Advertisement
Editorial Commentary| Volume 35, ISSUE 1, P51-53, January 2019

Download started.

Ok

Editorial Commentary: “Doctor, Are You Sure the Steroid Injection Won't Harm My Shoulder?” Perhaps We Should Stop Injecting Corticosteroids and Just Repair Those Rotator Cuffs

DOI:https://doi.org/10.1016/j.arthro.2018.10.009
Editorial Commentary: “Doctor, Are You Sure the Steroid Injection Won't Harm My Shoulder?” Perhaps We Should Stop Injecting Corticosteroids and Just Repair Those Rotator Cuffs
Previous ArticleIncreasing Numbers of Shoulder Corticosteroid Injections Within a Year Preoperatively May Be Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery
Next ArticleMinimal Clinically Important Differences and Correlating Factors for the Rowe Score and the American Shoulder and Elbow Surgeons Score After Arthroscopic Stabilization Surgery for Anterior Shoulder Instability

      Abstract

      Analysis of insurance records indicates that 2 or more corticosteroid injections before rotator cuff repair could triple the odds of revision. The cause-and-effect relationship cannot be ascertained because it remains unclear whether steroids worsen outcomes or are injected in shoulders that are worse to start with. Registry studies cannot adjust for lesional determinants of prognosis and should be interpreted with caution to avoid depriving patients from safe and simple treatments to delay or circumvent surgery. The risks of corticosteroids could be mitigated using radiographically guided infiltration and, ultimately, by rapid surgical repair in young patients before the advent of fatty infiltration and tendon retraction.
      At last we have what many of us have long waited for: A nationwide investigation of the potential risks of shoulder corticosteroid injections (CSIs) before rotator cuff repair (RCR). The outstanding study of Desai, Camp, Boddapati, Dines, Brockmeier, and Werner,
      • Desai V.S.
      • Camp C.L.
      • Boddapati V.
      • Dines J.S.
      • Brockmeier S.F.
      • Werner B.C.
      Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery.
      Arthroscopy. 2019; 35: 45-50
      entitled “Increasing Numbers of Shoulder Corticosteroid Injections Within a Year Preoperatively May Be Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery,” addresses the issue using big data, from both public and private insurance records, and with sophisticated statistics. The authors found that patients who had 2 or more shoulder CSIs in the year before RCR were nearly 3 times more likely to require revision surgery. The cohort sizes are compelling (110,567 and 12,892), the differences in revision rates are substantial (3.4%-3.8% vs 7.0%-9.4%), and the findings are consistent across public and private databases. Although the authors acknowledge that they could not establish causality, their findings could easily be seen as “undisputable evidence” of the harms of subacromial CSIs and potentially deprive patients from a conservative treatment that could well delay or completely circumvent surgery.
      Combinations of CSIs and physiotherapy are often prescribed in symptomatic shoulders
      • Nunley R.M.
      • Wilson J.M.
      • Gilula L.
      • Clohisy J.C.
      • Barrack R.L.
      • Maloney W.J.
      Iliopsoas bursa injections can be beneficial for pain after total hip arthroplasty.
      Clin Orthop Relat Res. 2010; 468: 519-526
      , 
      • Baumbach S.F.
      • Lobo C.M.
      • Badyine I.
      • Mutschler W.
      • Kanz K.G.
      Prepatellar and olecranon bursitis: Literature review and development of a treatment algorithm.
      Arch Orthop Trauma Surg. 2014; 134: 359-370
      and have been shown to relieve pain and alleviate stiffness in 80% of patients
      • Griesser M.J.
      • Harris J.D.
      • Campbell J.E.
      • Jones G.L.
      Adhesive capsulitis of the shoulder: A systematic review of the effectiveness of intra-articular corticosteroid injections.
      J Bone Joint Surg Am. 2011; 93: 1727-1733
      , 
      • Oh J.H.
      • Oh C.H.
      • Choi J.A.
      • Kim S.H.
      • Kim J.H.
      • Yoon J.P.
      Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder: A prospective, randomized short-term comparison study.
