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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, though short-term benefits dissipate over time [2]. In snapping scapula syndrome, patients with a good transient response to preoperative ultrasound-guided subscapular cortisone injection achieve significantly better recovery than those without [6].

Therapeutic effects of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections are best observed after the first and second doses, 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 needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular 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]. The risk of reoperation for revision rotator cuff repair significantly declines if more than 6 months elapse between injection and surgery [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 those who did not receive a preoperative injection [7].

Anatomy & Pathophysiology

Kinematics and Motion

Scapulothoracic motion constitutes an important component of active shoulder motion and function in both healthy shoulders and those compromised by common pathologies [23]. In patients with frozen shoulder, range of motion is susceptible to pain and muscle contraction [31].

Impingement and Classification

A comprehensive classification of all individualized impingements occurring around the anterior aspect of the shoulder, including newly described entities, addresses conflicting theories to improve understanding of their etiologic factors, diagnosis, and treatment [26]. The development of standardized, clearly described eligibility criteria—particularly regarding terminology, disease stage, pain and range of motion criteria, symptom duration, and exclusion of other shoulder pathologies—strengthens methodological rigor and improves the interpretability of future clinical trials [27].

Rotator Cuff Pathology

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].

Arthroplasty Anatomy

Subacromial notching correlates with patients' anatomical characteristics and degree of lateralization during reverse total shoulder arthroplasty [32].

Classification

Injection Modality and Timing: Image-guided corticosteroid injection provides statistically and clinically relevant improvements in shoulder function and pain up to 4 months for patients with glenohumeral arthritis [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]. The effect of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections was best observed 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]. Patients undergoing image-guided (ultrasound) injections for shoulder pain had statistically significant greater improvement in shoulder pain and function at 6 weeks after injection compared to blind injections [12]. 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].

Surgical Interval and Risk Stratification: The risk of reoperation after rotator cuff repair significantly declines if more than 6 months elapse between the injection and the surgery [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]. Corticosteroid injections administered within 12 months prior to anatomic or 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].

Nerve and Periarticular Management: Half of the nerve injuries following the Latarjet procedure resulted in residual symptoms [3]. A UK-based consensus exercise provided information from expert NHS clinicians to help determine the method of suprascapular nerve block injection delivery for future clinical trials in rotator cuff disorders [22]. 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 [48].

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]. 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].

Ultrasound-Guided vs. Blind Injections: Patients undergoing image-guided (ultrasound) injections have statistically significant greater improvement in shoulder pain and function at 6 weeks after injection compared to those receiving blind injections [12]. Patients 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].

Post-Operative Complications and Risks: Half of the nerve injuries occurring after the Latarjet procedure lead to residual symptoms [3]. 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]. Clinicians should be aware of central serous retinopathy as a rare but significant complication of steroid injection into the shoulder bursa, which can cause loss of visual acuity [15].

Alternative Therapies and Imaging Correlations: Subacromial injections of human placenta hydrolysate show significant improvement in pain, functional level, and quality of life in patients with shoulder impingement syndrome [40]. 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].

Investigations

Plain radiography: Standard imaging remains foundational for evaluating glenohumeral arthritis and acromioclavicular (AC) joint osteoarthritis. In the context of AC joint pathology, further 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 indicates that the donor site following autologous osteochondral mosaicplasty for elbow cartilaginous lesions is resurfaced with fibrous tissue [53]. Additionally, 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].

Aspiration: Aspiration is not explicitly detailed in the provided evidence base for diagnostic yield; however, injection techniques are well-characterized. High clinical injection success for the AC joint is irrefutably substantiated when ultrasound guidance is used in conjunction with arthrography [11].

Laboratory: Laboratory markers are not addressed in the current evidence set.

Other Considerations: Image-Guidance: Patients undergoing image-guided (ultrasound) injections demonstrate statistically significant greater improvement in shoulder pain and function at 6 weeks post-injection compared to those receiving blind injections [12]. The accuracy of isolated AC osteoarthritis steroid injection does not appear to depend on physician experience and may be irrelevant for treating shoulder pain of multiple origins [14].

