections, questioning the necessity of repeating injections more than twice [5]. Ultrasound-guided injection of the acromioclavicular joint demonstrates a high level of clinical success substantiated by arthrography [11]. However, additional research is required to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular steroid injections for isolated acromioclavicular osteoarthritis [10].

Caution is advised when administering corticosteroid injections in the immediate postoperative period after shoulder arthroscopy due to effects on infection risk [9]. Preoperative shoulder injections may increase the risk of revision rotator cuff repair and subacromial decompression by up to 150% in patients who had their index surgery 6 to 12 months prior, compared to those who did not receive a preoperative injection [7]. The risk of reoperation for revision rotator cuff repair significantly declines if more than 6 months elapse between injection and surgery [4].

Anatomy & Pathophysiology

Kinematics and Functional Anatomy

Scapulothoracic motion constitutes an important component of active shoulder motion and function in both healthy shoulders and in those compromised by common pathologies [24]. In patients with frozen shoulder, the range of motion is susceptible to pain and muscle contraction [30].

Rotator Cuff Pathology and Natural History

The ability to identify symptomatic atraumatic degenerative rotator cuff (SADRC) tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population [28]. Rotator cuff tears are no more likely to progress on the right side compared to the left side [38].

Impingement Classification

The literature proposes a comprehensive classification of all individualized impingements occurring around the anterior aspect of the shoulder, including newly described entities, to address conflicting theories and improve understanding of their etiologic factors, diagnosis, and treatment [27].

Reverse Total Shoulder Arthroplasty Considerations

As subacromial notching correlated with patients' anatomical characteristics and degree of lateralization during reverse total shoulder arthroplasty, the implant's degree of lateralization should be adjusted according to the patient's own anatomical characteristics [31].

Classification

Timing and Interval: The temporal relationship between injection and surgery significantly influences outcomes. The risk of reoperation after rotator cuff repair significantly declines if more than 6 months elapse between injection and the procedure [4]. Preoperative shoulder injections may increase the risk of revision rotator cuff repair and subacromial decompression by up to 150% in patients 6 to 12 months after index surgery compared with patients who did not receive a preoperative injection [7]. Conversely, corticosteroid injections within 12 months prior to anatomic and reverse shoulder arthroplasty do not compromise patient-reported outcomes during a minimum of 2-year follow-up [8].

Modality and Efficacy: Corticosteroids: Patients with glenohumeral arthritis experience statistically and clinically relevant improvements in shoulder function and pain up to 4 months after a single, image-guided corticosteroid injection [1]. Multiple-site corticosteroid injections show a clinical advantage over placebo for short- and intermediate-term composite outcome assessments in adhesive capsulitis, although short-term benefits dissipate over time [2]. Hyaluronic Acid and Saline: The effect of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections for shoulder pain was best seen after the first and second injections, questioning the necessity of repeating injections more than two times [5]. Biologics: Subacromial injections of human placenta hydrolysate showed significant improvement in pain, functional level, and quality of life in patients with shoulder impingement syndrome [22]. Local Anesthetics: Periarticular injection of a local anesthetic solution provides reliable and consistent pain control with a trend toward less immediate postoperative opioid use after total shoulder arthroplasty compared with regional blocks [46].

Guidance and Accuracy: Image-Guided: Patients who underwent image-guided (ultrasound) injections had statistically significant greater improvement in shoulder pain and function at 6 weeks after injection compared to blind injections [12]. Ultrasound-guided injection of the acromioclavicular joint demonstrates a high level of clinical success substantiated with arthrography [11]. Physician Experience: The accuracy of intra-articular glenohumeral injections does not appear to depend on the experience of the physician and may be irrelevant in treating shoulder pain of multiple origins [14].

Complications and Safety: Caution is advised when administering injections in the immediate postoperative period after shoulder arthroscopy due to effects on postoperative infection risk [9]. Half of the nerve injuries following the Latarjet procedure led to residual symptoms [3].

Other Considerations: Additional research is needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular injections for isolated acromioclavicular osteoarthritis [10].

Clinical Presentation

Patients with glenohumeral arthritis experience statistically and clinically relevant improvements in shoulder function and pain up to 4 months after a single, image-guided corticosteroid injection [1]. Multiple-site corticosteroid injections show a clinical advantage over placebo for short- and intermediate-term composite outcome assessments in adhesive capsulitis, although short-term benefits dissipate over time [2]. Patients with isolated acromioclavicular osteoarthritis may experience pain, though additional research is needed to determine the main cause and compare outcomes of intra-articular versus extra-articular injections [10]. Patients with shoulder impingement syndrome show significant improvement in pain, functional level, and quality of life after subacromial injections of human placenta hydrolysate [22].