      J Shoulder Elbow Surg. 2011; 20: 1034-1040
      , 
      • Ranalletta M.
      • Rossi L.A.
      • Bongiovanni S.L.
      • Tanoira I.
      • Elizondo C.M.
      • Maignon G.D.
      Corticosteroid injections accelerate pain relief and recovery of function compared with oral NSAIDs in patients with adhesive capsulitis: A randomized controlled trial.
      Am J Sports Med. 2016; 44: 474-481
      , 
      • Shin S.J.
      • Lee S.Y.
      Efficacies of corticosteroid injection at different sites of the shoulder for the treatment of adhesive capsulitis.
      J Shoulder Elbow Surg. 2013; 22: 521-527
      within 3 or 4 months.
      • Ando A.
      • Sugaya H.
      • Hagiwara Y.
      • et al.
      Identification of prognostic factors for the nonoperative treatment of stiff shoulder.
      Int Orthop. 2013; 37: 859-864
      , 
      • Diercks R.L.
      • Stevens M.
      Gentle thawing of the frozen shoulder: A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years.
      J Shoulder Elbow Surg. 2004; 13: 499-502
      CSIs are also used to treat pain and stiffness following RCR,
      • Huberty D.P.
      • Schoolfield J.D.
      • Brady P.C.
      • Vadala A.P.
      • Arrigoni P.
      • Burkhart S.S.
      Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair.
      Arthroscopy. 2009; 25: 880-890
      , 
      • Shin S.J.
      • Do N.H.
      • Lee J.
      • Ko Y.W.
      Efficacy of a subacromial corticosteroid injection for persistent pain after arthroscopic rotator cuff repair.
      Am J Sports Med. 2016; 44: 2231-2236
      , 
      • Kim I.B.
      • Jung D.W.
      An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.
      Am J Sports Med. 2018; 46: 2192-2202
      although some studies reported that they are associated with worse outcomes
      • Baverel L.
      • Boutsiadis A.
      • Reynolds R.J.
      • Saffarini M.
      • Barthélémy R.
      • Barth J.
      Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?.
      JSES Open Access. 2018; 2: 54-59
      because of apoptosis at the injection site,
      • Ramirez J.P.
      • Bonati-Richardson F.
      • Garcia M.P.
      • et al.
      Intra-articular treatment with corticosteroids increases apoptosis in human rotator cuff tears.
      Connect Tissue Res. 2018; : 1-8
      and decreased microvascularisation,
      • Bonnevialle N.
      • Bayle X.
      • Faruch M.
      • Wargny M.
      • Gomez-Brouchet A.
      • Mansat P.
      Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder?.
      J Shoulder Elbow Surg. 2015; 24: 1257-1262
      cell proliferation,
      • Geary M.B.
      • Elfar J.C.
      Rotator cuff tears in the elderly patients.
      Geriatr Orthop Surg Rehabi. 2015; 6: 220-224
      and pull-out strength of suture anchors.
      • Dolkart O.
      • Chechik O.
      • Bivas A.
      • et al.
      Subacromial corticosteroid injections transiently decrease suture anchor pullout strength: Biomechanical studies in rats.
      J Shoulder Elbow Surg. 2017; 26: 1789-1793
      There is no consensus at present regarding the dosage or timing of CSIs, and the guidelines of the American Academy of Orthopaedic Surgeons remain inconclusive, deferring the choice to the discretion of clinicians.
      • Donohue N.K.
      • Prisco A.R.
      • Grindel S.I.
      Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears.
      Muscles Ligaments Tendons. 2017; 7: 34-39
      , 
      • Pedowitz R.A.
      • Yamaguchi K.
      • Ahmad C.S.
      • et al.
      Optimizing the management of rotator cuff problems.
      J Am Acad Orthop Surg. 2011; 19: 368-379
      , 
      • Varkey D.T.
      • Patterson B.M.
      • Creighton R.A.
      • Spang J.T.
      • Kamath G.V.
      Initial medical management of rotator cuff tears: A demographic analysis of surgical and nonsurgical treatment in the United States Medicare population.
      J Shoulder Elbow Surg. 2016; 25: e378-e385
      The dilemma persists because the cause-and-effect relationship between CSIs and outcomes cannot be ascertained from observational studies, no matter their cohort sizes or statistical models. It could well be that CSIs compromise tissue quality and lead to poor outcomes of RCR, but it could also be that CSIs were given to patients who had more pain or stiffness to start with and hence worse prognosis for RCR.
