Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint

There is debate among orthopaedists about the efficacy of steroid therapy to treat painful joints. Using an uncontrolled, retrospective study, we examined the usefulness of local corticosteroid injections in thirty-one patients (twenty-four men, seven women) with isolated AC joint arthropathy. No patients had signs of impingement or rotator cuff disease. All injections were performed using a standardized technique with each patient receiving 1cc Celestone/Soluspan or Dexamethasone and 2cc Lidocaine. At an average follow-up of nineteen months, patients were asked to answer questions regarding activity of daily living, according to the American Shoulder and Elbow Surgeons (ASES) format, average level of pain, length of pain relief from steroid injection, and time to return to full activity. Four patients could not be contacted for follow-up questions and, therefore, were excluded from the study leaving twenty-seven patients. Pain and function improved in twenty-five of twenty-seven (93%) patients after injection. Mean duration of improvement was twenty days (range, two hours to three months). Two patients reported continued relief at 1.5 and two years after injection. Due to persistent, insidious pain, eighteen of twenty-seven (67%) patients underwent distal clavicle excision an average of four months after injection. Overall, twenty-two of twenty-seven (81%) patients failed to obtain long-term relief from the injection. The results of this study suggest that the administration of local corticosteroids into the AC joint may provide short-term pain relief, but does not alter the natural progression of disease.