In this article, you will find out everything you need to know about steroid injections in the shoulder and the most effective alternatives, including an advanced treatment called Prolotherapy.
Steroid injections are in common use during the treatment of any acute inflammatory condition of the shoulder. They are also called anti-inflammatory drugs. Your clinician uses steroidal injections as the last line of medical treatment when other interventions, such as physical therapy and NSAIDs have failed to improve the condition.
Inflammatory conditions of the shoulder joint include;
- Rotator cuff tear
- Adhesive capsulitis
- Inflammation of the bursa (bursitis)
- Osteoarthritis of the shoulder joint
- ‘Rheumatoid arthritis or osteoporosis of glenohumeral joint
You should take cortisol injections after determining the severity of the inflammatory condition using an x-ray or MRI. Sterile conditions are mandatory for the administration of injections. However, a local anaesthetic is usually not required as it is a painless procedure.
Cortisol injections are very effective for the treatment of inflammation. Triamcinolone and methylprednisolone are in common use for articular injection. They are not essentially painkillers but they significantly reduce the inflammation. Steroids effectively reduce acute inflammation but not chronic one.
In this article, you will get accurate information about every aspect of steroid injection into the shoulder which everyone should know before getting the procedure done.
How do steroid injections work?
When your doctor injects steroids at the site of inflammation, they reduce swelling and redness and therefore decrease the severity of your inflammation. They do so by decreasing the activity of the body’s natural defense system, the immune system, against any infection or illness.
When infectious agents enter the body, your immune system recognizes them. Your immune cells migrate to that site and try to eliminate the infectious agent. In doing so, they produce the chemicals that cause the blood to move out of vessels into the site of infection, and that ultimately results in swelling. So, the inflammation you see at the site is due to the activity of the immune system against the pathogen.
The administration of steroids decreases the activity of the immune system(1). As a result, the immune cells do not migrate in significant numbers to the site of infection. It also prevents the blood from moving out of the vasculature. As the immune response is decreased, the inflammatory reaction is also reduced.
Benefits of steroid injections
Local steroid injections have plenty of benefits and they are less likely to cause significant side effects. The main benefit of steroid injections is a reduction in the inflammatory response in joints so that your shoulder joint can work efficiently.
The administration of cortisol injections has some important advantages in the treatment of inflammatory conditions, these include;
- Instant pain reduction
- Reduction in swelling and redness
- High success rate
NSAIDs and physical therapy are usually short-term treatments against inflammatory conditions. However, if you are suffering from acute inflammatory conditions and are unresponsive to this treatment, you should go for steroid injections(2). The severe symptoms such as intense pain due to impingement syndrome limit joint movement and are very distressing. So you need steroid therapy for the treatment of this condition.
If you have tendinitis or tendinopathy of your long head of the biceps tendon, then subacromial injection (into subacromial space) will prevent degeneration of the tendon. For this purpose, you need to consult a physiotherapist (physio) or an orthopedic doctor.
Side effects of shoulder injections
Steroid injections are useful in treating inflammatory conditions but there are side effects as well. Some of the significant side effects are:
Steroid injections inhibit the functions of the immune system. The immune system normally protects the body against harmful agents. When the immune system does not remain efficient as it should be, your body becomes prone to developing various infectious diseases because the immune system is not there to fight against the infectious agent.
At the site of administration of the injection, you will see flare-ups within 24 hours(3). You can use painkillers such as paracetamol to get rid of it. You may see discoloration of skin at the site of administration, and rarely there are chances of development of infection.
Repeated use of cortisol injections can cause prolonged pain known as a cortisone flare. This is due to the crystal formation of steroids leading to swelling and infection, which is more worse and painful than the infection that is being treated.
Corticosteroids can elevate your blood sugar levels(4) in addition to reducing inflammation. If you have diabetes, you should contact your doctor before obtaining a cortisone injection, and monitor your blood sugar properly for a day or two afterward. Although the injection does not directly transport cortisone into the bloodstream, it can nevertheless have an effect on blood sugar levels in some patients.
Failure of steroid injections
Cortisone injections are a common treatment for a variety of shoulder problems. However, they are not the only therapy option, but rather a component of a larger management strategy. Cortisone injections do not treat the illness, but they do provide symptom relief by reducing inflammation. This allows you to carry out pain-free rehabilitation exercises, which improve joint motion, muscle strength and function, preventing joint pain from happening again in the future. You should follow a physiotherapy regimen after cortisone injections that includes manual treatment and an exercise prescription.
Cortisone injections might fail for a variety of causes:
Appropriate diagnosis is the most crucial element to consider. You cannot treat an acromioclavicular joint (ac joint) condition or subacromial bursitis by a rotator cuff injection which is given in rotator cuff tendonitis. You need to undergo thorough history and examination, as well as ultrasound guidance to back up the diagnosis.
It’s also crucial to get the needle in the right spot. To validate the needle position, imaging support (such as an x-ray) may be employed in some circumstances.
Another typical reason for cortisone injection failure or limited success is insufficient follow-up therapy and activity adjustment. Athletes can be sluggish in their recuperation or simply refuse to rest.
Preventive measures after the steroid shots
For a day or two, cover your injection site. If you have a cortisone shot in your shoulder, avoid hard lifting and exercise(5). But after about 10 days to 2 weeks, you should start a gentle range of motion exercises.
