Physicians and patients are often tempted to try injection of the shoulder to see if this gives pain relief. While intra articular injection of steroids (like cortisone) may be of at least temporary benefit in lessening symptoms, each injection does carry the risk of infection as emphasized in these posts
Can injection infect the shoulder with Propionibacterium?
Should the painful shoulder arthroplasty be injected with corticosteroids?
Are shoulder injections safe before shoulder joint replacement and arthroscopy?
Injection can increase the risk of infection in rotator cuff repairs
Rotator cuff repair - does injection increase the risk of infection?
The authors of Does Pre-Operative Corticosteroid Injection Increase the Risk of Periprosthetic Joint Infection After Reverse Shoulder Arthroplasty? investigated the association between the timing of corticosterioid injection (CSI) for osteoarthritis and the incidence of periprosthetic infection (PJI) of a reverse total shoulder arthroplasty using a national, all-payer database.
Their analysis demonstrated a significantly increased risk of PJI at 90 days and at one year after surgery in patients who received CSI within one month prior to RSA. While the authors state that no significant increase in PJI risk was noted for patients who received CSI more than one month before their RSA, a plot of their data suggests that the average rate of PJI remains higher for all patients having CSI prior to RSA in comparison to those not having prior CSI
Alcohol abuse, chronic kidney disease, and depression were also identified as risk factors for PJI.
The types of organisms causing PJI in this series are not specified.
Comment: The rate of PJI after RSA is high: at least one in 14 patients in this series. There is usually no rush in proceeding with these joint replacements. Infection is worth avoiding to every extent possible.
The reasons why injections increase the risk of PHI are not known. Is it
(1) contamination by the needle taking bacteria from the skin and inoculating the joint?
(2) does the injection activate bacteria that are already existing in the shoulder?
(3) does the steroid diminish host resistance to the ever present risk of infection, or
(4) some combination of these and other factors.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
