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RETROSPECTIVE STUDY AND CASE-SERIES CHART REVIEW REEVALUATING PATIENT MORBIDITIES FOLLOWING AN INTRAARTICULAR CORTICOSTEROID SHOULDER INJECTION

J Pham
M Curtin

Abstract

RETROSPECTIVE STUDY AND CASE-SERIES CHART REVIEW REEVALUATING PATIENT MORBIDITIES FOLLOWING AN INTRAARTICULAR CORTICOSTEROID SHOULDER INJECTION

J. Pham1, M. Curtin2

1University of Idaho, Moscow, ID;1University of Washington School of Medicine, Seattle, WA

Chondrolysis is the rapid, progressive degeneration of articular cartilage tissue. Avascular bone necrosis (AVN) is cellular death in bones due to the lack/loss of blood supply to the bone tissue. Infection is the invasion of potentially disease-causing agents, such as bacteria or viruses, into the human body. Corticosteroid injections are a common procedure to help temporarily relieve joint pain, such as in the shoulders. However, invasive procedures, such as steroid injections, bring the risk of infection. Long-term steroid use can result in AVN (Al-Omari AA). The risk of chondrolysis varies depending on the local anesthetic used. PURPOSE: This case review aimed to perform a retrospective study, a case-series chart review going back an additional two years from the most recent case for reevaluation of morbidities in patients following an intraarticular injection into the shoulder. METHODS: Combinations of chondrolysis and/or AVN were found in patients following a steroid injection within our group in the Southwest Idaho area within a few months of each other. This led to the findings of 4 patients with subsequent morbidities with varying combinations of chondrolysis, AVN, and infection. The demographics of this case study include four women between their mid-50s and early 70s. Nothing in their background suggests a correlation of risk factors that could have caused their observed morbidities. RESULTS: Morbidities were found following intraarticular corticosteroid injections into the shoulder. Patient 1: Chondrolysis and Infection (partial P. Acnes). Patient 2: Chondrolysis and AVN and Infection (P. Acnes). Patient 3: Chondrolysis. Patient 4: AVN and Infection (possibility P. Acnes). CONCLUSION: There is no evidence to suggest that the primary cause of chondrolysis, AVN, or infection in the shoulder following a steroid injection. Infections are a common risk following an invasive procedure. Local anesthesia also has a risk of increasing the risk of chondrolysis, which is why the group has chosen ropivacaine as the primary anesthesia due to the relatively decreased rate of morbidity. Our findings are consistent with the expected morbidity rates found in the literature. However, further research must be conducted on the correlation and causation of potential infection, chondrolysis, and AVN in patients.

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