      • Baverel L.
      • Boutsiadis A.
      • Reynolds R.J.
      • Saffarini M.
      • Barthélémy R.
      • Barth J.
      Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?.
      JSES Open Access. 2018; 2: 54-59
      Moreover, although large registry studies may be sufficiently powered, their respective databases seldom contain details of lesion characteristics and patient activities that correlate with retear rates and functional outcomes. Randomized trials and case series may adjust for such factors, conversely, but remain underpowered to detect differences in revision or retear rates.
      The multivariable analysis of Desai et al.
      • Desai V.S.
      • Camp C.L.
      • Boddapati V.
      • Dines J.S.
      • Brockmeier S.F.
      • Werner B.C.
      Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery.
      Arthroscopy. 2019; 35: 45-50
      controlled for a large number of demographic variables and medical comorbidities, but could not adjust for the strongest predictors of RCR outcomes: tear size and pattern,
      • Barth J.
      • Andrieu K.
      • Fotiadis E.
      • Hannink G.
      • Barthelemy R.
      • Saffarini M.
      Critical period and risk factors for retear following arthroscopic repair of the rotator cuff.
      Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2196-2204
      , 
      • Godeneche A.
      • Freychet B.
      • Lanzetti R.M.
      • Clechet J.
      • Carrillon Y.
      • Saffarini M.
      Should massive rotator cuff tears be reconstructed even when only partially repairable?.
      Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2164-2173
      tendon retraction,
      • Nove-Josserand L.
      • Saffarini M.
      • Hannink G.
      • Carrillon Y.
      Influence of pre-operative tear size and tendon retraction on repair outcomes for isolated subscapularis tears.
      Int Orthop. 2016; 40: 2559-2566
      fatty infiltration,
      • Barth J.
      • Andrieu K.
      • Fotiadis E.
      • Hannink G.
      • Barthelemy R.
      • Saffarini M.
      Critical period and risk factors for retear following arthroscopic repair of the rotator cuff.
      Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2196-2204
      , 
      • Godeneche A.
      • Freychet B.
      • Lanzetti R.M.
      • Clechet J.
      • Carrillon Y.
      • Saffarini M.
      Should massive rotator cuff tears be reconstructed even when only partially repairable?.
      Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2164-2173
      and overhead manual activities.
      • Djahangiri A.
      • Cozzolino A.
      • Zanetti M.
      • et al.
      Outcome of single-tendon rotator cuff repair in patients aged older than 65 years.
      J Shoulder Elbow Surg. 2013; 22: 45-51
      , 
      • Seidler A.
      • Bolm-Audorff U.
      • Petereit-Haack G.
      • et al.
      Work-related lesions of the supraspinatus tendon: A case-control study.
      Int Arch Occup Environ Health. 2011; 84: 425-433
      In our recent work,
      • Baverel L.
      • Boutsiadis A.
      • Reynolds R.J.
      • Saffarini M.
      • Barthélémy R.
      • Barth J.
      Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?.
      JSES Open Access. 2018; 2: 54-59
      we found that adjusting for the aforementioned factors, preoperative CSIs did not compromise RCR outcomes, whereas postoperative CSIs were associated with significantly compromised RCR outcomes. Contrary to the understanding of Desai et al.,
      • Desai V.S.
      • Camp C.L.
      • Boddapati V.
      • Dines J.S.
      • Brockmeier S.F.
      • Werner B.C.
      Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery.
      Arthroscopy. 2019; 35: 45-50
      we did indeed account for the number of CSIs administered in our multivariable analyses because we considered preoperative and postoperative CSIs as distinct continuous variables. We also acknowledged that our sample size may be insufficient to affirm that preoperative CSIs do not cause deleterious effects and that our data cannot be used to determine whether postoperative CSIs compromised outcomes or whether postoperative CSIs were administered in patients with worse outcomes to start with.