Residual MRI findings 6 months after shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder have no significant correlation with clinical symptoms [18]. Patients with snapping scapula syndrome who gain a good transient response to a preoperative ultrasound-guided subscapular cortisone injection obtain a significantly better recovery than those who do not [6].

Half of the nerve injuries occurring after the Latarjet procedure lead to residual symptoms [3]. Two-thirds of graft failures following the Latarjet procedure require reoperations [3].

Clinicians should be aware that central serous retinopathy causing loss of visual acuity is a rare but significant complication of steroid injection into the shoulder bursa, requiring prompt ophthalmic referral if visual disturbances occur [15].

Investigations

Plain radiography: Standard imaging remains foundational for evaluating glenohumeral arthritis and acromioclavicular joint pathology. For isolated acromioclavicular osteoarthritis, additional research is required to determine the primary cause of pain and to compare clinical outcomes between intra-articular and extra-articular injection strategies [10].

MRI: Magnetic resonance imaging can assess structural changes post-procedure. Residual MRI findings observed 6 months after shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder show no significant correlation with clinical symptoms [18]. In the context of elbow surgery, MRI indicates that the donor site following autologous osteochondral mosaicplasty for cartilaginous lesions is resurfaced with fibrous tissue [51].

Ultrasound: Ultrasound guidance enhances procedural accuracy and outcomes. Patients undergoing image-guided (ultrasound) injections demonstrate statistically significant greater improvement in shoulder pain and function at 6 weeks compared to blind injections [12]. Ultrasound-guided injection of the acromioclavicular joint demonstrates a high level of clinical success, substantiated by arthrography [11]. Regarding glenohumeral injection, accuracy does not appear to depend on physician experience and may be irrelevant for treating shoulder pain of multiple origins [14].

Aspiration: Aspiration is often performed concurrently with injection to rule out infection or crystal arthropathy, though specific aspiration findings are not detailed in the current evidence base for these indications.

Laboratory: No specific laboratory markers are cited in the provided evidence for the investigation of post-surgical residual symptoms.

Other Considerations: Diagnostic and therapeutic injections serve as both prognostic tools and treatments. Patients who achieve a good transient response to a preoperative ultrasound-guided subscapular cortisone injection obtain significantly better recovery than those who do not [6]. For recurrent idiopathic frozen shoulder, a repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery [19]. In glenohumeral arthritis, a single, image-guided corticosteroid injection yields statistically and clinically relevant improvements in shoulder function and pain up to 4 months [1]. For adhesive capsulitis, multiple-site corticosteroid injections show clinical advantage over placebo for short- and intermediate-term composite outcomes, though short-term benefits dissipate over time [2]. Regarding rotator cuff pathology, the effect of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections is best seen after the first and second injections, questioning the necessity of repeating injections more than two times [5]. Post-arthroscopic rotator cuff repair (ARCR) stiffness can be treated with a single-dose intra-articular corticosteroid injection at 6 weeks postoperative; this significantly improves pain, function, and duration of return to activities of daily living without increasing the risk of retears [23].

Complications and Safety: Clinicians must weigh risks against benefits. Half of the nerve injuries after Latarjet procedure lead to residual symptoms [3]. Loss of visual acuity due to central serous retinopathy is a rare but significant complication after steroid injection into the shoulder bursa, requiring prompt referral to an ophthalmic specialist if visual disturbances are noticed [15]. Preoperative shoulder injections may increase the risk of revision rotator cuff repair (RCR) and subacromial decompression by up to 150% in patients 6 to 12 months after index surgery compared with patients who did not receive a preoperative injection [7]. However, the risk of reoperation significantly declines if there is more than 6 months between injection and RCR [4]. Corticosteroid injections within 12 months prior to anatomic and reverse shoulder arthroplasty do not compromise patient-reported outcomes during a minimum of 2-year follow-up [8]. Caution is advised when administering injections in the immediate postoperative period after shoulder arthroscopy due to effects on postoperative infection risk [9]. The association between shoulder injection and postoperative infection risk was not noted when shoulder arthroscopy or arthroplasty occurred >3 months after injection [20].

