Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
권호 표지
DOI QR코드

DOI QR Code

Effects of steroid injection during rehabilitation after arthroscopic rotator cuff repair

  • Ha, Joong-Won (Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital) ;
  • Kim, Hyunkyo (Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital) ;
  • Kim, Seong Hun (Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital)
  • 투고 : 2021.05.26
  • 심사 : 2021.07.05
  • 발행 : 2021.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: This study aims to compare the clinical outcomes of steroid injections during the rehabilitation period after arthroscopic rotator cuff repair (ACRC). Methods: Among patients who underwent ARCR, 117 patients who met the inclusion and exclusion criteria were enrolled. Pain and range of motion (ROM) recovery at the 3-, 6-, and 24-month follow-up visits and functional outcome at the 24-month follow-up were compared between 45 patients who received ultrasound-guided subacromial steroid injection at postoperative week 4 or 6 and 72 patients who did not. Functional outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) score and Constant score. Healing of the repaired tendon and retear were observed at the 6-month follow-up via magnetic resonance imaging (MRI) or computed tomography (CT) arthrography. Results: At the 3-month follow-up, the steroid injection group showed lower visual analog scale scores than the control group (p<0.05) and showed faster recovery of forward flexion and internal rotation (p<0.05). From the 6-month follow-up, the two groups did not show differences in pain and ROM, and the ASES score and Constant score also did not significantly differ at the 24-month follow-up. The two groups did not differ in retear rate as determined by MRI or CT arthrography at the 6-month follow-up. Conclusions: This study demonstrated that ultrasound-guided subacromial steroid injection at 4 or 6 weeks after ARCR leads to quick pain reduction and ROM recovery until 3 months after surgery. Therefore, subacromial steroid injection is speculated to be an effective and relatively safe method to assist rehabilitation.