      In our practice, delivering CSIs under ultrasound or fluoroscopic guidance is key to their success, and to avoid their adverse effects.
      • Koivikko M.P.
      • Mustonen A.O.
      Shoulder magnetic resonance arthrography: A prospective randomized study of anterior and posterior ultrasonography-guided contrast injections.
      Acta Radiol. 2008; 49: 912-917
      , 
      • Patel D.N.
      • Nayyar S.
      • Hasan S.
      • Khatib O.
      • Sidash S.
      • Jazrawi L.M.
      Comparison of ultrasound-guided versus blind glenohumeral injections: A cadaveric study.
      J Shoulder Elbow Surg. 2012; 21: 1664-1668
      , 
      • Rutten M.J.
      • Collins J.M.
      • Maresch B.J.
      • et al.
      Glenohumeral joint injection: A comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography.
      Eur Radiol. 2009; 19: 722-730
      Image-guided infiltrations ensure that the steroid is delivered at the desired subacromial or intra-articular zone, maximizing its anti-inflammatory effect, and minimizing tendon damage by needling.
      • Hsieh L.F.
      • Hsu W.C.
      • Lin Y.J.
      • Wu S.H.
      • Chang K.C.
      • Chang H.L.
      Is ultrasound-guided injection more effective in chronic subacromial bursitis?.
      Med Sci Sports Exercise. 2013; 45: 2205-2213
      , 
      • Kim Y.S.
      • Lee H.J.
      • Kim Y.V.
      • Kong C.G.
      Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy.
      J Shoulder Elbow Surg. 2014; 23: 1640-1646
      It is uncertain whether CSIs delivered in the study of Desai et al. were guided in any way and whether rotator cuff tissue was potentially damaged by the corticosteroids, or by repetitive contact with sharp needles. In our experience, shoulder stiffness because of tissue adhesions and capsular contractions should also be resolved before RCR to optimize outcomes.
      • Cho N.S.
      • Rhee Y.G.
      Functional outcome of arthroscopic repair with concomitant manipulation in rotator cuff tears with stiff shoulder.
      Am J Sports Med. 2008; 36: 1323-1329
      , 
      • Seo S.S.
      • Choi J.S.
      • An K.C.
      • Kim J.H.
      • Kim S.B.
      The factors affecting stiffness occurring with rotator cuff tear.
      J Shoulder Elbow Surg. 2012; 21: 304-309
      Finally, rapid surgical repair is advised, particularly for young or active patients, to prevent fatty degeneration, as even the first stage can compromise long-term outcomes.
      • Godeneche A.
      • Elia F.
      • Kempf J.F.
      • et al.
      Fatty infiltration of stage 1 or higher significantly compromises long-term healing of supraspinatus repairs.
      J Shoulder Elbow Surg. 2017; 26: 1818-1825
      Better diagnosis and early intervention could therefore reduce the need for CSIs and obviate their potential harms, although those recommendations may be difficult to implement, because access to magnetic resonance imaging remains limited and surgery on older patients may not be advisable.
      In my opinion, future research should focus on means to render advanced imaging more accessible and to empower clinicians with computer-aided diagnosis to facilitate rapid and accurate detection of rotator cuff tears. Such advancements could improve the outcomes of RCR by offering rapid intervention to patients that need it and hence avoid repetitive CSIs in those who are likely to require subsequent surgery. Naturally, a large and rigorous randomized controlled trial is also necessary to determine whether preoperative CSIs compromise outcomes of RCR, but the study design, ethical considerations and large sample required would be challenging to overcome. Until then, Desai et al.
      • Desai V.S.
      • Camp C.L.
      • Boddapati V.
      • Dines J.S.
      • Brockmeier S.F.
      • Werner B.C.
      Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery.
      Arthroscopy. 2019; 35: 45-50
      demonstrated that 1 preoperative CSI does little or no harm, so unless contraindicated, try that 1 injection, but consider other conservative or surgical treatments before giving a second injection.