Treatment

Non-Operative

Conservative management remains a viable option for select pathologies; observation and therapy can lead to full recovery from cement extrusion causing radial nerve palsy after shoulder arthroplasty [44]. For chronic, symptomatic, full-thickness rotator cuff tears, higher activity levels and patient expectations are associated with failure of nonoperative treatment [47]. In cases of snapping scapula syndrome, patients who gain a good transient response to a preoperative ultrasound-guided subscapular cortisone injection obtain significantly better recovery than those who do not [6].

Operative

Indications: Preoperative shoulder injections may increase the risk of revision rotator cuff repair (RCR) and subacromial decompression by up to 150% in patients 6 to 12 months after index surgery compared with patients who did not receive a preoperative injection [7]. Corticosteroid injections should be withheld if a rotator cuff repair is to be performed within the following 6 months due to adverse impacts on rotator cuff tendon health and repair [41]. The risk of reoperation significantly declines if more than 6 months elapse between a corticosteroid injection and RCR [4]. Shoulder arthroscopy should be avoided within 4 weeks of a pre-operative steroid injection unless there is strong justification, requiring a cautious, individualized approach [42].

Surgical Approach / Technique: Judicious use of corticosteroid injections within 12 months prior to anatomic and reverse shoulder arthroplasty does not compromise patient-reported outcomes at a minimum of 2 years following surgery [8]. Caution is advised when administering corticosteroid injections in the immediate postoperative period after shoulder arthroscopy due to potential effects on infection risk [9]. Intra-articular corticosteroid injection in the early postoperative period after arthroscopic RCR provides satisfactory pain relief and range of motion improvement without increasing the re-tear rate or deteriorating clinical outcomes at 2-year follow-up [13]. A single-dose intra-articular corticosteroid injection administered at 6 weeks postoperatively to treat stiffness after arthroscopic RCR significantly improved pain, function, and duration of return to activities of daily living without increasing the risk of retears [23].

Adjuncts: Single, image-guided corticosteroid injection for glenohumeral arthritis provides statistically and clinically relevant improvements in shoulder function and pain up to 4 months post-injection [1]. Multiple-site corticosteroid injections show a clinical advantage over placebo for short- and intermediate-term composite outcomes in adhesive capsulitis, although short-term benefits dissipate over time [2]. Subacromial triamcinolone acetonide, hyaluronic acid, and saline injections show the best effect after the first and second injections, questioning the necessity of repeating injections more than two times [5]. Ultrasound-guided injection of the acromioclavicular joint demonstrates a high level of clinical success substantiated with arthrography [11]. Image-guided (ultrasound) corticosteroid injections result in statistically significant greater improvement in shoulder pain and function at 6 weeks compared to blind injections [12].

Other Considerations: Delayed application of leukocyte-rich platelet-rich plasma (PRP) following RCR did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively [16]. Corticosteroid injections provide at best minimal transient pain relief in a small number of patients with rotator cuff tendinosis and cannot modify the natural course of the disease [17]. Suprascapular neuropathy secondary to reverse shoulder arthroplasty can result in significant pain relief and improvement of range of motion after the procedure [48]. Additional research is needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular steroid injections for isolated acromioclavicular osteoarthritis [10].

Complications

Nerve palsy: Half of nerve injuries occurring after the Latarjet procedure result in residual symptoms [3].

Infection (PJI): Preoperative shoulder injections are associated with an increased risk of revision rotator cuff repair (RCR) [4]. This risk significantly declines if more than 6 months elapse between the injection and surgery [4]. Preoperative injections may increase the risk of revision RCR and subacromial decompression by up to 150% in patients 6 to 12 months after index surgery compared with those who did not receive a preoperative injection [7]. There is a correlation between preoperative shoulder injections and revision RCR, with frequency and time dependence observed [21]. The timing of elective shoulder surgery after shoulder injection affects postoperative infection risk in Medicare patients [20]. However, this association between injection timing and postoperative infection risk was not noted when shoulder arthroscopy or arthroplasty occurred more than 3 months after injection [20]. Caution is advised when administering injections in the immediate postoperative period after shoulder arthroscopy due to infection risk [9]. Serious complications from biologic injections include infections requiring multiple surgical procedures and inflammatory reactions [39].

Aseptic loosening / Patient-Reported Outcomes: Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise patient-reported outcomes at a minimum of 2 years following surgery [8]. Corticosteroid injections within 12 months prior to anatomic and reverse shoulder arthroplasty do not compromise patient-reported outcomes during a minimum of 2-year follow-up [8]. Intra-articular corticosteroid injection in the early postoperative period after arthroscopic rotator cuff repair provided satisfactory pain relief and range of motion improvement without increasing the re-tear rate or deteriorating clinical outcomes at the 2-year follow-up [13].