키워드

참고문헌

  1. Severud EL, Ruotolo C, Abbott DD, Nottage WM. All-arthroscopic versus mini-open rotator cuff repair: a long-term retrospective outcome comparison. Arthroscopy 2003;19:234-8. https://doi.org/10.1053/jars.2003.50036
  2. Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 2000;82:304-14.
  3. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004;86:219-24. https://doi.org/10.2106/00004623-200402000-00002
  4. Chung SW, Huong CB, Kim SH, Oh JH. Shoulder stiffness after rotator cuff repair: risk factors and influence on outcome. Arthroscopy 2013;29:290-300. https://doi.org/10.1016/j.arthro.2012.08.023
  5. Denard PJ, Ladermann A, Burkhart SS. Prevention and management of stiffness after arthroscopic rotator cuff repair: systematic review and implications for rotator cuff healing. Arthroscopy 2011;27:842-8. https://doi.org/10.1016/j.arthro.2011.01.013
  6. Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy 2006;22:581-6. https://doi.org/10.1016/j.arthro.2006.03.004
  7. Chen AL, Shapiro JA, Ahn AK, Zuckerman JD, Cuomo F. Rotator cuff repair in patients with type I diabetes mellitus. J Shoulder Elbow Surg 2003;12:416-21. https://doi.org/10.1016/S1058-2746(03)00172-1
  8. Hannafin JA, Chiaia TA. Adhesive capsulitis: a treatment approach. Clin Orthop Relat Res 2000;(372):95-109.
  9. Oh JH, Oh CH, Choi JA, Kim SH, Kim JH, Yoon JP. Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder: a prospective, randomized short-term comparison study. J Shoulder Elbow Surg 2011;20:1034-40. https://doi.org/10.1016/j.jse.2011.04.029
  10. Perdreau A, Joudet T. Efficacy of multimodal analgesia injection combined with corticosteroids after arthroscopic rotator cuff repair. Orthop Traumatol Surg Res 2015;101(8 Suppl):S337-45. https://doi.org/10.1016/j.otsr.2015.09.006
  11. Lambert MI, St Clair Gibson A, Noakes TD. Rupture of the triceps tendon associated with steroid injections. Am J Sports Med 1995;23:778. https://doi.org/10.1177/036354659502300627
  12. Oh CH, Oh JH, Kim SH, Cho JH, Yoon JP, Kim JY. Effectiveness of subacromial anti-adhesive agent injection after arthroscopic rotator cuff repair: prospective randomized comparison study. Clin Orthop Surg 2011;3:55-61. https://doi.org/10.4055/cios.2011.3.1.55
  13. Creamer P. Intra-articular corticosteroid injections in osteoarthritis: do they work and if so, how. Ann Rheum Dis 1997;56: 634-6. https://doi.org/10.1136/ard.56.11.634
  14. Bal A, Eksioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. Effectiveness of corticosteroid injection in adhesive capsulitis. Clin Rehabil 2008;22:503-12. https://doi.org/10.1177/0269215508086179
  15. Ryans I, Montgomery A, Galway R, Kernohan WG, McKane R. A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology (Oxford) 2005;44:529-35. https://doi.org/10.1093/rheumatology/keh535
  16. Carette S, Moffet H, Tardif J, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum 2003;48:829-38. https://doi.org/10.1002/art.10954
  17. Roh YH, Yi SR, Noh JH, et al. Intra-articular corticosteroid injection in diabetic patients with adhesive capsulitis: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2012;20:1947-52. https://doi.org/10.1007/s00167-011-1776-6
  18. Blair B, Rokito AS, Cuomo F, Jarolem K, Zuckerman JD. Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 1996;78:1685-9. https://doi.org/10.2106/00004623-199611000-00007
  19. Marder RA, Kim SH, Labson JD, Hunter JC. Injection of the subacromial bursa in patients with rotator cuff syndrome: a prospective, randomized study comparing the effectiveness of different routes. J Bone Joint Surg Am 2012;94:1442-7. https://doi.org/10.2106/JBJS.K.00534
  20. Stefanich RJ. Intraarticular corticosteroids in treatment of osteoarthritis. Orthop Rev 1986;15:65-71.
  21. Gialanella B, Prometti P. Effects of corticosteroids injection in rotator cuff tears. Pain Med 2011;12:1559-65. https://doi.org/10.1111/j.1526-4637.2011.01238.x
  22. Wei AS, Callaci JJ, Juknelis D, et al. The effect of corticosteroid on collagen expression in injured rotator cuff tendon. J Bone Joint Surg Am 2006;88:1331-8. https://doi.org/10.2106/00004623-200606000-00022
  23. Stannard JP, Bucknell AL. Rupture of the triceps tendon associated with steroid injections. Am J Sports Med 1993;21:482-5. https://doi.org/10.1177/036354659302100327
  24. Watson M. Major ruptures of the rotator cuff: the results of surgical repair in 89 patients. J Bone Joint Surg Br 1985;67:618-24. https://doi.org/10.1302/0301-620X.67B4.4030862
  25. Cho CH, Song KS, Min BW, et al. Multimodal approach to postoperative pain control in patients undergoing rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2011;19:1744-8. https://doi.org/10.1007/s00167-010-1294-y
  26. Shin SJ, Do NH, Lee J, Ko YW. Efficacy of a subacromial corticosteroid injection for persistent pain after arthroscopic rotator cuff repair. Am J Sports Med 2016;44:2231-6. https://doi.org/10.1177/0363546516648326
  27. Knudsen K, Beckman Suurkula M, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997;78:507-14. https://doi.org/10.1093/bja/78.5.507
  28. Namdari S, Green A. Range of motion limitation after rotator cuff repair. J Shoulder Elbow Surg 2010;19:290-6. https://doi.org/10.1016/j.jse.2009.07.009
  29. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy 2009; 25:880-90. https://doi.org/10.1016/j.arthro.2009.01.018
  30. Gumina S, Izzo R, Pintabona G, Candela V, Savastano R, Santilli V. Mobility recovery after arthroscopic rotator cuff repair. Eur J Phys Rehabil Med 2017;53:49-56.