Efficacy of a Subacromial Corticosteroid Injection for Persistent Pain After Arthroscopic Rotator Cuff Repair.
Corticosteroid injections have been widely used for reducing shoulder pain. However, catastrophic complications induced by corticosteroid such as infections and tendon degeneration have made surgeons hesitant to use a corticosteroid injection as a pain control modality, especially during the postoperative recovery phase.



To determine the effectiveness and safety of a subacromial corticosteroid injection for persistent pain control during the recovery period and to analyze the factors causing persistent pain after arthroscopic rotator cuff repair.



Cohort study; Level of evidence, 3.



A total of 458 patients who underwent arthroscopic rotator cuff repair were included in this study. Patient-specific parameters, tear size and pattern, and pain intensity were reviewed. Seventy-two patients were administered a postoperative subacromial corticosteroid injection under ultrasound guidance. The corticosteroid injection was administered to patients who awakened overnight because of constant severe shoulder pain or whose pain was exacerbated at the time of rehabilitation exercises within 8 weeks after surgery. Pain intensity, patient satisfaction, and functional outcomes using the American Shoulder and Elbow Surgeons (ASES) and Constant scores were compared between the patients with and without a subacromial corticosteroid injection. The retear rate was evaluated with magnetic resonance imaging at 6 months postoperatively.



In patients with an injection, the mean (±SD) visual analog scale for pain (pVAS) score was 7.7 ± 1.2 at the time of the injection. This significantly decreased to 2.3 ± 1.4 at the end of the first month after the injection, demonstrating a 70.2% reduction in pain (P < .01). At 3 months after the injection, the mean pVAS score was 1.2 ± 1.8. Functional outcomes at final follow-up showed no significant differences between patients with and without an injection (ASES score: 90.1 ± 14.6 with injection, 91.9 ± 8.2 without injection [P = .91]; Constant score: 89.1 ± 12.9 with injection, 84.5 ± 13.0 without injection [P = .17]). Patients with an injection showed no significant increase in the retear rate (6.8% with injection, 18.4% without injection; P = .06). According to the tear pattern, L-shaped rotator cuff tears (41.8%) showed a higher occurrence of severe postoperative persistent pain. Preoperative shoulder stiffness was revealed as a predisposing factor for persistent pain (odds ratio, 0.2; P = .04).



A subacromial corticosteroid injection can be considered as a useful and safe modality for the treatment of patients having severe persistent pain during the recovery phase after arthroscopic rotator cuff repair.
Global Top 5 Research Program, Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea sjshin622@ewha.ac.kr.
Sang-Jin
SJ
Shin
Joint Center, Department of Orthopedic Surgery, Baro Hospital, Incheon, Korea.
Nam-Hoon
NH
Do
Global Top 5 Research Program, Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
Juyeob
J
Lee
Global Top 5 Research Program, Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
Young-Won
YW
Ko
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D011184:Postoperative Period; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology; D014463:Ultrasonography
D000305:Adrenal Cortex Hormones
rotator cuff repair; shoulder pain; subacromial injection