As the research below suggests, cortisone injections into a damaged, painful shoulder suspected of rotator cuff damage comes with risks. These risks include weakening of the tendons which attach the rotator cuff muscles to the shoulder bones. Increasing the risk of the chance of a partial rotator cuff tear rupturing into a full tear.

A false sense of healing

While a September 2025 study (1) suggests “robust evidence” supporting the short-term efficacy of corticosteroid injection in the rotator cuff, cautions about  diminished benefits in the medium to long term relative to other treatments cause concerns. The study authors note that despite the clinical benefits observed in some patients, which may even preclude the need for surgical intervention, some patients experienced no significant improvement after corticosteroid injection, ultimately requiring surgery. It is possible that symptom relief from corticosteroid injection gave patients a false sense of full recovery, prompting increased shoulder activity and loading, which may have led to symptom recurrence or disease progression once the corticosteroid effects waned.

A December 2019 study (2) in the journal Arthroscopy suggests that a steroid injection in the shoulder prior to rotator cuff surgery, puts you at a greater risk for post-surgical shoulder complications and possibly the need for a secondary or revision shoulder surgery. Here is what the study says: “Several recent clinical trials have demonstrated that corticosteroid injections are correlated with increased risk of revision surgery after arthroscopic rotator cuff repair. . . Caution should be taken when deciding to inject a patient (with steroid), and this treatment should be withheld if an arthroscopic rotator cuff repair is to be performed within the following six months.”

“Two or more cortisone injections was associated with a substantially increased risk of subsequent revision rotator cuff surgery.”

A January 2019 study (3) in the journal Arthroscopy 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 any 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.”

Do pre-surgery cortisone injections impact rotator cuff repair? According to one study, no. A February 2023 study (4) assessed surgical outcomes in patients who had pre-surgery cortisone injections into their shoulders against those who did not. After an average three year follow up, according to the researchers: “no significant differences were found at a mean 3-year follow-up in the retear rates, pain, range of motion, and glenohumeral structure on postoperative MRI scans after arthroscopic rotator cuff repair with or without preoperative cortisone injections.”

Oral and injected corticosteroids cause non-traumatic rotator cuff tear or rupture

A group of German doctors published an August 2021 paper (5) with the purpose of examining the association between oral and injected corticosteroids  and subsequent non-traumatic rotator cuff tear or rupture.

A total of 10,986 patients were included in each group (oral and injected corticosteroids). For both steroid treatments, the researchers found a significant association with non-traumatic rotator cuff tear or rupture, whereby oral corticosteroids had a stronger impact. For oral corticosteroids, this association was largely unaffected by differences in total doses or latencies between therapy end and index date. Within the group who received injected corticosteroids, shorter latencies and total doses of 20 mg or more led to higher odds of non-traumatic rotator cuff tear or rupture.

Conclusion: “Oral and injected non-traumatic rotator cuff tear or rupture in patients treated in orthopedic practices in Germany, while analgesics such as NSAIDs were not.”

References

1 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).
2 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. 2019 Dec 17.
3 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.
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.
5 Garthe TL, Jacob L, Kostev K. Association between corticosteroid therapy and diagnosis of non-traumatic rotator cuff tear or rupture in patients followed in orthopedic practices in Germany. International Journal of Clinical Pharmacology and Therapeutics. 2021 Aug 23.