Other Considerations: Two-thirds of graft failures after the Latarjet procedure required reoperations [3]. Delayed application of leukocyte-rich platelet-rich plasma (PRP) postrotator cuff repair did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively [16]. Loss of visual acuity due to central serous retinopathy is a rare but significant complication after steroid injection into the shoulder bursa [15].

Recovery

Light activity (weeks): Patients typically resume desk work, driving, and light activities of daily living within the first few weeks post-operatively. Specific timelines for these early milestones are not explicitly defined in the provided evidence base.

Full activity (months): Return to manual work, sport, and full range of motion/strength is not explicitly quantified in the provided evidence. However, clinical advantage over placebo for composite outcomes in adhesive capsulitis is observed in the short- and intermediate-term, though these benefits dissipate over time [2].

Complete recovery / outcome plateau (months): Shoulder function and pain show statistically and clinically relevant improvements up to 4 months after a single, image-guided corticosteroid injection for glenohumeral arthritis [1]. For subacromial impingement syndrome, subacromial hyaluronate injections produce similar pain and functional improvement to corticosteroids at short-term follow-up [45], while subacromial corticosteroids serve as an effective short-term therapy [43]. In rotator cuff repair, intra-articular corticosteroid injection in the early postoperative period provides satisfactory pain relief and range of motion improvement without increasing re-tear rates or deteriorating clinical outcomes at 2-year follow-up [13]. Delayed application of leukocyte-rich platelet-rich plasma following rotator cuff repair did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively [16].

Rehabilitation protocol: Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise patient-reported outcomes at a minimum of 2 years following surgery [8]. The timing of corticosteroid injection prior to shoulder arthroplasty is a critical factor in postoperative outcomes [49]. Preoperative shoulder corticosteroid injection is associated with revision after primary rotator cuff repair, with consideration given to minimizing preoperative injections or delaying primary rotator cuff repair for 6 months following injection [50]. The risk of reoperation for rotator cuff repair significantly declines if there is more than 6 months between injection and the procedure [4].

Functional milestones: Patients who gained a good transient response to a preoperative ultrasound-guided subscapular cortisone injection obtained a significantly better recovery than those who did not [6]. Corticosteroid injections provide, at best, minimal transient pain relief in a small number of patients with rotator cuff tendinosis and cannot modify the natural course of the disease [17]. Half of the nerve injuries following the Latarjet procedure led to residual symptoms [3]. The effect of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections was best seen after the first and second injections, questioning the necessity of repeating injections more than two times [5].

Other Considerations: Evidence regarding specific rehabilitation protocols, such as PT phasing, immobilisation duration, or sling removal timing, is not present in the provided evidence base.

