Steroid injections (i.e. cortisone) are designed to remedy inflammation. They have been used to “treat” joint/tendon/ligament pain for decades. Only recently have the damaging effects been investigated and confirmed. When steroids are given around knee (patellar and quadriceps tendons), ankle (Achilles tendons) and hand (flexor tendons), reports of tendon ruptures are well known. Data shows that when used for tennis elbow, pain relief is predictable but long term effects are detrimental and are believed to be cumulative; meaning that a single injection may be satisfactory, but repeated injections lead to tendon DAMAGE and inhibit healing.
Shoulder pain from a rotator cuff problem, including “impingement syndrome” and bursitis, is typically associated with degeneration, NOT INFLAMMATION. While steroid injections are commonplace because they provide almost immediate pain reduction for patients, Dr. Bailie has used them very sparingly, always believing that over-utilization can be dangerous. Because of the documented harmful degradation of human tissue (muscle, tendon, ligament and cartilage), Dr. Bailie has never advocated repeated steroid injections for shoulder or knee pain. In fact, he has seen numerous tears of the rotator cuff that were likely made worse by injections. Until recently, this negative cause-effect relationship has been speculated but not studied.
A recent study presented at the AAOS (American Academy of Orthopedic Surgeons) Meeting in March 2018, paper #838 by Travern et al, titled “Steroid Injection Prior to Rotator Cuff Repair is Associated with Increased Risk of Subsequent Surgery”, demonstrated that the toxicity of steroids on rotator cuff tendons is now supported by a large study.
This analysis looked at 4959 patients, aged 18-64, who had a rotator cuff repair surgery. They found that previously known risk factors (including smoking, male gender, and age equal to or greater than 53 years old) did, indeed, lead to increased risk of failed surgery. However, new data was discovered, demonstrating that if a patient had even a single steroid injection within a year of surgery, (with risk shown to be highest in those patients receiving injection within 6 months of surgery) the odds of the repair FAILING was 43.5% HIGHER than patients who did not receive an injection. Thus, revision surgery would be necessary and often less predictable.
In summary, although many physicians and insurance carriers believe that the first step to alleviate shoulder pain should be a steroid injection, recent data suggests it may be best to consider alternative treatments.
