Overall, exercise is the most effective treatment for shoulder pain. However, severe shoulder pain sometimes limits the amount of exercise that can be done. In these cases, steroid injections in the shoulder can reduce pain and allow more exercise. We discuss the pros and cons of a cortisone shot in the shoulder and the alternative to a steroid injection in the shoulder.
How do steroid injections in the shoulder work?
Tendonitis or arthritic joints release inflammation that causes pain. Cortisone is a powerful drug that reduces inflammation and, therefore, pain. So, a cortisone shot in the shoulder reduces shoulder pain and inflammation.
Steroid injections in the shoulder: What are available?
Shoulder steroid injections treat shoulder pain.
- Bursal injections aim for the bursa above the shoulder tendons.
- Shoulder joint injections target the shoulder ball and socket joint. These injections treat frozen shoulder or shoulder joint arthritis.
- Acromioclavicular joint (AC joint) injections are used for acromioclavicular degeneration. This condition causes pain at the top of the shoulder.
- The long head of biceps tendon injection is used to treat biceps tendonitis, which can cause pain in the front of the shoulder.
- A suprascapular nerve block targets the suprascapular nerve at the back of the shoulder. This injection treats shoulder arthritis and rotator cuff tears.
Also, a cortisone shot in the shoulder can treat calcium build-up in the shoulder tendons. Calcific tendonitis in the shoulder causes sudden severe pain and stiffness. Barbotage or lavage procedure involves breaking up or sucking out calcium to reduce pressure in the tendon.
Are steroid injections in the shoulder painful?
People generally say shoulder injections are not particularly painful. However, using ultrasound to perform the injection decreases pain.
How long does a cortisone shot in the shoulder last?
Generally, cortisone shots in the shoulder reduce pain and improve movement. However, these effects only last a few months. Nevertheless, a careful injection helps to reduce pain and improve the response to exercise.
Dr Masci has written a paper on cortisone injections in tendonitis, including shoulder or rotator cuff tendonitis.
Should you use ultrasound for a cortisone shot in the shoulder?
should we use ultrasound for injections?
Firstly, using ultrasound increases the accuracy of a steroid injection. Greater accuracy can reduce side effects such as skin thinning and tendon weakening. Secondly, we know that ultrasound improves the impact of an injection. Finally, ultrasound injections are generally cheaper than X-ray-guided injections.
Cost of a Cortisone shot in the shoulder
Dr Masci offers a competitive self-pay rate starting from £380. However, not all practitioners who provide cortisone injections are doctors or have experience using ultrasound. So, do your homework and ensure your practitioner has a medical degree and ultrasound expertise.
Frequently asked questions about steroid injections in the shoulder
Is an injection for shoulder pain just a painkiller?
Cortisone is a potent anti-inflammatory, so it has two actions: It reduces inflammation and pain. The key to a successful result is to follow the injection with rehab to strengthen the shoulder.
Is there a limit to the number of steroid injections in the shoulder?
Generally, we suggest 1-2 cortisone shots for shoulder pain. If two injections don’t work, it is unlikely that more will be effective.
My cortisone shot in the shoulder did not work. What does this mean?
Sometimes, a cortisone shot does not work. The reasons for an ineffective injection can be many, including the wrong diagnosis or inaccurate placement of the cortisone.
Cortisone shot in shoulder side effects: Are they common?
Generally, a cortisone shot is safe. However, you need to be aware of side effects.
The most common side effect is a cortisone flare, which usually starts within 24 hours of the injection and lasts up to a week. Other side effects include infection (1 in 100,000 cases), an allergy to cortisone, bleeding into joints, and high sugar levels in people with diabetes.
Also, we should avoid repeated cortisone injections into one area, as cortisone can weaken the tendon structure.
Should you rest after a cortisone shot in the shoulder?
Generally, we suggest you rest for at least a week after a cortisone shot in the shoulder.
Rest varies depending on your sport:
Spinning, lower body weights, running: You should rest until the cortisone flare settles (1-4 days)
Upper body weights, Pilates, Yoga: You should rest your shoulder for at least a week and resume at a reduced or lower intensity. Ideally, you should see a physiotherapist who can guide your exercise therapy.
These guidelines might be affected by the severity of your shoulder problem, so you should ask your doctor about post-injection activity.