Key Evidence

  • [L4] Patients experienced statistically and clinically relevant improvements in shoulder function and pain up to 4 months after injection. (10.1016/j.jse.2020.08.008)
  • [L1] Multiple-site corticosteroid injections showed clinical advantage over placebo for short- and intermediate-term composite outcome assessments, though short-term benefits of steroids dissipated over time. (10.1177/0363546518823337)
  • [L4] Two-thirds of the graft failures required reoperations, and half of the nerve injuries in this study led to residual symptoms. (10.1016/j.jse.2020.09.002)
  • [L3] The risk of reoperation significantly declines if there is more than 6 months between injection and RCR. (10.1016/j.arthro.2018.10.107)
  • [L1] The effect was best seen after the first and second injections, questioning the necessity of repeating injections more than two times. (10.1186/1471-2474-15-352)
  • [L3] Patients who gained a good transient response to a preoperative ultrasound-guided subscapular cortisone injection obtained a significantly better recovery than those who did not. (10.1016/j.arthro.2020.07.024)
  • [L3] Preoperative shoulder injections may increase the risk of revision RCR and subacromial decompression by up to 150% in patients 6 to 12 months after index surgery compared with patients who did not receive a preoperative injection. (10.1016/j.arthro.2018.08.042)
  • [L3] Corticosteroid injections within 12 months prior to anatomic and reverse shoulder arthroplasty do not compromise patient-reported outcomes during a minimum of 2-year follow-up. (10.1016/j.jse.2024.03.006)
  • [L3] This study adds to the evidence suggesting caution when administering injections in the immediate postoperative period after shoulder arthroscopy. (10.1177/0363546518825348)
  • [L4] Additional research is needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular injections. (10.5397/cise.2023.00311)
  • [L4] This high level of clinical injection success, irrefutably substantiated with arthrography, has not been previously demonstrated. (10.1016/j.jse.2014.01.012)
  • [L1] Patients who underwent image-guided (ultrasound) injections had statistically significant greater improvement in shoulder pain and function at 6 weeks after injection compared to blind injections. (10.1186/1471-2474-12-137)
  • [L3] Intra-articular corticosteroids injection in the early postoperative period after arthroscopic rotator cuff repair provided satisfactory pain relief and ROM improvement without increasing the re-tear rate or deteriorating clinical outcomes at the 2-year follow-up. (10.1007/s00167-019-05486-3)
  • [L2] The accuracy of the injection does not appear to depend on the experience of the physician and may be irrelevant in treating shoulder pain of multiple origins. (10.1016/j.jse.2010.03.014)
  • [L4] Clinicians should be aware of this rare but significant complication to allow prompt referral to an ophthalmic specialist if visual disturbances are noticed after injection. (10.1016/j.jse.2011.01.019)
  • [L2] The delayed application of PRP postrotator cuff repair did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively. (10.1016/j.arthro.2019.09.026)
  • [L1] Corticosteroid injections provide—at best—minimal transient pain relief in a small number of patients with rotator cuff tendinosis and cannot modify the natural course of the disease. (10.1007/s11999-016-5002-1)
  • [L4] Residual MRI findings 6 months after manipulation had no significant correlation with clinical symptoms. (10.1016/j.jses.2018.11.001)
  • [L4] A repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. (10.1186/s13018-020-02120-8)
  • [L3] This association was not noted when shoulder arthroscopy or arthroplasty occurred >3 months after injection. (10.1016/j.jse.2015.08.039)
  • [L3] This study strongly suggests a correlation between preoperative shoulder injections and revision rotator cuff repair, with frequency and time dependence observed. (10.1016/j.arthro.2018.10.116)
  • [L1] Subacromial injections showed significant improvement in pain, functional level, and quality of life in patients with shoulder impingement syndrome. (10.1186/s12891-024-08266-4)
  • [L3] Single-dose intra-articular corticosteroid injection administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI. (10.5397/cise.2022.01256)
  • [L3] Scapulothoracic motion is an important component of active shoulder motion and function in both healthy shoulders and in those compromised by common pathologies. (10.1007/s00264-018-4027-3)
  • [L4] The article proposes a comprehensive classification of all individualized impingements occurring around the anterior aspect of the shoulder, including newly described entities, to address conflicting theories and improve understanding of their etiologic factors, diagnosis, and treatment. (10.1007/s00264-017-3515-1)
  • [L5] The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. (10.1016/j.jht.2017.05.006)
  • [L4] The ROM in patients with frozen shoulder is susceptible to pain and muscle contraction. (10.1016/j.jseint.2023.05.014)
  • [L3] As subacromial notching correlated with patients' anatomical characteristics and degree of lateralization during reverse total shoulder arthroplasty, the implant's degree of lateralization should be adjusted according to the patient's own anatomical characteristics. (10.1016/j.jse.2023.03.009)
  • [L3] Rotator cuff tears are no more likely to progress on the right, as compared to the left side. (10.1016/j.jseint.2023.04.005)
  • [L4] This study demonstrates that serious complications can occur following treatment with biologic injections, including infections requiring multiple surgical procedures and inflammatory reactions. (10.1016/j.arthro.2021.03.065)
  • [L1] Caution should be taken when deciding to inject a patient, and this treatment should be withheld if a rotator cuff repair is to be performed within the following 6 months. (10.1016/j.arthro.2019.12.006)
  • [L5] The editorial concludes that shoulder arthroscopy should be avoided within 4 weeks of a pre-operative steroid injection unless there is strong justification, and that a cautious, individualized approach should be used before offering corticosteroid injections to patients anticipated to undergo subsequent shoulder arthroscopy. (10.1016/j.arthro.2023.10.006)
  • [L1] Subacromial injection of corticosteroids is an effective short-term therapy for the treatment of symptomatic subacromial impingement syndrome. (10.2106/00004623-199611000-00007)
  • [Case_report] Conservative management with observation and therapy can lead to full recovery. (10.1016/j.jse.2009.01.006)
  • [L2] A subacromial hyaluronate injection to treat impingement syndrome produces similar pain and functional improvement to corticosteroid at a short-term follow-up. (10.1016/j.jse.2011.11.009)
  • [L3] Periarticular injection of a local anesthetic solution provides reliable and consistent pain control with a trend toward less immediate postoperative opioid use after TSA compared with regional blocks. (10.1016/j.jseint.2019.12.007)
  • [L2] Higher activity level and patient expectations were associated with failure of nonoperative treatment. (10.1016/j.jse.2016.04.030)
  • [Case_report] The patient had significant pain relief and improvement of range of motion after the procedure. (10.1016/j.jse.2009.10.004)
  • [L3] The study suggests that the timing of the injection is a critical factor in postoperative outcomes. (10.1302/0301-620x.104b5.bjj-2021-0024.r3)
  • [L5] Timing matters and so does frequency; consideration should be given to minimizing preoperative injections in patients requiring rotator cuff repair or delaying primary rotator cuff repair for 6 months following injection. (10.1016/j.arthro.2018.12.025)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)

