Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
The well-known side effects of cortisone will not be listed here. We have a very extensive article listing recent research on cortisone side effects. Please see the Alternatives to cortisone shots. One side effect that we will touch on is that cortisone injections can negatively impact future surgical outcomes.
Researchers have shown that cortisone injections into the shoulder prior to rotator cuff repair surgery can negatively impact patient outcomes. This can lead to surgical failure, re-tear of the rotator cuff, the need for more surgery and other complications. In the emails we get into our office, after a description of the size of the tear, we will in many cases, get the cortisone injection history this person has had. An example will go like this: “I have a 5 cm tear in my rotator cuff. I just had a cortisone injection and it helped for a while, but now the pain is back and my doctor wants to perform the surgery.” This person will continue with their concern that the cortisone injections that they previously had will cause concerns with their procedure. Doctors too have long expressed concerns.
Surgeons suggest “Caution should be taken when deciding to inject a patient (with cortisone).”
Cortisone is of course the last best anti-inflammatory weapon that your shoulder specialist may have. While some people will get a short-term benefit from cortisone, doctors are concerned with the long-term and how this would impact a future rotator cuff repair surgery.
In May 2020, researchers at Tufts Medical Center, Rush University Medical Center, and the Hospital For Special Surgery published these research findings in the medical journal Arthroscopy. (1) In it, they examined if cortisone injections for rotator cuff problems before surgery cause complication problems after surgery and if this caused a higher risk for the need for a second surgery.
What they discovered was:
- Single cortisone injection for rotator cuff tendinosis was associated with an increased risk of revision rotator cuff repair when administered up to a year prior to surgery.
- A single cortisone injection increased the risks of postoperative infections when administered within a month prior to rotator cuff tendinosis.
- The risk of adverse outcomes after arthroscopic rotator cuff repair is greatest if a cortisone injection is administered within 6 months of surgery or if more than two cortisone injections are given within a year of surgery.
The authors note that several recent clinical trials have demonstrated that cortisone injections are correlated with an increased risk of revision surgery after arthroscopic rotator cuff repair. They conclude: “Caution should be taken when deciding to inject a patient, and this treatment should be withheld if an arthroscopic rotator cuff repair is to be performed within the following six months.”
The effects of one or multiple corticosteroid injections
This research followed a January 2019 study (2) in the journal Arthroscopy which examined the effects of one or multiple corticosteroid injections a patient received for shoulder pain prior to having rotator cuff surgery. Here were these findings:
- “A single shoulder injection within a year prior to arthroscopic rotator cuff repair was not associated with an increased risk of revision surgery; however, the administration of 2 or more injections was associated with a substantially increased risk of subsequent revision rotator cuff surgery . . . caution is recommended when considering more than 1 shoulder corticosteroid injection in patients with potentially repairable rotator cuff tears.
In May 2022, doctors writing in the journal Family practice (3) also called on better awareness on the possible detrimental use of corticosteroid for shoulder issues. In their study, the doctors noted that fellow physicians were not following guidelines for shoulder pain in general practice and the recommend treatment with corticosteroid injections. Mainly that many doctors were giving corticosteroid injections as the first line of treatment.
What the doctors found was: 26% of the patients with a new episode of shoulder pain received a cortisone injection. If the patient was older, with a history of shoulder pain, they were more likely to get a shot on the initial consultation and have repeated injections. Half of the patients received the injection in the first consultation. A finding of the study was that the older patients (mid 40s to mid 60s) may have been given the cortisone injection because the doctors were reluctant to prescribe NSAIDs or opioids in the older group.
A February 2023 paper in the American Journal of Sports Medicine (4) compared both the functional and the structural outcomes in patients who had pre-surgery cortisone injections into their shoulders against those who did not and assessed the outcomes following arthroscopic rotator cuff repair in both groups.
After an average 3-year follow-up, the 2 groups demonstrated no significant differences in re-tear rate; visual analog scale for pain; shoulder functional scores; and active ROM including forward flexion, abduction, external rotation, and internal rotation. No significant differences were observed on postoperative MRI scans of the rotator cuff tendon (tendon integrity, healing type, residual tendon attachment area, etc.), cartilage thickness, and muscle atrophy.
Patients receiving more than 2 injections within less than 6 months before surgery was significantly associated with a higher postoperative retear risk.
A September 2025 study in the Orthopaedic journal of sports medicine (5) examined the role of preoperative corticosteroid injections in rotator cuff repair outcomes noting that research is controversial, with mixed evidence regarding their effect on tendon healing and postoperative recovery.
This study included 365 patients who underwent arthroscopic rotator cuff repair. Patients were divided into groups of patients having received steroid injections before one year or less before surgery before surgery and control group without preoperative injections.
- At 3 months postoperatively, the cortisone group exhibited significantly reduced active abduction and external rotation compared with the control group.
- Pain at night was also higher in the cortisone group than the control group at 3 months.
- Patients receiving more than 2 injections within less than 6 months before surgery was significantly associated with a higher postoperative retear risk.
More articles
Rotator Cuff Tendinopathy: Comparing physical therapy, injections, and surgical options
Prolotherapy injections for rotator cuff tears and rotator cuff tendinopathy
References
1 Puzzitiello RN, Patel BH, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Adverse impact of corticosteroid injection on rotator cuff tendon health and repair: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 May 1;36(5):1468-75. [Google Scholar]
2 Desai VS, Camp CL, Boddapati V, Dines JS, Brockmeier SF, Werner BC. Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019 Jan 1;35(1):45-50. [Google Scholar]
3 van Doorn PF, Schiphof D, Rozendaal RM, Ottenheijm RP, van der Lei J, Bindels PJ, de Schepper EI. The use and safety of corticosteroid injections for shoulder pain in general practice: a retrospective cohort study. Family Practice. 2022 May 1;39(3):367-72. [Google Scholar]
4 Feng S, Li H, Zhong Y, Xie Y, Chen J, Chen Y, Chen S. Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections. The American Journal of Sports Medicine. 2023 Feb 3:03635465221145949. [Google Scholar]
5 Wang X, Liu H, Wang C, Ruan D, Shen W. Multiple Injections and Injections≤ 6 Month Injections Before Rotator Cuff Repair May Increase the Risk of Retear: A Propensity Score–Matched Study. Orthopaedic Journal of Sports Medicine. 2025 Sep 1;13(9). [Google Scholar]