Corticosteroid and Anesthetic Injections for Muscle Strains and Ligament Sprains in the NFL

HSS Journal: Volume 10, Issue 2

Mark C. Drakos, MD

Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery
Instructor of Orthopaedic Surgery, Weill Cornell Medical College

Patrick Birmingham, MD

Medical College of Wisconsin, Milwaukee, WI,

Demetris Delos, MD

Orthopaedic and Neurosurgery Specialists, Greenwich, CT

Ronnie Barnes, ATC

New York Giants Medical Services and Training, East Rutherford, NJ

Conor Murphy, BA

Department of Orthopaedic Surgery, Hospital for Special Surgery

Leigh Weiss, ATC, PT

New York Giants Medical Services and Training, East Rutherford, NJ

Russell F. Warren, MD
Russell F. Warren, MD
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Surgeon-in-Chief Emeritus, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College


Administering local anesthetic or corticosteroid injections in professional athletes to allow return to play is common but has traditionally been viewed as suspect and taboo. The skepticism surrounding therapeutic injections stems predominantly from anecdotal experience as opposed to scientific data.

The purpose of this paper is to evaluate the current use of corticosteroid injections for muscle strains and ligaments sprains in the National Football League to document player’s ability to return to play and possible adverse effects.

Patients and Methods
Athletes from a single National Football League team who received at least one corticosteroid or anesthetic injection for either a muscle strain or ligament sprain during three consecutive seasons were retrospectively reviewed. Thirty-seven injections were given over the three seasons. Injections were either performed blindly or by using ultrasound guidance.

Twice as many defensive players were injected than offensive players. The average number of days of conservative treatment before injection was 6.5 days. All players returned to play after injection. There were no complications from any of the injections. Seventeen (55%) players did not miss a single game, and nine (30%) did not miss a single day. Quadriceps strains were associated with the most missed games (four) and the most missed days (36.5). Proximal hamstring strains were second with an average of three missed games and 28 missed days.

Corticosteroid injections are a safe and effective therapeutic intervention for treating muscle strains and ligament sprains in order to enable athletes to return to competition earlier.
Level of Evidence: Retrospective Case Series, Level IV. See the Guidelines for Authors for a complete description of levels of evidence.
Work performed at Hospital for Special Surgery and the New York Giants Medical Services and Training Center.

This article appears in HSS Journal: Volume 10, Issue 2
View the full HSS Journal Online First article at

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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