37Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications
AJR American Journal of Roentgenology (2024) · Sarah I. Kamel, Humberto G. Rosas, Tetyana Gorbachova
This comprehensive review outlines both local and systemic adverse effects associated with corticosteroid injections used for musculoskeletal conditions. Local side effects include post-injection flare, skin hypopigmentation and atrophy, infection, tendon rupture, accelerated progression of osteoarthritis, and osseous injury. Systemic side effects encompass adrenal suppression or insufficiency, facial flushing, hypertension, hyperglycemia, and osteoporosis. The authors emphasize the importance of recognizing these potential side effects when counseling patients and planning individual injections. The review highlights the need for further research regarding the long-term complications of continuous corticosteroid use, particularly concerning osseous effects.
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62Early Motion After Rotator Cuff Repair May Increase Retear Risk
Journal of Shoulder and Elbow Surgery (2017) · Saltzman BM, Zuke WA, Go B, Mascarenhas R, Verma NN, Cole BJ, Romeo AA, Forsythe B
This systematic review analyzed 9 meta-analyses comparing early motion versus delayed motion rehabilitation after arthroscopic rotator cuff repair. The researchers found no clear superiority in functional outcomes for either approach. While early motion provided slightly better range of motion in the first year, there was concern that it may lead to higher retear rates, particularly in patients with larger tears. Tendon healing results either showed no difference or favored delayed motion. The findings suggest that rushing back to movement after rotator cuff repair may increase the risk of reinjury without providing meaningful long-term benefits.
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64Delayed Rehabilitation Produces Better Healing for Larger Rotator Cuff Tears
Journal of Shoulder and Elbow Surgery (2012) · Cuff DJ, Pupello DR
This randomized controlled trial enrolled 68 patients with full-thickness supraspinatus tears to compare early passive motion versus delayed rehabilitation after arthroscopic rotator cuff repair. While both groups showed similar overall outcomes, the delayed rehabilitation group demonstrated significantly better tendon healing rates, particularly for larger tears. The study found that early motion did not improve functional outcomes and that a more conservative approach with delayed movement allowed better tissue repair. These results support the concept that giving the rotator cuff adequate rest after injury or repair promotes better healing than rushing into exercise.
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83Corticosteroid Injections Carry Real Risks Including Tendon Rupture
BMC Musculoskeletal Disorders (2010) · Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM
This systematic review examined 87 studies to estimate the occurrence and types of adverse effects after extra-articular (soft tissue) corticosteroid injections. The researchers categorized adverse events as major or minor. Major adverse events, which required intervention or did not resolve, included serious infections such as osteomyelitis and cellulitis, one fatal case of necrotizing fasciitis, tendon ruptures, skin atrophy, hypopigmentation, and local skin defects. The incidence of major adverse events ranged from 0 to 5.8% across studies. Minor adverse events, which were transient and did not require intervention, ranged from skin rash to flushing and disturbed menstrual patterns, with incidence as high as 81% in some studies. Increased pain or steroid flare after injection was reported in 19 studies. The review confirms that corticosteroid injections, while commonly used for pain relief, carry meaningful risks including tendon rupture, tissue atrophy, and serious infection. These findings support the recommendation that patients should be educated about these risks and encouraged to seek a second opinion before proceeding with corticosteroid injections, particularly when the injection is targeting tendon or ligament tissue that could be weakened by the steroid.
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