Steroid injections are a widely used treatment for shoulder pain, especially in conditions like rotator cuff injuries, frozen shoulder, and bursitis. While these injections can provide rapid relief, it’s important to understand their benefits, potential side effects, and alternative treatments. This article, written by leading shoulder pain specialist Mr Oliver Eaton, provides evidence-based insights, real patient experiences, and expert recommendations to help you make informed decisions about your shoulder health.
What Are Steroid Injections for Shoulder Pain?
Steroid injections, also known as corticosteroid injections, are used to reduce inflammation and relieve pain in the shoulder joint and surrounding tissues. Steroid injections can also be administered into soft tissues such as tendons and ligaments to treat inflammation and pain. They are commonly recommended for conditions such as rotator cuff tendinitis, adhesive capsulitis (frozen shoulder), and shoulder bursitis [1]. The procedure involves injecting a synthetic corticosteroid, often combined with a local anaesthetic, directly into the affected area to target inflammation and pain. The local anaesthetic is used to reduce pain during the procedure, its effects typically last for a few hours, and it helps improve patient comfort.
How Do Steroid Injections Work?
Steroid injections work by suppressing the body’s inflammatory response in the shoulder. These steroids are used in medical treatment to reduce swelling, relieve pain, and improve mobility. Relief can be felt within a few days and may last from several weeks to several months, depending on the underlying condition and individual response [2].
While steroid injections can effectively reduce symptoms such as pain and inflammation, they do not address the underlying cause of shoulder pain.
Who Can Benefit from Shoulder Steroid Injections?
Steroid injections are often recommended for patients with:
- Rotator cuff injuries
- Shoulder impingement syndrome
- Frozen shoulder (adhesive capsulitis)
- Shoulder bursitis or tendinitis
- Arthritis of the shoulder joint
- Inflammatory arthritis
Joint injections are also used to manage symptoms in related conditions, such as autoimmune diseases and other inflammatory disorders.
They are typically considered when other treatments, such as physical therapy and oral medications, have not provided sufficient relief.
Benefits of Steroid Injections for Shoulder Pain
Steroid injections offer significant benefits for individuals struggling with shoulder pain due to inflammatory conditions such as rheumatoid arthritis, tendonitis, or bursitis. By targeting inflammation within the affected joint, these injections can quickly reduce swelling and provide pain relief, often easing even intense pain that limits daily activities. Many patients experience improved range of motion and greater comfort, allowing them to participate more fully in physical therapy and other treatments designed to restore shoulder function. For those with arthritis or other inflammatory joint conditions, steroid injections can be an effective way to manage symptoms and improve quality of life. Consulting with a healthcare professional will help determine if this treatment is appropriate for your specific needs and how it can be integrated with other therapies for optimal results.
When to Consider a Cortisone Shot
Cortisone shots are often considered when patients continue to experience shoulder pain, joint pain, painful joints, or swollen and painful joints despite trying other treatments. If you have persistent symptoms in your shoulder, rotator cuff, or other joints that have not improved with physical therapy, anti-inflammatory medications, or rest, your healthcare provider may recommend a cortisone injection. Cortisone is a type of steroid that works by reducing inflammation to ease pain and reduce pain in affected joints, making it a valuable option for patients whose symptoms have not responded to more conservative therapies [3].
Preparation for a Steroid Injection
Proper preparation before a steroid injection can help minimize risks and ensure the best possible outcome. Your healthcare professional will guide you through the process, but there are a few key steps to keep in mind. If you are taking blood-thinning medications, such as aspirin or warfarin, you may be advised to pause them for a short period before your injection to reduce the risk of bleeding at the injection site. It’s important to inform your healthcare professional about any medical conditions you have, especially diabetes, as steroid injections can cause a temporary increase in blood sugar levels. On the day of your appointment, wear loose, comfortable clothing to allow easy access to the affected joint. After the injection, you may be instructed to rest the affected area and use an ice pack to help reduce swelling and discomfort. Following these steps and communicating openly with your healthcare professional will help ensure a smooth and safe experience.
What to Expect During the Procedure
Before the procedure, a health professional will check your blood pressure, as steroid injections can sometimes cause blood pressure to rise.
The procedure is usually performed in a clinic setting. The skin over the shoulder is cleaned, and a local anaesthetic may be used to numb the area. Using ultrasound guidance, the health professional injects the medication directly into the affected joint or soft tissue. The medication is injected directly to deliver targeted relief where it is needed most. The process takes about 10-15 minutes, and most patients can return home shortly after. Some mild discomfort or soreness at the injection site is normal and typically resolves within 48 hours.
Recovery and Aftercare
After the injection, mild soreness or swelling at the injection site is common and usually resolves within 48 hours. Mild bruising at the injection site can also occur and usually resolves quickly. Applying an ice pack and resting the shoulder for a day or two can help. Most patients notice pain relief within a few days. It’s important to follow your clinician’s advice regarding activity and rehabilitation exercises to maximize the benefits of the injection.