      Supplementary Data

      References

        • Desai V.S.
        • Camp C.L.
        • Boddapati V.
        • Dines J.S.
        • Brockmeier S.F.
        • Werner B.C.
        Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery.
        Arthroscopy. 2019; 35: 45-50
        View in Article
        • Nunley R.M.
        • Wilson J.M.
        • Gilula L.
        • Clohisy J.C.
        • Barrack R.L.
        • Maloney W.J.
        Iliopsoas bursa injections can be beneficial for pain after total hip arthroplasty.
        Clin Orthop Relat Res. 2010; 468: 519-526
        View in Article
        • Baumbach S.F.
        • Lobo C.M.
        • Badyine I.
        • Mutschler W.
        • Kanz K.G.
        Prepatellar and olecranon bursitis: Literature review and development of a treatment algorithm.
        Arch Orthop Trauma Surg. 2014; 134: 359-370
        View in Article
        • Griesser M.J.
        • Harris J.D.
        • Campbell J.E.
        • Jones G.L.
        Adhesive capsulitis of the shoulder: A systematic review of the effectiveness of intra-articular corticosteroid injections.
        J Bone Joint Surg Am. 2011; 93: 1727-1733
        View in Article
        • Oh J.H.
        • Oh C.H.
        • Choi J.A.
        • Kim S.H.
        • Kim J.H.
        • Yoon J.P.
        Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder: A prospective, randomized short-term comparison study.
        J Shoulder Elbow Surg. 2011; 20: 1034-1040
        View in Article
        • Ranalletta M.
        • Rossi L.A.
        • Bongiovanni S.L.
        • Tanoira I.
        • Elizondo C.M.
        • Maignon G.D.
        Corticosteroid injections accelerate pain relief and recovery of function compared with oral NSAIDs in patients with adhesive capsulitis: A randomized controlled trial.
        Am J Sports Med. 2016; 44: 474-481
        View in Article
        • Shin S.J.
        • Lee S.Y.
        Efficacies of corticosteroid injection at different sites of the shoulder for the treatment of adhesive capsulitis.
        J Shoulder Elbow Surg. 2013; 22: 521-527
        View in Article
        • Ando A.
        • Sugaya H.
        • Hagiwara Y.
        • et al.
        Identification of prognostic factors for the nonoperative treatment of stiff shoulder.
        Int Orthop. 2013; 37: 859-864
        View in Article
        • Diercks R.L.
        • Stevens M.
        Gentle thawing of the frozen shoulder: A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years.
        J Shoulder Elbow Surg. 2004; 13: 499-502
        View in Article
        • Huberty D.P.
        • Schoolfield J.D.
        • Brady P.C.
        • Vadala A.P.
        • Arrigoni P.
        • Burkhart S.S.
        Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair.
        Arthroscopy. 2009; 25: 880-890
        View in Article
        • Shin S.J.
        • Do N.H.
        • Lee J.
        • Ko Y.W.
        Efficacy of a subacromial corticosteroid injection for persistent pain after arthroscopic rotator cuff repair.
        Am J Sports Med. 2016; 44: 2231-2236
        View in Article
        • Kim I.B.
        • Jung D.W.
        An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.
        Am J Sports Med. 2018; 46: 2192-2202
        View in Article
        • Baverel L.
        • Boutsiadis A.
        • Reynolds R.J.
        • Saffarini M.
        • Barthélémy R.
        • Barth J.
        Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?.
        JSES Open Access. 2018; 2: 54-59
        View in Article
        • Ramirez J.P.
        • Bonati-Richardson F.
        • Garcia M.P.
        • et al.
        Intra-articular treatment with corticosteroids increases apoptosis in human rotator cuff tears.
        Connect Tissue Res. 2018; : 1-8
        View in Article
        • Bonnevialle N.
        • Bayle X.
        • Faruch M.
        • Wargny M.
        • Gomez-Brouchet A.
        • Mansat P.
        Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder?.
        J Shoulder Elbow Surg. 2015; 24: 1257-1262
        View in Article
        • Geary M.B.
        • Elfar J.C.
        Rotator cuff tears in the elderly patients.
        Geriatr Orthop Surg Rehabi. 2015; 6: 220-224
        View in Article
        • Dolkart O.
        • Chechik O.
        • Bivas A.
        • et al.
        Subacromial corticosteroid injections transiently decrease suture anchor pullout strength: Biomechanical studies in rats.
        J Shoulder Elbow Surg. 2017; 26: 1789-1793
        View in Article
        • Donohue N.K.
        • Prisco A.R.
        • Grindel S.I.
        Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears.
        Muscles Ligaments Tendons. 2017; 7: 34-39
        View in Article
        • Pedowitz R.A.
        • Yamaguchi K.
        • Ahmad C.S.
        • et al.
        Optimizing the management of rotator cuff problems.
        J Am Acad Orthop Surg. 2011; 19: 368-379
        View in Article
        • Varkey D.T.
        • Patterson B.M.
        • Creighton R.A.
        • Spang J.T.
        • Kamath G.V.
        Initial medical management of rotator cuff tears: A demographic analysis of surgical and nonsurgical treatment in the United States Medicare population.
        J Shoulder Elbow Surg. 2016; 25: e378-e385
        View in Article
        • Barth J.
        • Andrieu K.
        • Fotiadis E.
        • Hannink G.
        • Barthelemy R.
        • Saffarini M.
        Critical period and risk factors for retear following arthroscopic repair of the rotator cuff.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2196-2204
        View in Article
        • Godeneche A.
        • Freychet B.
        • Lanzetti R.M.
        • Clechet J.
        • Carrillon Y.
        • Saffarini M.
        Should massive rotator cuff tears be reconstructed even when only partially repairable?.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2164-2173
        View in Article
        • Nove-Josserand L.
        • Saffarini M.
        • Hannink G.
        • Carrillon Y.
        Influence of pre-operative tear size and tendon retraction on repair outcomes for isolated subscapularis tears.
        Int Orthop. 2016; 40: 2559-2566
        View in Article
        • Djahangiri A.
        • Cozzolino A.
        • Zanetti M.
        • et al.
        Outcome of single-tendon rotator cuff repair in patients aged older than 65 years.
        J Shoulder Elbow Surg. 2013; 22: 45-51
        View in Article
        • Seidler A.
        • Bolm-Audorff U.
        • Petereit-Haack G.
        • et al.
        Work-related lesions of the supraspinatus tendon: A case-control study.
        Int Arch Occup Environ Health. 2011; 84: 425-433
        View in Article
        • Koivikko M.P.
        • Mustonen A.O.
        Shoulder magnetic resonance arthrography: A prospective randomized study of anterior and posterior ultrasonography-guided contrast injections.
        Acta Radiol. 2008; 49: 912-917
        View in Article
        • Patel D.N.
        • Nayyar S.
        • Hasan S.
        • Khatib O.
        • Sidash S.
        • Jazrawi L.M.
        Comparison of ultrasound-guided versus blind glenohumeral injections: A cadaveric study.
        J Shoulder Elbow Surg. 2012; 21: 1664-1668
        View in Article
        • Rutten M.J.
        • Collins J.M.
        • Maresch B.J.
        • et al.
        Glenohumeral joint injection: A comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography.
        Eur Radiol. 2009; 19: 722-730
        View in Article
        • Hsieh L.F.
        • Hsu W.C.
        • Lin Y.J.
        • Wu S.H.
        • Chang K.C.
        • Chang H.L.
        Is ultrasound-guided injection more effective in chronic subacromial bursitis?.
        Med Sci Sports Exercise. 2013; 45: 2205-2213
        View in Article
        • Kim Y.S.
        • Lee H.J.
        • Kim Y.V.
        • Kong C.G.
        Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy.
        J Shoulder Elbow Surg. 2014; 23: 1640-1646
        View in Article
        • Cho N.S.
        • Rhee Y.G.
        Functional outcome of arthroscopic repair with concomitant manipulation in rotator cuff tears with stiff shoulder.
        Am J Sports Med. 2008; 36: 1323-1329
        View in Article
        • Seo S.S.
        • Choi J.S.
        • An K.C.
        • Kim J.H.
        • Kim S.B.
        The factors affecting stiffness occurring with rotator cuff tear.
        J Shoulder Elbow Surg. 2012; 21: 304-309
        View in Article
        • Godeneche A.
        • Elia F.
        • Kempf J.F.
        • et al.
        Fatty infiltration of stage 1 or higher significantly compromises long-term healing of supraspinatus repairs.
        J Shoulder Elbow Surg. 2017; 26: 1818-1825
        View in Article

      Article info

      Footnotes

      The author reports that he has no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

      See related article on page 45

      Identification

      DOI: https://doi.org/10.1016/j.arthro.2018.10.009

      Copyright

      © 2018 by the Arthroscopy Association of North America

      ScienceDirect

      Access this article on ScienceDirect

      Linked Article

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX