What is the recommended time interval between a steroid injection in the shoulder and a rotator cuff repair?

Recommended Time Interval Between Steroid Injection and Rotator Cuff Repair

A minimum of 1 month should elapse between a steroid injection in the shoulder and rotator cuff repair to minimize the risk of surgical site infection. 1

Evidence-Based Timing Recommendations

Infection Risk

• Patients receiving a corticosteroid injection within 1 month prior to arthroscopic rotator cuff repair have a significantly higher rate of surgical site infection (1.3%) compared to those without preoperative injections (0.8%) 1
• Multivariate analysis identified preoperative corticosteroid injections within 1 month of surgery as an independent risk factor for developing surgical site infection (OR 2.1) 1
• No increased infection risk was observed when surgery was delayed by at least 1 month following an injection 1

Repair Integrity Considerations

• Preoperative injections within 6 months prior to rotator cuff repair were associated with significantly higher risk of requiring revision rotator cuff repair 2
• The risk of reoperation significantly declines if there is more than 6 months between injection and rotator cuff repair 2
• Patients who received injections within 3-6 months prior to surgery had the highest risk (AOR 1.822) of requiring revision surgery 2

Clinical Decision Algorithm

1. Immediate surgical need (acute traumatic tear):

   • If surgery is urgently indicated, consider proceeding without prior steroid injection
   • If a steroid injection has already been given, delay surgery for at least 1 month to minimize infection risk 1

2. Non-urgent cases:

   • Optimal timing: Wait at least 6 months between steroid injection and rotator cuff repair to minimize revision risk 2
   • Minimum safe interval: At least 1 month to reduce surgical site infection risk 1
   • If multiple injections have been given, the timing should be calculated from the most recent injection

Special Considerations

Postoperative Injections

• If considering steroid injections after rotator cuff repair (for persistent pain or stiffness):
  • Intra-articular steroid injections at 6 weeks postoperatively for shoulder stiffness do not appear to compromise repair integrity 3
  • Early postoperative intra-articular steroid injections (3 months) have shown no significant difference in re-tear rates compared to no injections 4

Risk Factors for Complications

• Additional factors that increase surgical site infection risk include:
  • Male sex (OR 1.7)
  • Obesity (OR 1.4)
  • Diabetes (OR 1.3)
  • Smoking status (OR 1.7) 1

Common Pitfalls to Avoid

• Performing rotator cuff repair too soon after steroid injection (within 1 month) increases infection risk 1
• Multiple preoperative injections may compromise tissue quality and increase revision rates 2
• Failing to consider the timing of the most recent injection when scheduling surgery
• Not accounting for patient-specific risk factors that may compound infection risk

While moderate evidence supports the use of a single corticosteroid injection for short-term improvement in pain and function 5, the timing of subsequent surgical intervention must be carefully planned to minimize complications and optimize outcomes.