Steroids Cause The Same Tissue Changes As Tendon Injury

Patients who get a steroid injection in their shoulder for rotator cuff pain relief or improved shoulder function should not return to their regular activities or start physical therapy for a few weeks, a Loyola University Health System study shows.

"Steroid injection temporarily produces a molecular response in the tissue that is similar to that of a tendon injury, possibly making it more vulnerable to damage during this time," said senior study investigator Dr. John Callaci, assistant professor, department of orthopedic surgery and rehabilitation, Loyola University Chicago Stritch School of Medicine, Maywood, Ill.

"This is especially important because steroids often give patients rapid pain relief," said Callaci. "If a patient returns to rigorous activities right after a steroid injection, the weakened tissue may not be able to sustain itself."

He cautioned that these findings should not preclude people from having a steroid injection or physicians from administering steroids. "The study gives us a better understanding of what is happening on the molecular level," he said.

Loyola presented the findings here today at the 53rd annual meeting of the Orthopaedic Research Society.

"We found that steroid injections cause a tendon to behave in a way where it thinks it has been acutely injured," noted Callaci. "Steroids rapidly provide anti-inflammatory and pain relief. That is why steroids are so popular, but physical therapy also can produce some of the same effects. It just takes longer."

For the study, Callaci and colleagues examined the global gene expression profiles in rotator cuff tendons following injury or exposure to corticosteroid. The researchers used gene array analysis of the complete rat genome to characterize the molecular response of rat rotator cuff tendon tissue to injury, injection of corticosteroids, and the presence of both injury and corticosteroid.

Results of the study shows that 2,000 genes were changed by injury; 1,000 genes were changed by steroids. A significant number, 750, of the changed genes overlapped between the two groups.

"Not only did gene expression overlap but so did some biological pathways," said Callaci. "Acute injury of the rat rotator cuff tendon significantly modulated the expression of genes in 26 different biological pathways and steroids affected 13 pathways. Twelve of the 13 overlap with the injured pathways.

"The implication of an overlapping pathway is that you have pathways that are modulated after an injury suggesting the tendon is doing things to try to heal itself," said Callaci. "That might suggest there might be a temporary period of vulnerability or weakness in a tendon. It thinks it is being injured and it produces things that normally it produces after injury, which might cause some temporary instability."

Loyola currently is conducting a biomechanical study to determine if the steroids change strength, stress, strain or elasticity of tendons. "We are investigating the biological basis of how tendons heal and how steroids may modulate that healing," said Callaci.

"We want to see if there are actual differences in biomechanical properties right after steroid injection," he said. "If you have a tendon injury already and you're given steroids, how is that modulating the healing response? Do you get more scar formation or do other things change? These are the questions we are researching now."

Co-authors of the study with Callaci are principal investigator Dr. Anthony S. Wei, who did his research at Loyola and now is at Washington University Medical Center in St. Louis; Dr. Benjamin Sears, Loyola resident, Dr. Dainius Juknelis, research associate, Dr. Frederick Wezeman, professor of orthopaedic surgery and rehabilitation, Loyola University Chicago Stritch School of Medicine, director, musculoskeletal biology research laboratory, Loyola University Health System, and associate dean, Loyola University Chicago Graduate School at Loyola University Medical Center, Maywood, Ill.; and Dr. Pietro Tonino, associate professor of orthopaedic surgery, department of orthopaedic surgery and rehabilitation, Loyola University Chicago Stritch School of Medicine and chief of sports medicine.

For more information on Loyola University Health System, log onto http://www.loyolamedicine.org

Funding for the study was provided by a gift from Mr. and Mrs. Charles R Walgreen III and a research grant from the Mid America Orthopaedic Association.

The 53rd Annual Meeting of the Orthopaedic Research Society at the San Diego Convention Center, 111 W. Harbor Drive, San Diego, runs through February 14, 2007.

Loyola University Health System, a wholly owned subsidiary of Loyola University Chicago (LUC), includes the private teaching hospital at Loyola University Medical Center (LUMC), 14 specialty and primary care centers in the western and southwestern suburbs, the Loyola Ambulatory Surgery Center at Oakbrook and the Loyola Oakbrook Terrace Imaging Center; and serves as co-owner-operator of RML Specialty Hospital, a long-term acute hospital specializing in ventilation weaning and other medically complex patients in suburban Hinsdale, Ill. Loyola is nationally recognized for its specialty care and groundbreaking research in cancer, neurological disorders, neonatology and the treatment of heart disease. The 61-acre medical center campus in Maywood, Ill., includes the 523-licensed bed Loyola University Hospital with a Level I trauma center, the region's largest burn unit, one of the Midwest's most comprehensive organ transplant programs, the Russo Surgical Pavilion and the Ronald McDonald® Children's Hospital of LUMC. Also on campus are Loyola's Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, Loyola Outpatient Center and LUC Stritch School of Medicine. The medical school includes the Cardiovascular Institute, Oncology Institute, Burn & Shock Trauma Institute, Neuroscience Institute and the Neiswanger Institute for Bioethics and Health Policy.

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