RESEARCH UPDATE: Rotator Cuff Repairs and Steroid Injections

This post will serve to kick off a new blog series from the Shoulder and Elbow team at KOC highlighting the latest medical research topics related to our area of practice!

These posts will be housed at our new Research page on the website where we will also include summaries and highlights of our past, current and future research projects. Stay tuned, as the page is still under construction!

Rotator cuff pathology is an exceedingly frequent cause of shoulder pain and disfunction. Data from a recent article cites approximately 4.5 million physician visits related to rotator cuff pathology every year. Many patients experience temporary relief of their symptoms with corticosteroid injections, but there has yet to be sufficient data analyzing the potential effect of these injections on surgical success rates.

This article, published in 2019, utilized databases from 2 national insurance providers to analyze the association between corticosteroid injections and subsequent revision operations after a rotator cuff repair. The data revealed a positive correlation between both the number and timing of corticosteroid injections and the need for revision rotator cuff surgery. Essentially, more injections and getting injections closer to the time of surgery decreases the surgical success rate.

So what does this mean in practice?

Extrapolating this data to produce a meaningful philosophy in practice requires further analysis. While it may seem at first glance that this data suggests never receiving any steroid injections, medical decision-making always requires a risk-benefit analysis for any potential treatment.

For example, it is first worth noting that the revision rate for patients who never received a steroid injection was approximately 3.2%, while the revision rate for patients who had received an injection was approximately 4.7%. This is a noticeable and statistically significant difference, but some patients may feel that the slight increase in risk for a revision operation is worth being able to delay surgery for a few months.

Additionally, the study also noted an increase in revision rate that correlated with the total number of injections received. Patients who received one steroid injection were observed to have approximately a 4.0% revision rate, while this rate climbed to over 6.5% after a second injection. In this case, the risk-benefit analysis of a first injection is far more favorable than that of a subsequent injection, and this is where the medical decision-making may lean more heavily towards rotator cuff repair as opposed to continued corticosteroid injection if surgical repair seems to be the ultimate outcome. Additionally, the study noted a significant increase in revision rates in the first month after an injection, with this increase becoming far less significant with each subsequent month between the injection and treatment.

Taking all of this data into consideration offers a very unique perspective on the use of corticosteroid injections in our practice. While injections can be a fantastic tool to help manage pain and disfunction without the need for surgical intervention, it is important to ensure we are not trading a good long-term result for a short-term fix. New advances in medical research, like the data discussed in this post, allow our team to provide effective short-term treatment for our patients while maximizing long-term outcomes.

Hopefully, this post has helped offer some insight into one of the many ways Dr. Spencer utilizes the latest in medical research to offer the highest standard of evidence-based care. The article has been attached below as a PDF if you would like to read further.

Thanks for reading!

Rotator Cuff Repairs- Different Strokes for Different Folks

Rotator cuff tears are very common. Rotator cuff repairs are the fifth most common surgery performed the United States. Most tears are degenerative and occur with greater frequency in patients over the age of 50. They can, however, occur from traumatic events such as falls or dislocations.

Most rotator cuff tears occur when the tendon or tendons pull away or avulses from the bony attachment at the greater tuberosity. The tear pattern can vary greatly from patient to patient. Most rotator cuff repairs are performed with anchors that are placed into the greater tuberosity. The sutures from those anchors are then passed through the rotator cuff tendons and tied down to the tuberosity bone. This provides very secure fixation. A demonstration of this typical rotator cuff repair can be seen at the bottom of our Rotator Cuff page, here.

The following is a video of an atypical rotator cuff tear where the rotator cuff tendon tore within its mid substance. These types of tears are less common and can be much more difficult to treat as we are not able to use anchors in this situation. However with arthroscopic techniques we are able to achieve a good repair with a very good clinical result.