Steroid injections are a widely used treatment for shoulder pain, especially in conditions like rotator cuff injuries, frozen shoulder, and bursitis. Steroid injections are also used to treat inflammation in various parts of the body, including joints, muscles, and the spine, but this article focuses on their use in the shoulder. 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. They are commonly recommended for conditions such as rotator cuff tendinitis, adhesive capsulitis (frozen shoulder), and shoulder bursitis, where the bursae—fluid-filled sacs that cushion joint movements—can become inflamed [1]. The procedure involves injecting a synthetic corticosteroid, often combined with a local anesthetic, directly into the affected area to target inflammation and pain.
How Do Steroid Injections Work?
Steroid injections work by suppressing the body’s inflammatory response in the shoulder. This reduces swelling, relieves pain, and improves mobility. Relief can be felt within a few days and may last from several weeks to a few months, depending on the underlying condition and individual response [2]. The dose of corticosteroid used in the injection can influence both the effectiveness of pain relief and the risk of side effects.
Who Can Benefit from Shoulder Steroid Injections?
Steroid injections are often recommended for patients with:
- Rotator cuff disease or injuries
- Shoulder impingement syndrome
- Frozen shoulder (adhesive capsulitis as a disease)
- Shoulder bursitis or tendinitis
- Arthritis of the shoulder joint
They are typically considered when other treatments, such as physical therapy and oral medications, have not provided sufficient relief.
When to Get a Cortisone Shot
Cortisone shots are often considered when patients continue to experience shoulder pain or inflammation 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. This type of steroid injection is used to treat a range of conditions, including frozen shoulder, arthritis, and tendonitis, especially when inflammation is a key factor in your discomfort.
Cortisone is a type of steroid that works by reducing inflammation and providing pain relief, making it a valuable option for patients whose symptoms have not responded to more conservative therapies. Your healthcare professional will carefully assess your symptoms, medical history, and overall health to determine if a cortisone shot is appropriate for your condition. In many cases, cortisone injections are used to treat inflammatory conditions of the shoulder and joints when other treatments have not provided the needed relief. If you are struggling with ongoing pain or limited mobility, discussing the possibility of a cortisone shot with your provider may help you get back to your normal activities.
What to Expect During the Procedure
The procedure is usually performed in a clinic setting. The skin over the shoulder is cleaned, and a local anesthetic may be used to numb the area. Using ultrasound guidance, the clinician injects the steroid medication into the targeted site. Some patients may find the injection mildly painful, but any discomfort is typically brief. The process takes about 10-15 minutes, and most patients can return home shortly after.
Injection Site and Technique
The location and technique for administering a cortisone shot depend on the specific condition being treated and the healthcare provider’s approach. Common injection sites include the shoulder joint, rotator cuff, and surrounding tendons or bursae. To ensure the medication reaches the precise area of inflammation, your provider may use ultrasound or X-ray guidance during the procedure. This helps improve accuracy and effectiveness, especially in complex joints like the shoulder.
During the injection, a sterile needle is used to deliver the corticosteroid directly into the affected joint or tissue. The process is usually quick and most patients experience only mild discomfort or a brief pinch at the injection site. Some swelling or soreness may occur in the days following the injection, but these effects are generally short-lived. After receiving a cortisone shot, patients are often advised to rest the shoulder and avoid heavy lifting or strenuous activity for a few days to allow the medication to take full effect. This careful approach helps maximize the benefits of the injection and supports the healing process.
Recovery and Aftercare
After the injection, mild soreness or swelling at the injection site is common and usually resolves within 48 hours. 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. As your pain decreases and function improves, you can start getting back to normal activities.
Potential Side Effects and Risks
While steroid injections are generally safe, some side effects and risks are associated with the use of steroids, especially when a higher number of injections are given over time. These 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, and more likely with an increased number of steroid injections.
- Infection: Rare but possible at the injection site.
- Tendon weakening or rupture: With repeated injections, particularly when the number of steroid injections is high.
- Allergic reaction: Extremely rare.
Repeated injections should be limited to reduce the risk of joint or tendon damage [3].
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: The patient noticed significant reduction in pain and improved range of motion within a short time—specifically, one week after the injection. Over the following month and a half, 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.
- Lifestyle Modifications: Activity modification, ergonomic adjustments, and weight management.
In some cases, surgery may be considered if other treatments do not provide relief. Steroid injections can be used for general shoulder pain as well as specific conditions.
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 shoulder pain specialist to discuss your symptoms, medical history, and all available treatment options. If your symptoms persist despite conservative treatments, you may need a steroid injection. However, injections may provide short-term relief but are not always a long-term solution. 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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Conclusion
In summary, cortisone shots are a common and effective treatment for a variety of inflammatory conditions, including shoulder pain, rotator cuff injuries, and arthritis. By delivering cortisone—a type of steroid—directly into the affected area, these injections can help reduce inflammation, relieve pain, and restore range of motion. While cortisone shots offer significant benefits, it’s important to be aware of potential side effects, such as short-term increases in blood sugar levels and, with repeated use, long-term risks like tendon weakness.
Patients should work closely with their healthcare provider to determine if a cortisone shot is the right treatment for their specific condition. Open communication about the risks, benefits, and expected results will help ensure the best possible outcome. With proper use and careful monitoring, cortisone shots can provide valuable pain relief and help patients regain function, making them an important option in the management of shoulder and joint conditions. By understanding how cortisone shots work and what to expect, patients can make informed decisions and take an active role in their treatment plan.
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.