More Bad News about Shoulder Steroid Shots!!
Shoulder rotator cuffs are the topic of much study of late. I reviewed the literature surrounding rotator cuff tear surgery and before that I discussed new research that shows why injecting steroids into shoulder tendons was a dumb idea. This new study continues to show that shoulder steroid shots injecting steroids into shoulder tendons is a really bad idea.
The most common injection into the shoulder world-wide is steroid and anesthetic. The type of steroid is called “corticosteroid” because it’s the anti-inflammatory type. Not much has really changed in the world of steroid injections since the 1950s when the Upjohn drug Cortisone was first sold. So when you’re offered a “Cortisone” or steroid injection for shoulder pain, it should likely give you pause that you’re being offered a 60+ year old therapy. Remember that in 1950, lobotomy was all the rage…
We’ve known for a long-time that steroids harm tissue. There are more than 62,000 research papers that come up on a search of the U.S. National Library of Medicine on “corticosteroid side effects”. In fact, the first paper about the side effects of steroids in arthritis was published in 1951! By the 1960s we got our first inkling that steroids could harm soft tissues. Some of the older among us can likely remember NFL lore that Joe Namath’s bum knee was largely due to repeated steroid shots to keep him playing.
Why are steroids so bad for tissue? First, the dose of steroids was never determined by studying the effects of the substance on human tissues like cartilage, tendon, or muscle, but instead by observing that a certain dose (milligrams) helped diseases like Asthma when given intravenous to the patient. So the dose is way off. How “out there” is the dosing? If the amount that a normal tendon would be exposed to when produced by the body to control swelling is represented by the height of a matchbook, the amount that doctors inject into shoulder tendons is the height of the Empire state building! The second issue is the direct effects of steroids on tissue. All bones, tendons, muscles, and cartilage have reserve cells living inside them, called stem or progenitor cells. These are there to help maintain cells that die off due to normal wear and tear. However, studies have shown that steroids at high doses hurt these cells, leaving the tissue without any ability to repair or maintain itself for many months.
The new study focused on the effects of steroids on the tendons of real patients undergoing rotator cuff surgery. The original goal of the study was to map the amount and density of blood vessels in different parts of the shoulder rotator cuff tendons. Why would this be important? Because newer studies show that rotator cuff tears don’t heal well when the tendon has developed fewer blood vessels and has poor blood supply. While the study showed a pattern of blood vessels that might be helpful to surgeons, the biggest startling finding was that patients who had shoulder steroid shots before the surgery had 1/3 fewer blood vessels than the patients who didn’t get the shots. Ouch!
The upshot? Steroid injections are bad news. Study after study continues to show that they damage tissue at a cellular level, with this most recent study showing they decrease the blood supply critical for healthy tissue. Having said that, because they’re covered by insurance, they’re the most common injection for orthopedic pain conditions. So if your doctor wants to inject steroids into your shoulder tendons, unless it comes with a long discussion about how these substances can cause tissue damage, run…