Are shoulder injections safe before shoulder joint replacement and arthroscopy?

The Timing of Elective Shoulder Surgery after Intra-articular Shoulder Injection Affects Postoperative Infection Risk

These authors queried a national insurance database to evaluate the association of preoperative intra-articular shoulder injection before shoulder arthroscopy and arthroplasty with the incidence of postoperative infection for surgeries performed between 2005 and 2012. Control cohorts were created for each study group by matching patients who underwent the same procedure without a preoperative injection to the study cohorts based on age, gender, obesity, diabetes and smoking.

Three shoulder arthroscopy cohorts were created: shoulders having arthroscopy within 3 months of ipsilateral shoulder injection, shoulders having arthroscopy between 3 and 12 months after ipsilateral shoulder injection, and matched control arthroscopy without prior injection. 

Three similar shoulder arthroplasty cohorts were created.

Infection rates within 3 and 6 months postoperatively were assessed using ICD-9 and CPT codes.

The incidence of infection after shoulder arthroscopy at 3 months (0.7%, OR 2.2, P < 0.0001) and 6 months (1.1%, OR 1.6, P = 0.003) was significantly higher in patients who underwent injection within the 3 months prior to arthroscopy compared to matched controls [Table 1A-B].

The incidence of infection after shoulder arthroplasty at 3 months (3.0%, OR 2.0, P = 0.007) and 6 months (4.6%, OR 2.0, P = 0.001) was significantly higher in patients who underwent injection within the 3 months prior to arthroplasty compared to matched controls [Table 2A-B].

There was no significant difference in infection rates in patients who underwent shoulder arthroscopy or arthroplasty between 3–12 months after injection compared to controls.

Comment: Patients often ask about having an injection to address their symptoms before proceeding with surgery. The data presented here suggest that injections within three months of surgery increase the risk of subsequent infection.

Because of the nature of the data base, we do not know details, such as what was injected, which organisms were responsible for the infections, and how serious the infections were. Nevertheless, we now have useful information that we can share with our patients who are asking for injections.

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Steroid injection - what's in the bottle? "Can't you just give me a cortisone injection, doc?"

In Vitro Cytotoxic Effects of Benzalkonium Chloride in Corticosteroid Injection Suspension


Patients often ask for an injection of their shoulder to relieve pain or to get them ready for some special event. We've never been a big fan of the use of intraarticular steroids because of a concern of the potential risk of tendon and cartilage degeneration.

The authors of this article point to another possible risk: that due to preservatives in the bottle.

They treated human and bovine articular chondrocytes, bovine synovial cells, mouse C3H10T1/2 cells, and human osteosarcoma MG-63 cells were treated for thirty minutes in monolayer or suspension culture with an injectable corticosteroid suspension or its chemical components, including betamethasone sodium phosphate, betamethasone acetate, and benzalkonium chloride (as preservative). 

They found that the injectable corticosteroid suspension caused death in in vitro culture of human and bovine articular chondrocytes as well as bovine synovial cells because of its preservative benzalkonium chloride. The betamethasone corticosteroids per se did not cause significant chondrocyte death under the conditions tested.

We need to read the bottle and be sure we're comfortable with what we're injecting.

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Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'


See from which cities our patients come.


See the countries from which our readers come on this post.