Predictors of Success of Corticosteroid Injection for the Management of Rotator Cuff Disease

Fernando Contreras MD
Hospital for Special Surgery, New York, NY


Haydée C. Brown MD
Hospital for Special Surgery, New York, NY


Robert G. Marx, MD, MSc, FRCSC

Robert G. Marx, MD, MSc, FRCSC

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery and Professor of Public Health, Weill Cornell Medical College

Abstract

Background

The use of subacromial corticosteroid injection (CSI) to treat rotator cuff tendinopathy is controversial. We hypothesized that characteristics such as activity level, American Shoulder and Elbow Surgeons (ASES) score, duration of symptoms, and status of the rotator cuff may be prognostic factors for resolution of symptoms postinjection.

Methods

During a 12-month period, consecutive patients with rotator cuff disease were analyzed. Patients received subacromial CSI, oral NSAIDs, and physical therapy. Baseline ASES score, simple shoulder test, an activity scale, and demographic data were recorded. Patients who remained symptomatic and were indicated for surgery were considered failures. Patients that did not undergo surgery were reassessed after a minimum of 1 year.

Results

Forty-nine patients met our criteria. Follow-up was obtained for 81.6%. Sixteen cases (40%) failed conservative treatment at final follow-up (22.4 ± 11 months). CSI were successful in 76.2% of males and 45% of females (p=0.04). Full-thickness tears were present in 8% of the patients with symptom resolution and 25% of those that failed conservative treatment (p=0.29). No significant difference was found in age, hand dominance, duration of symptoms, or any of the scoring systems.

Conclusion

It is difficult to predict outcomes after CSI. Our treatment strategy showed a 40% failure rate.

This article appears in HSS Journal: Volume 9, Number 1.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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