Will a cortisone shot help a torn shoulder labrum?
A torn labrum, such as a SLAP tear, can cause shoulder pain. Usually, we perform a cortisone shot into the shoulder joint to reduce inflammation from a torn labrum. However, this injection must be followed by an exercise program to strengthen the shoulder.
Hydrodistension for frozen shoulder: Is it better than a cortisone shot?
Yes, we think so.
Studies suggest that hydrodilatation is better than a simple cortisone shot. Generally, hydrodistension means injecting a higher volume of cortisone, local anaesthetic, and sterile water.
We can inject either a moderate volume (20-40mls) or a high volume (over 40mls). We think that shoulder hydrodistension with moderate volume is better than high volumes. One study found that stretching the capsule is much better for pain and function than rupturing the capsule.
So, aim for a moderate volume that stretches but doesn’t rupture the capsule.
Is hydrodistension the same as a cortisone injection?
Yes. Both injections have cortisone, but a hydrodistension uses more volume to stretch the capsule while reducing inflammation.
What is the evidence for a steroid shot for shoulder joint arthritis?
Shoulder joint arthritis leads to pain and restriction of movement in the shoulder.
Is there an alternative to a cortisone injection in the shoulder?
Yes, there are alternatives to a cortisone injection in the shoulder. Options include gel treatment with hyaluronic acid and platelet-rich plasma (PRP).
For example, people with shoulder arthritis injected with hyaluronic acid performed better than those who exercised. Another study found that hyaluronic acid injections for shoulder arthritis were better than cortisone.
For rotator cuff tendonitis, a recent study found that a PRP injection was better than cortisone at three months. Moreover, a recent review study on shoulder tendonitis suggests that PRP injections are better than other injections at twelve months. So, PRP might be an alternative to a cortisone injection in shoulder tendonitis. We outline PRP options for shoulder pathology in this recent blog.
Final word from Sportdoctorlondon About a Cortisone Shot in the Shoulder
Overall, cortisone injections for the shoulder reduce inflammation and pain. Depending on where the pain is coming from, different structures are targeted. Moreover, using ultrasound increases injection accuracy and effect.
Other Common Shoulder Conditions:
- Shoulder tendon calcification
- Barbotage for shoulder calcification
- Hydrodilatation for frozen shoulder
- Frozen shoulder injection
- AC joint degeneration of the shoulder
- Shoulder arthritis
- Rotator cuff injury/ bursitis
- Long head of biceps tendonitis
- Suprascapular nerve block
- PRP injections for shoulder
Have often I should take a cortisone injection
Hi thanks for your comment. So a cortisone shot should only be done as needed. I try not to repeat an injection unless absolutely necessary. Nevertheless, if I perform a repeat injection, the time between injections should not be less than 6 weeks. Also, i try not to inject one area more than 3 times over a few years.
I have bursitis in my shoulder and was to have a shot but I am wondering about getting the Pzifer Covid Vaccine and wondering if I should do this before of after the vaccine shot??
As a general rule, I suggest you avoid cortisone injections up to 2 weeks before and 2 weeks after a COVID vaccine. We know that cortisone reduces the immune response to the influenza vaccine. Even though we don’t have data on COVID vaccine, I think you should be cautious.
I got a shot in the back of my shoulder, now I have a small bruise and redness at the front of my shoulder, as if it was done there. Is this normal?
Hi Talia, yes you can get some bruising after a cortisone injection although this should settle in a few days.
Morning I was done the injection but the pain is still there what could be the problem
I have had a cortisone injection to my shoulder, done at the hospital, and I am in a lot of pain and can’t lift my arm. It has been 30hrs since I had the injection. Is this normal as I am a little worried
yes steroid flares can last for up to a week. Average is 3-4 days. if your pain doesn’t start to. get better in another 48 hours, then I’d contact the hospital. Lorenzo
I got qa steroid shot today now I cant lift my arm or pick up anything
Hi Margaret,
If the cortisone shot had no effect on your pain, I’d see your doctor again. You may have another cause for your pain eg some people who have a steroid shot for tendon pain may have another cause, such as a frozen shoulder or referred pain from the neck.
LM
Do you do amnion based injections in the shoulder? I have a couple of partial torn muscles. I got an amnion shot about five months ago and it has helped. I want a second shot. The first one was done at a clinic in Indianapolis and now I’m living in southwest Fl. Any suggestions?
sorry I don’t do amnion injections.
