Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis

Metzger, Cameron; Farooq, Hassan; Merrell, Gregory A.; Kaplan, F. Thomas D.; Greenberg, Jeffrey A.; Crosby, Nicholas E.; Peck, Kathryn; Hoyer, Reed W.

doi:10.1016/j.jse.2020.08.008

Cited by 15 publications

(10 citation statements)

References 19 publications

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“…Several studies have also tried to quantify the duration of symptom relief provided by corticosteroid injections among shoulder arthritis patients. Metzger et al [ 14 ] conducted a prospective study that found that glenohumeral OA symptoms were significantly alleviated by ultrasound-guided steroid injections with improvements in shoulder function and pain lasting up to 4 months post-injection. By contrast, Merolla et al [ 15 ] found in a retrospective comparative cohort study that corticosteroids only reduced glenohumeral OA pain for up to 1-month post-injection.…”

Section: Discussionmentioning

confidence: 99%

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections

Shankar

Mojica

Colasanti

et al. 2023

Clin Shoulder Elbow

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Background: The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections.Methods: We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05.Results: The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00–1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05–2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80–0.95; P=0.003).Conclusions: There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

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Section: Discussionmentioning

confidence: 99%

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections

Shankar

Mojica

Colasanti

et al. 2023

Clin Shoulder Elbow

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“…9 To date, the American Academy of Orthopaedic Surgeons has been unable to make steadfast recommendations for the use of IA corticosteroid injections for GHOA. 4,5,10 This is largely due to the fact that there is a lack of level 1 and 2 evidence supporting their use in the shoulder. 3,4 The present study demonstrates that the utilization of both HA and CO glenohumeral injections in the year and 90 days prior to TSA for patients with shoulder arthritis are on the decline.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,10 This is largely due to the fact that there is a lack of level 1 and 2 evidence supporting their use in the shoulder. 3,4 The present study demonstrates that the utilization of both HA and CO glenohumeral injections in the year and 90 days prior to TSA for patients with shoulder arthritis are on the decline. From 2010 to 2017, we observed a 79% decrease in HA injections and a 68% decrease in CO injections in the year prior to TSA.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are currently no level 1 or 2 studies evaluating the use of CO for GHOA, several cohort studies have found improved functionality and decreased pain for up to 4 months following an injection. 4 HA injections have proven to provide effective pain relief as well as increase shoulder range of motion and quality of life. 2 Despite the short-term pain relief afforded by IA injections, total shoulder arthroplasty (TSA) may eventually become necessary for definitive management if symptoms continue to be functionally limiting.…”

Section: Introductionmentioning

confidence: 99%

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The effect of pre-operative shoulder injections on post-operative opioid use, infection and revision following shoulder arthroplasty

et al. 2022

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Background Treatment of glenohumeral osteoarthritis (GHOA) may include conservative management with use of intraarticular injections, prior to considering total shoulder arthroplasty (TSA). The purpose of this study was to assess trends in the use of preoperative cortisone (CO) and hyaluronic acid (HA) injections, as well as investigate the relationship between injection use and infection or revision arthroplasty following TSA. Methods Pearl Driver was used to identify all patients undergoing TSA for GHOA between 2010 and 2018. Patients were categorized based on the type and number of injections they received. Outcomes of interest included post-operative opioid use, post-operative infection, and risk of revision surgery within 1 year of the index procedure. Results The incidence of patients receiving a CO or HA injections within 1 year of their TSA decreased by 83% and 54%, respectively. Patients who had received 1 or more steroid injections had higher odds of prolonged opiate use following surgery. Patients that received 1 or 2 CO injection prior to TSA had an increased risk of needing revision surgery. Discussion Use of intraarticular injections for the management of GHOA has declined. Patients receiving preoperative injections had increased odds of prolonged opiate use and the need for revision surgery.

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“…Since then, other joints affected by OA have also become sites of injection, and this form of therapy remains an area of active research [170][171][172][173]. These investigations aim to assess the duration of the anti-inflammatory and analgesic effects of corticosteroids, considering that the latest evidence indicates a relatively short duration, from a few weeks to months, necessitating careful consideration when determining the appropriate posology for treatment [166].…”

Section: Steroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts

Coppola,

Greco,

Munir

et al. 2024

CIMB

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Osteoarthritis (OA) stands as a prevalent and progressively debilitating clinical condition globally, impacting joint structures and leading to their gradual deterioration through inflammatory mechanisms. While both non-modifiable and modifiable factors contribute to its onset, numerous aspects of OA pathophysiology remain elusive despite considerable research strides. Presently, diagnosis heavily relies on clinician expertise and meticulous differential diagnosis to exclude other joint-affecting conditions. Therapeutic approaches for OA predominantly focus on patient education for self-management alongside tailored exercise regimens, often complemented by various pharmacological interventions primarily targeting pain alleviation. However, pharmacological treatments typically exhibit short-term efficacy and local and/or systemic side effects, with prosthetic surgery being the ultimate resolution in severe cases. Thus, exploring the potential integration or substitution of conventional drug therapies with natural compounds and extracts emerges as a promising frontier in enhancing OA management. These alternatives offer improved safety profiles and possess the potential to target specific dysregulated pathways implicated in OA pathogenesis, thereby presenting a holistic approach to address the condition’s complexities.

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Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis

Cited by 15 publications

References 19 publications

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections

The effect of pre-operative shoulder injections on post-operative opioid use, infection and revision following shoulder arthroplasty

Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts

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