What is the risk of osteomyelitis (infection of the bone) of the humerus (upper arm bone) from a single corticosteroid (e.g. prednisone) injection of the right shoulder?

From the Guidelines

The risk of osteomyelitis to the humerus from a single corticosteroid injection in the right shoulder is extremely low when proper sterile technique is used. Osteomyelitis following shoulder corticosteroid injections is a rare complication, with estimated incidence rates below 0.01% 1. When administering a shoulder injection, clinicians typically use antiseptic skin preparation, sterile gloves, and proper anatomical placement to minimize infection risk. The greatest risk factors for developing post-injection osteomyelitis include improper sterile technique, immunocompromised status, diabetes mellitus, or concurrent skin infection near the injection site. If a patient develops increasing pain, redness, swelling, fever, or warmth at the injection site after the procedure, they should seek immediate medical attention as these could indicate infection. The mechanism behind this rare complication involves introducing bacteria directly into the joint space or adjacent bone during the injection procedure. While corticosteroids themselves can temporarily suppress local immune function, this alone rarely leads to bone infection unless other risk factors are present. Most shoulder injections are performed safely in outpatient settings with excellent safety profiles when standard precautions are followed.

Some key points to consider:

• The use of corticosteroid injections in the treatment of patients with glenohumeral osteoarthritis is not well supported by evidence, with no studies demonstrating a clear benefit or harm 1.
• The American Heart Association/American Stroke Association guidelines for adult stroke rehabilitation and recovery discuss the use of corticosteroid injections for hemiplegic shoulder pain, but do not provide specific recommendations regarding the risk of osteomyelitis 1.
• Overall, the risk of osteomyelitis from a single corticosteroid injection in the right shoulder is extremely low, and proper sterile technique can minimize this risk.

It is essential to note that the provided evidence does not directly address the risk of osteomyelitis from a single corticosteroid injection in the right shoulder. However, based on the available information and general medical knowledge, the risk of osteomyelitis is extremely low when proper sterile technique is used.

From the Research

Risk of Osteomyelitis from Corticosteroid Injection

• The risk of osteomyelitis (infection of the bone) of the humerus (upper arm bone) from a single corticosteroid injection of the right shoulder is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, the studies discuss the treatment and management of osteomyelitis, including chronic osteomyelitis of the humerus 3, 4.
• The studies suggest that osteomyelitis can be caused by various factors, including trauma and hematogenous spread 4, but do not specifically mention corticosteroid injections as a risk factor.
• One study mentions the use of antibiotic-impregnated cement spacers and plates to treat chronic osteomyelitis of the humerus 4, while another study discusses the use of long-term antibiotic suppression to manage chronic osteomyelitis 6.
• Overall, the provided studies do not provide direct evidence on the risk of osteomyelitis from a single corticosteroid injection of the right shoulder, but rather focus on the treatment and management of osteomyelitis once it has occurred 2, 3, 4, 5, 6.

Treatment and Management of Osteomyelitis

• The treatment of osteomyelitis typically involves a combination of antibiotic therapy and surgical intervention 2, 3, 4.
• The choice of treatment depends on the severity and location of the infection, as well as the patient's overall health and medical history 2, 4.
• Surgical options may include debridement, bone grafting, and the use of antibiotic-impregnated cement spacers and plates 3, 4.
• Long-term antibiotic suppression may be considered in some cases, particularly for patients who are not candidates for surgery or who have a high risk of reinfection 6.

Complications and Outcomes

• Osteomyelitis can lead to significant morbidity and complications, including chronic pain, limited mobility, and nerve damage 4, 5.
• The outcome of treatment depends on various factors, including the severity of the infection, the effectiveness of treatment, and the patient's overall health and medical history 4, 5.
• In some cases, osteomyelitis may require multiple surgeries and prolonged antibiotic therapy, and may result in significant long-term disability 4, 5.