If you feel pain or soreness at the site of injection, you can use ice packs to reduce the pain. Avoid using heating pads for at least 24 to 48 hours after injection, and also do not use a bathtub, hot tub, or whirlpool. However, It’s fine to take a shower.
Keep an eye out for signs of infection, such as persistent discomfort, redness, and swelling that lasts longer than 48 hours. If you notice any of these symptoms then report them to your doctor.
Other treatment options
Prolotherapy
Prolotherapy
In recent years, prolotherapy has built its reputation within the medical community due to 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 small needles. This has been shown to reduce swelling, which helps with shoulder pain.
As prolotherapy is helping to treat the root cause of shoulder pain, it is deemed a permanent fix, preventing the symptoms from returning.
Conclusion
Steroid injection into the shoulder is the last line of medical treatment for your shoulder pain, frozen shoulder, or any other shoulder conditions. However, you should be very careful about the medical treatment you are taking for your illness. You need to consult your orthopaedic doctor about whether you need a steroid injection or not. In addition, you should also keep in mind the possible benefits as well as adverse effects of the injection into the shoulder. Take care of yourself and take preventive measures after a steroid shot. This would be a step ahead in managing your healthy lifestyle and avoiding diseases.
Frequently Asked Questions
Is steroid injection in the shoulder painful?
At the time of joint injection, you may feel a little pain(6) but it is not from steroids but from the local anesthetic that causes shoulder impingement. Occasionally, there is flare formation for about 24 to 48 hours after administration. But after that, pain and inflammation of the affected area decreases.
How long does it take for a steroid injection to work in your shoulder?
It typically takes 3 to 7 days for a corticosteroid injection to start working. The drug may take up to two weeks to reduce inflammation to the point where your discomfort is reduced. It may take up to 6 weeks following injection to feel the full benefit of the corticosteroid. The effects normally last up to two months, but they can sometimes persist longer.
What should I expect after a cortisone shot in the shoulder?
There are many benefits that you will experience after your cortisone shot, but you may see adverse effects as well. Following a cortisone shot, some patients experience redness and warmth in their chest and face. A cortisone shot may temporarily raise your blood sugar levels if you have diabetes. Consult your doctor to get rid of the side effects.
Where is the most painful place to get a cortisone shot?
Depending on where the cortisone injection is given, some will pain more than others. Injections into the palm of the hand and the sole of the foot can be particularly unpleasant. When cortisone is supplied to a small location, injections hurt the most.
Do I need time off work after cortisone injection?
A cortisone shot usually takes 4-5 days to start functioning. However, we recommend leaving about a week before an event to allow the cortisone shot to take effect. You should know clearly that cortisone can trigger a pain flare-up in the first few days. To prevent the flare from worsening, you must relax for a few days following the cortisone shot.
What happens if cortisone shot in the shoulder doesn’t work?
Cortisone therapies do not always provide pain relief for some patients. If the first injection doesn’t relieve your pain, your doctor may try again four to six weeks later. A third injection is not indicated and if there is no improvement after the second injection, then you may need to undergo surgery.
References
- Miller, A. H., Spencer, R. L., McEwen, B. S., & Stein, M. (1993b). Depression, Adrenal Steroids, and the Immune System. Annals of Medicine, 25(5), 481–487. https://doi.org/10.3109/07853899309147316
- Arroll, B., & Goodyear-Smith, F. (2005). Corticosteroid injections for painful shoulder: a meta-analysis. British Journal of General Practice, 55(512), 224–228. https://bjgp.org/content/55/512/224.short
- Goldfarb, C. A., Gelberman, R. H., McKeon, K., Chia, B., & Boyer, M. I. (2007). Extra-Articular Steroid Injection: Early Patient Response and the Incidence of Flare Reaction. The Journal of Hand Surgery, 32(10), 1513–1520. https://doi.org/10.1016/j.jhsa.2007.08.002
- Miller, S. E. P., & Neilson, J. McE. (1964). Clinical Features of the Diabetic Syndrome Appearing after Steroid Therapy. Postgraduate Medical Journal, 40(469), 660–669. https://doi.org/10.1136/pgmj.40.469.660
- Mease, P. J., Wei, N., Fudman, E. J., Kivitz, A. J., Schechtman, J., Trapp, R. G., Hobbs, K. F., Greenwald, M., Hou, A., Bookbinder, S. A., Graham, G. E., Wiesenhutter, C. W., Willis, L., Ruderman, E. M., Forstot, J. Z., Maricic, M. J., Dao, K. H., Pritchard, C. H., Fiske, D. N., & Burch, F. X. (2010). Safety, Tolerability, and Clinical Outcomes after Intraarticular Injection of a Recombinant Adeno-associated Vector Containing a Tumor Necrosis Factor Antagonist Gene: Results of a Phase 1/2 Study. The Journal of Rheumatology, 37(4), 692–703. https://doi.org/10.3899/jrheum.090817
- Gottlieb, N. L. (1980). Complications of Local Corticosteroid Injections. JAMA: The Journal of the American Medical Association, 243(15), 1547. https://doi.org/10.1001/jama.1980.03300410035021