Preoperative and Postoperative Injections: * Glenohumeral Arthritis: A single, image-guided corticosteroid injection yields statistically and clinically relevant improvements in shoulder function and pain up to 4 months post-procedure [1]. * Adhesive Capsulitis: Multiple-site corticosteroid injections provide a clinical advantage over placebo for short- and intermediate-term composite outcomes, although short-term benefits dissipate over time [2]. * Rotator Cuff Repair (RCR): 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 to those without preoperative injections [7]. Conversely, a good transient response to a preoperative ultrasound-guided subscapular cortisone injection predicts significantly better recovery [6]. Caution is advised regarding injection timing; the risk of reoperation significantly declines if more than 6 months elapse between injection and RCR [4]. * Post-Arthroscopic RCR: A single-dose intra-articular corticosteroid injection administered at 6 weeks postoperatively to treat stiffness significantly improves pain, function, and duration of return to activities of daily living (ADLs) without increasing the risk of retears [21]. * Shoulder Arthroplasty: Corticosteroid injections within 12 months prior to anatomic or reverse shoulder arthroplasty do not compromise patient-reported outcomes during a minimum 2-year follow-up [8]. * Immediate Postoperative Period: Clinicians should exercise caution when administering injections in the immediate postoperative period after shoulder arthroscopy due to potential effects on postoperative infection risk [9].

Nerve Blocks and Manipulation: * 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 for recurrence of idiopathic frozen shoulder [19]. * Rotator Cuff Disorders: A UK-based consensus exercise provided expert NHS clinician guidance to determine the method of suprascapular nerve block (SSNB) injection delivery for patients with rotator cuff disorders [22].

Complications and Outcomes: * Latarjet Procedure: Half of the nerve injuries identified in a 10-year single-institution experience after Latarjet procedure resulted in residual symptoms [3]. * Visual Disturbances: Clinicians must be aware of central serous retinopathy as a rare but significant complication following steroid injection into the shoulder bursa; prompt referral to an ophthalmic specialist is required if visual disturbances occur [15]. * Injection Frequency: The effect of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections is best observed after the first and second injections, questioning the necessity of repeating injections more than twice [5].

Treatment

Non-Operative

Single, image-guided corticosteroid injections for glenohumeral arthritis provide statistically and clinically relevant improvements in shoulder function and pain up to 4 months post-injection [1]. Patients undergoing image-guided (ultrasound) injections demonstrate statistically significant greater improvement in shoulder pain and function at 6 weeks compared to blind injections [12]. High clinical injection success for the acromioclavicular joint using ultrasound is substantiated with arthrography [11]. For adhesive capsulitis, multiple-site corticosteroid injections show a clinical advantage over placebo for short- and intermediate-term composite outcomes, although short-term benefits dissipate over time [2]. 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]. Corticosteroid injections provide minimal transient pain relief in a small number of patients with rotator cuff tendinosis and cannot modify the natural course of the disease [17]. 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].

Operative

Preoperative Timing and Risk: Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise patient-reported outcomes at a minimum of 2 years following surgery [8]. However, the risk of reoperation significantly declines if more than 6 months elapse between a corticosteroid injection and rotator cuff repair (RCR) [42]. 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 [7]. Corticosteroid treatment should be withheld if a rotator cuff repair is to be performed within the following 6 months [42]. Shoulder arthroscopy should be avoided within 4 weeks of a pre-operative steroid injection unless there is strong justification, and a cautious, individualized approach should be used before offering corticosteroid injections to patients anticipated to undergo subsequent shoulder arthroscopy [44].

Postoperative Management: Caution is advised when administering 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 rotator cuff repair 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 rotator cuff repair significantly improves pain, function, and duration of return to activities of daily living without increasing the risk of retears [21]. Delayed application of leukocyte-rich platelet-rich plasma (PRP) following rotator cuff repair does not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively [16].

Adjuncts and Specific Syndromes: Patients who gain a good transient response to a preoperative ultrasound-guided subscapular cortisone injection obtain significantly better recovery after arthroscopic superior medial scapuloplasty for snapping scapula syndrome than those who do not [6]. Conservative management with observation and therapy can lead to full recovery in cases of cement extrusion causing radial nerve palsy after shoulder arthroplasty [46]. Significant pain relief and improvement of range of motion can occur in cases of suprascapular neuropathy secondary to reverse shoulder arthroplasty [50].

Complications

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

Infection (PJI): The timing of elective shoulder surgery relative to injection influences postoperative infection risk in Medicare patients [39]. This association is not observed when shoulder arthroscopy or arthroplasty is performed more than 3 months after injection [39]. Caution is advised regarding injections administered in the immediate postoperative period following shoulder arthroscopy due to effects on infection risk [9].

Graft Failure / Reoperation: Two-thirds of graft failures following the Latarjet procedure necessitate reoperations [3].

