Paper of the week: The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk. Kew ME, Cancienne JM, Christensen JE, Werner BC. Am J Sports Med. 2019 Feb 13:363546518825348. doi: 10.1177/0363546518825348.
Commentary by Thema A. Nicholson MS, Surena Namdari MD
Arthroscopic shoulder surgery is exceedingly common and results in reliable pain relief and functional restoration. Unfortunately, there is a subset of patients that have pain or stiffness following shoulder arthroscopy that affects the quality of life and ability to participate in rehabilitation. A corticosteroid injection may be considered in these patients; however, the benefits of improved pain must be balanced by the risks of infection and/or poor tissue healing. This study sought to establish whether or not corticosteroid injections after arthroscopic surgery are a safe option to provide pain relief without predisposing patients to infection. A query of private payer and Medicare databases yielded 3946 patients that underwent an injection within 4 months after arthroscopic shoulder surgery. Patients who underwent an injection within 1 month after arthroscopic shoulder surgery had a 3.5% infection rate compared to a ≤0.5% infection rate in patients who underwent an injection at 2, 3 or 4 months. While data from large national databases can be flawed in many ways, this study supports our current practice of avoiding corticosteroid injections in the early postoperative period after shoulder arthroscopy. The influence of injections on tissue healing remains unknown.