I got a steroid shot in the shoulder that felt like my arm was being broken in slow motion. So, so painful. Now it’s been since April 2021 since I got it and the pain is starting up again. Should I get another shot?
In general, shoulder injections should not be particularly painful. Having the injection done under ultrasound is much better and should be less painful.
Another injection would be reasonable if the first one was over 6 months ago.
Lorenzo
Hi
I had these injections in my shoulders about 10 days ago in the last few days I have noticed black and blue bruses on the front of my arm from my shoulder to my elbow .
Not on top of my shoulders where I got the needles.
Should I be worried it is very sore.
Thank you
Hi Alo, I’d speak to your doctor about your shoulder. Bruising in the arm is not common after a cortisone injection.
LM
Mine was excruciating, and I have a pretty high pain tolerance.
I have a tear in and scar tissue I had a cortisone injection 5 days ago it still hurts to lift my arm at night still unable to get a good night sleep should I consider Arthur cutscopical surgery
hi, you need to give the cortisone injection a bit more time to work. Generally, the maximal effect of cortisone is between 2 and 4 weeks. Lorenzo
I have a stiff shoulder after 3 months recovering from a clavicle injury. I can almost reach straight up , Ive also been doing extensive stretching exercises as well. Would you recommend a cortisone shot
Generally, I’d only recommend an injection for significant pain. if you have stiffness but no pain, I think rehab should get it right in the end. LM
After a cortisone injection in my left shoulder is it normal to have headaches ? It was for my bursitis !
Hi Nini, Headache is a common side effect after a cortisone shot. See this blog for a detailed list of side effects:
https://sportdoctorlondon.com/how-long-does-it-take-for-a-cortisone-shot-to-work/
Lorenzo
I had for a rotator cup surgery five weeks ago today I got a Cortizone injection shot feels better how long will it last though and going to therapy at the same time see the pain clinic in about a month
Hi Ernest, Generally, a cortisone shot in the shoulder lasts anyway between 6 weeks and 6 months. You need to use this time to get stronger with physical therapy. see this blog for further details onna cortisone shot:
https://sportdoctorlondon.com/how-long-does-it-take-for-a-cortisone-shot-to-work/
Lorenzo
I have had a limited period of discomfort (2yrs), initially brought on following a traumatic event, increased pull force awkward position, with an initial dx of Bursitis of the shoulder. my last US indicated no degenerative changes or traumatic injury at the time, and I had a 2nd steroid injection. between this treatment and an eventual MRI (4 months between events) i have been dx significant trauma to several tendons but cannot determine an event which has/could have resulted in this injury. is such an injury, with no degenerative findings on US consistent with an acute injury event, and or could this also be related/associated or a result of US guided steroid injection? I am confident with the process and placement of the injection. Many Thanks Andrew
Hi Andrew, I suggest it’s unlikely that a cortisone shot has caused significant damage to your tendons. i suspect ‘trauma’ is just wear and tear changes in the tendon. Lorenzo
I have a shoulder issue for over two years which the most recent MRI stated that there were three partial rotator cuff tears. In addition I have recently been diagnosis with a “frozen” shoulder as I can not move my right arm behind my back. Any suggestions??
Hi David, I’d treat the frozen shoulder first with an injection. See my blog on hydrodistension.
https://sportdoctorlondon.com/shoulder-hydrodilatation-injection/
and treatments for frozen shoulder
https://sportdoctorlondon.com/frozen-shoulder-treatments/
Physio and Pilates has helped loads with the range of movement and strengthening. But I had an ultrasound guided steroid injection today in my shoulder (impingement of the bursa, no tears or damage, last spring). Even though I wasn’t having any significant pain, not even twinges in the joint really unless I caught it at an angle or something jolted it, but the scan showed fluid still in the joint. The needle didn’t hurt but it did hurt when the steroid was pushed in.
I’ve been told to rest the shoulder for 48hrs so cancelling a personal trainer session which was booked for Friday. However I am meant to be training for a kayaking event where every week counts. As I wasn’t having pain before it is confusing to know when I can consider get back to doing some training.