Other Considerations: 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 injection and surgery [4]. Patients receiving preoperative injections 6 to 12 months after index surgery face up to a 150% increased risk of revision RCR and subacromial decompression compared with those who did not receive injections [7]. A strong correlation exists between preoperative shoulder injections and revision RCR, with frequency and time dependence observed [20]. 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 did not increase the re-tear rate or deteriorate clinical outcomes at 2-year follow-up [13]. These early injections provided satisfactory pain relief and range of motion improvement [13]. Delayed application of leukocyte-rich platelet-rich plasma (PRP) following rotator cuff repair did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively [16]. Serious complications from biologic injections include infections requiring multiple surgical procedures and inflammatory reactions [38]. 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 with snapping scapula syndrome who achieved a good transient response to preoperative ultrasound-guided subscapular cortisone injection demonstrated significantly better recovery trajectories [6]. For adhesive capsulitis, multiple-site corticosteroid injections provide clinical advantages over placebo for short- and intermediate-term composite outcomes, although these short-term benefits dissipate over time [2]. Subacromial injection of corticosteroids serves as an effective short-term therapy for symptomatic subacromial impingement syndrome [45], with hyaluronate injections producing similar pain and functional improvement to corticosteroids at short-term follow-up [47].

Full activity (months): In the context of glenohumeral arthritis, patients experience statistically and clinically relevant improvements in shoulder function and pain up to 4 months following a single, image-guided corticosteroid injection [1]. The effect of subacromial injections with triamcinolone acetonide, hyaluronic acid, or saline is most pronounced after the first and second injections, questioning the necessity of repeating injections more than twice [5]. For adhesive capsulitis, while short-term benefits dissipate, intermediate-term composite outcome assessments remain superior to placebo [2].

Complete recovery / outcome plateau (months): Judicious use of corticosteroid injections within 12 months prior to anatomic and reverse shoulder arthroplasty does 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 provides 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]. 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]. 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].

Rehabilitation protocol: The timing of corticosteroid injection prior to shoulder arthroplasty is a critical factor in postoperative outcomes [51]. The risk of reoperation for rotator cuff repair significantly declines if there is more than 6 months between injection and the procedure [4]. Preoperative shoulder corticosteroid injection is associated with revision after primary rotator cuff repair, with timing and frequency being significant factors [52]. 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 [52].

Functional milestones: Half of the nerve injuries following a Latarjet procedure led to residual symptoms [3].

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 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)
  • [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)
  • [L4] This consensus study has provided valuable information from expert NHS clinicians to help determine the method of SSNB injection delivery in the conduct of a future clinical trial. (10.1177/17585732251350116)
  • [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 development of standardized, clearly described eligibility criteria, particularly regarding terminology, disease stage, pain and range of motion criteria, symptom duration, and exclusion of other shoulder pathologies, will help strengthen methodological rigor and improve the interpretability of future clinical trials. (10.1016/j.jse.2026.05.040)
  • [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)
  • [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)
  • [L3] This association was not noted when shoulder arthroscopy or arthroplasty occurred >3 months after injection. (10.1016/j.jse.2015.08.039)
  • [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)
  • [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)
  • [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] Injections Prior to Rotator Cuff Repair Are Associated With Increased Rotator Cuff Revision Rates. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.116

[21] 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

[22] A UK-based consensus exercise to determine the most acceptable method of suprascapular nerve block injection for people consulting with rotator cuff disorders. Shoulder & Elbow. 2025. DOI: 10.1177/17585732251350116

[23] 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

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

[27] Towards a common definition of frozen shoulder: a scoping review of randomized controlled trials. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.05.040

[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

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

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

[38] 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

[39] 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

[40] 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

[42] Adverse Impact of Corticosteroid Injection on Rotator Cuff Tendon Health and Repair: A Systematic Review. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.12.006

[44] Editorial Commentary: Corticosteroid Injections Administered Within 4 Weeks Before Shoulder Arthroscopy Are Associated With an Increased Risk of Infection. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.10.006

[45] Efficacy of Injections of Corticosteroids for Subacromial Impingement Syndrome. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199611000-00007

[46] Cement extrusion causing radial nerve palsy after shoulder arthroplasty: A case report. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.01.006

[47] Does hyaluronate injection work in shoulder disease in early stage? A multicenter, randomized, single blind and open comparative clinical study. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.009

[48] Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty. JSES International. 2020. DOI: 10.1016/j.jseint.2019.12.007

[50] Suprascapular neuropathy secondary to reverse shoulder arthroplasty: A case report. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.10.004

[51] Risk of revision based on timing of corticosteroid injection prior to shoulder arthroplasty. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b5.bjj-2021-0024.r3

[52] Preoperative Shoulder Corticosteroid Injection Is Associated With Revision After Primary Rotator Cuff Repair. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.12.025

[53] Donor Site Evaluation after Autologous Osteochondral Mosaicplasty for Cartilaginous Lesions of the Elbow Joint. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507306465

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