See Also

References

[1] Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.08.008

[2] Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546518823337

[3] Early postoperative complications after Latarjet procedure: a single-institution experience over 10 years. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.09.002

[4] Preoperative Shoulder Injections Are Associated With Increased Risk of Revision Rotator Cuff Repair. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.107

[5] Subacromial triamcinolone acetonide, hyaluronic acid and saline injections for shoulder pain an RCT investigating the effectiveness in the first days. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-352

[6] Prognosis After Arthroscopic Superior Medial Scapuloplasty for Snapping Scapula Syndrome Improves After a Transient Beneficial Response With an Ultrasound‐Guided Subscapular Cortisone Injection. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.07.024

[7] Preoperative Injections May Be an Iatrogenic Cause of Reoperation After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.08.042

[8] Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise outcomes at a minimum of 2 years following surgery. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.03.006

[9] The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546518825348

[10] Isolated acromioclavicular osteoarthritis and steroid injection. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00311

[11] Successful injection of the acromioclavicular joint with use of ultrasound: anatomy, technique, and follow-up. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.012

[12] Image-guided versus blind corticosteroid injections in adults with shoulder pain: A systematic review. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-137

[13] Intra‐articular injection of steroids in the early postoperative period does not have an adverse effect on the clinical outcomes and the re‐tear rate after arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05486-3

[14] Positive outcomes with intra-articular glenohumeral injections are independent of accuracy. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.03.014

[15] Loss of visual acuity due to central serous retinopathy after steroid injection into the shoulder bursa. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.01.019

[16] The Effect of Delayed Injection of Leukocyte‐Rich Platelet‐Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double‐Blind Controlled Trial. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.09.026

[17] Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis. Clinical Orthopaedics & Related Research. 2017. DOI: 10.1007/s11999-016-5002-1

[18] The course and clinical impact of articular magnetic resonance imaging findings 6 months after shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder. JSES Open Access. 2019. DOI: 10.1016/j.jses.2018.11.001

[19] Results of repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection for recurrence of frozen shoulder. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-02120-8

[20] The timing of elective shoulder surgery after shoulder injection affects postoperative infection risk in Medicare patients. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.039

[21] Injections Prior to Rotator Cuff Repair Are Associated With Increased Rotator Cuff Revision Rates. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.116

[22] Effectiveness and safety of human placenta hydrolysate injection into subacromial space in patients with shoulder impingement syndrome: a single-blind, randomized trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08266-4

[23] Effects of glenohumeral corticosteroid injection on stiffness following arthroscopic rotator cuff repair: a prospective, multicentric, case-control study with 18-month follow-up. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2022.01256

[24] The contribution of the scapula to active shoulder motion and self-assessed function in three hundred and fifty two patients prior to elective shoulder surgery. International Orthopaedics. 2018. DOI: 10.1007/s00264-018-4027-3

[27] Redefining anterior shoulder impingement: a literature review. International Orthopaedics. 2017. DOI: 10.1007/s00264-017-3515-1

[28] Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2017.05.006

[30] Relationship between pain and range of motion in frozen shoulder. JSES International. 2023. DOI: 10.1016/j.jseint.2023.05.014

[31] Subacromial notching after reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.03.009

[38] Progression of symptomatic bilateral rotator cuff disease. JSES International. 2023. DOI: 10.1016/j.jseint.2023.04.005

[39] Complications Following Biologic Therapeutic Injections: A Multicenter Case Series. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.03.065

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