Potential Side Effects and Risks
While steroid injections are generally safe, some side effects and risks include:
- Pain or swelling: Temporary discomfort at the injection site.
- Skin changes: Thinning or lightening of the skin around the injection area.
- Facial flushing: Redness and warmth in the face for a few hours.
- Elevated blood sugar: Especially in people with diabetes.
- Infection: Rare but possible at the injection site. Because steroid injections can suppress the immune system, there is an increased risk of infections, so it is important to monitor for signs of infection.
- Tendon weakening or rupture: With repeated injections, there is a small risk of soft tissue damage, including tendon or ligament injury.
- Allergic reaction: Extremely rare.
- Other side effects: Rare effects such as weight gain, hormonal changes, and mood swings may occur, especially with frequent or high-dose injections.
Hydrocortisone injections are a common type of steroid injection used for joint pain and inflammation. Steroid injections are different from anabolic steroids, which are used by bodybuilders to increase muscle size and strength. The corticosteroids used in medical treatments are medicines designed to reduce inflammation and pain.
Doctors and orthopaedic surgeons are among the healthcare professionals qualified to perform these injections. Always inform your doctor about any other medicines you are taking, as some medicines may interact with steroid injections and affect their safety or effectiveness.
Repeated injections should be limited to reduce the risk of joint or tendon damage [4].
Case Study: Steroid Injection for Frozen Shoulder
Patient: Male, 48, with severe frozen shoulder (adhesive capsulitis).
Treatment: Received a single ultrasound-guided steroid injection after months of limited improvement with physiotherapy.
Outcome: Within one week, the patient reported significant reduction in pain and improved range of motion. He was able to resume physiotherapy and returned to normal activities within six weeks. No adverse effects were reported.
Treatments: Alternatives to Steroid Injections for Shoulder Pain
If you are concerned about the risks of steroid injections or have not achieved lasting relief, several evidence-based alternatives are available:
- Physical Therapy: Targeted exercises to restore strength and mobility.
- Platelet-Rich Plasma (PRP): Uses your own blood components to promote healing.
- Prolotherapy: See below for more details.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) and pain relievers. Other medicines, such as disease-modifying drugs, may be considered depending on the underlying condition. It is important to inform your healthcare provider about all other medicines you are taking to ensure safety and effectiveness.
- Lifestyle Modifications: Activity modification, ergonomic adjustments, and weight management.
Different treatments and medicines may affect the body in various ways, so a healthcare professional can help determine the best option for your specific needs.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat shoulder pain.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with shoulder pain.
As prolotherapy is helping to treat the root cause of shoulder pain, it is deemed to be a permanent fix, preventing the symptoms from returning.
Expert Recommendations
Before considering steroid injections, consult with a qualified healthcare professional, such as a doctor, to discuss your symptoms, medical history, and all available treatment options. It is especially important to seek professional advice before your first injection to ensure proper diagnosis, preparation, and safety. At ProHealth Clinic, we prioritize patient education and long-term outcomes, offering a range of regenerative therapies tailored to your needs.
Frequently Asked Questions
Are steroid injections safe for shoulder pain?
When performed by an experienced clinician, steroid injections are generally safe for short-term relief of shoulder pain. However, repeated use increases the risk of side effects and long-term complications.
How long does pain relief from a shoulder steroid injection last?
Pain relief can last from several weeks to a few months, depending on the underlying condition and individual response.
How many steroid injections can I have in my shoulder?
Most guidelines recommend limiting steroid injections to three or four per year in the same area to reduce the risk of joint or tendon damage. Your clinician will advise on the safest frequency based on your specific case.
What are the alternatives to steroid injections for shoulder pain?
Alternatives include physical therapy, prolotherapy, PRP, medications, and lifestyle changes. A specialist can help determine the best option for your condition.
Is prolotherapy effective for shoulder pain?
Research and clinical experience suggest that prolotherapy can be effective for many types of shoulder pain, especially when other treatments have failed. It works by stimulating the body’s natural healing processes.
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating shoulder pain, with patients travelling to see him from across the UK, Europe, and the Middle East. With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with shoulder pain and providing effective treatment options to alleviate them. He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany. Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
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References
- National Institute for Health and Care Excellence (NICE). “Corticosteroid injections for shoulder pain.” NICE.
- Crawshaw DP, Helliwell PS, Hensor EM, et al. “Change in pain and function after steroid injection for shoulder pain: a prospective cohort study.” Ann Rheum Dis. 2012;71(5):705-710. Ann Rheum Dis.
- American Academy of Orthopaedic Surgeons. “Shoulder Injection.” AAOS.
- Carette S, Moffet H, Tardif J, et al. “Intraarticular corticosteroids, supervised physiotherapy, or a combination in the treatment of adhesive capsulitis of the shoulder.” Arthritis Rheum. 2003;48(3):829-838. Arthritis Rheum.