I’d recommend about a week off heavy loading/exercise after a cortisone shot. See this blog for more info:
https://sportdoctorlondon.com/how-long-does-it-take-for-a-cortisone-shot-to-work/
Top muscle in the front of my left arm caused plenty of pain. I went to an orthopedic doctor who handles hand to shoulder problems and a shot Cortizone in my shoulder muscle pointing it towards the top muscle in my left arm. I thought he was going to use the injection in the top of the muscle in the left arm, which a doctor Did 5 years ago and that injection help me with no pain for 5 years. I don’t know why he did it in the shoulder pointing it to the top left muscle. Is this normal? If I need another shot should I asked him to go through the top muscle in front of my left arm.
In my opinion, it’s better to do injections with an ultrasound.
Hi, I have shoulder pain when I lift the arm up to a certain height (horizontal angle). It all started after I received one of the vaccines injection for Covid, around 9 months ago. If I don’t move my arm up to such height, I don’t have pain. If I carry a weight, the pain appears sooner.
Would you recommend I take steroids or physiotherapy exercising to fully recover my moves range? Thanks.
Hi, I’ve many cases of COVID-induced shoulder pain – either rotator cuff pain or frozen shoulder. I would treat similarly to non-covid-induced shoulder pain ie physio +/- injeciton
what are the common symptoms of the the shoulder injection after taking please!
Hi, Please read my blog – it outlines the side effects and what to expect. Alos read this blog on FAQ about cortisone injections
https://sportdoctorlondon.com/how-long-does-it-take-for-a-cortisone-shot-to-work/
Hi
I have a cortisone shot scheduled the same day as my MRI – should I cancel the cortisone shot? Will it affect the reading of the MRI if I have it the same day.
Cannot life my arm past my chest.. thank
It shouldn’t although you should speak to your doctor to check
Hi I considering having a cortisone injection in my shoulder with yourself but, it is still not clear what I can do in terms of exercise after. Can I do spinning ( without arms involvement of course) and when? after 24 hours? 48 hours? Lower weight training when you just pick the weigh without overhead movement or any specific arm movement, when can you do it after a week? 2 weeks? Pilates with light bands resistance after a week? 10 days? Thanks and I ll be in touch soon
Hi Tiziana,
Many thanks for your comments – all excellent questions. I’ll add these questions to my blog
Spinning – absolutely, but I’d suggest waiting until the flare settles (2-3 days). Same for lower leg weights.
Upper body weights: Avoid loading the shoulder for about a week. After a week, you can go slowly. Ideally, you should see a physiotherapist who can guide your treatment and exercise therapy.
Pilates: I’d suggest restarting at ten days but be cautious of overloading your shoulder.
I would be delighted to see you.
LM
I have been given multiple diagnoses from several doctors. First, I went to the spine surgeon who had done successful back surgery on my lower back seven years ago. He sent me for an MRI, which showed stenosis was in my upper back near the neck and that I needed another surgery. I wanted another opinion hoping I wouldn’t have to have surgery. My primary care doctor referred me to a neurologist, who referred me to a pain management physician. He then sent me for physical therapy, saying it was nerve damage. The physical therapist said it was not nerve damage – that it was muscle. I went for 6 weeks, getting temporary relief by manual manipulation. It then started waking me up at night and she stopped the therapy and sent me back to the pain management doctor. I actually saw a physician assistant who took an x-ray. She said it showed arthritis, so she sent me to an orthopedic doctor. The orthopedic doctor did a kenolog injection in the shoulder which lasted three months. Because the pain started again, I went back for a second injection. He said he would do the injection although he thought I might have a rotator cuff tear and would need to do a test to see if I would have to have surgery. This injection lasted about three months, and since the pain has started to get bad again, I have another appt to see him. I’ve read a lot about the rotator cuff tear, but pain is not just in my shoulder. It now radiates down my arm all the way in to my fingers. I wanted to let you know I have had surgery for carpal tunnel syndrome on this hand but that was 20 + years ago. I am 74 years old and really would like to know which diagnosis is accurate, I sure would appreciate any help you can offer.
Hi Miriam, Cases like yours can be challenging. Given the steroid injeciton into the shoulder gave you 3 months of pain relief, a significant component of your pain is almost certainly shoulder-related. However, you should also tell your doctor about your carpal tunnel surgery as capral tunnel pain can also cause pain in the arm and hand. LM