Overall, exercise is the most effective shoulder pain treatment. However, severe shoulder pain sometimes limits the amount of exercise that can be done. In these cases, steroid injections in the shoulder directed to a painful structure can reduce pain and allow for more exercise.

How do steroid injections in the shoulder work?

Diseased tendons or arthritic joints release inflammation that causes pain. Cortisone is a powerful drug that reduces inflammation and therefore pain. So, reducing pain can help with exercise therapy.

Steroid injections in shoulder: what are available?

Shoulder steroid injections target areas that cause pain.

  • Bursal injections aim for the bursa above the shoulder tendons. This injection treats pain from shoulder or rotator cuff tendonitis.

Also, shoulder injections can treat calcium build-up in the shoulder tendons. Calcium build-up can lead to sudden severe shoulder pain and stiffness. A procedure known as barbotage involves breaking up or sucking out calcium to reduce pressure in the tendon.

Are steroid injections in shoulder painful?

In general, people say shoulder injections are not particularly painful. Using ultrasound often decreases pain as the injection is more accurate. However, a flare for a few days after an injection is common. Further information on cortisone injections can be found in this blog.

How long do steroid injection in shoulder last?

Generally, cortisone injections for the shoulder reduce pain and improve movement. However, these effects are short-lived. Nevertheless, a careful injection helps to keep patients engaged with exercise especially if pain is severe. Dr Masci has written a paper on the effects of cortisone injections in tendonitis including shoulder or rotator cuff tendonitis.

Should you use ultrasound for steroid injections in shoulder?

ultrasound-guided shoulder joint injection

Why 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 effect of an injection.  Finally, we do ultrasound injections in an office, which means that these injections are cheaper than those done in a hospital.

Cost of cortisone injection in shoulder

Dr Masci offers a competitive self-pay rate starting from £250. Remember, not all practitioners who offer cortisone injections are doctors or have experience in using ultrasound. Do your homework about your practitioner and make sure they have a medical degree and have the right experience.

Frequently asked questions about steroid injections in shoulder

Is an injection for shoulder pain just a pain killer? 

Cortisone is a powerful anti-inflammatory so it has two actions: reduces inflammation and reduces pain. The key is that you follow the injection with rehab from an experienced therapist.

Is there a limit to the number of steroid injections in shoulder you can have? 

Generally, we suggest 1-2 injections for shoulder pain. We think that if 2 injections don’t work, then it is unlikely that more injections will work.

Cortisone shot in the shoulder did not work: What does this mean? 

It is not uncommon for a cortisone shot to not work from time to time. However, if we are confident of the accuracy by using ultrasound, then we need to think about other potential causes such as referred pain from the neck.

Cortisone shot in shoulder side effects: Are they important? 

Generally,  a cortisone shot is well tolerated. However, you need to be aware of side effects.

Cortisone flare is the most common side effect. This flare usually starts within 24 hours of injection and lasts for up to a week. Other side effects include infection (1 in 100000 cases), allergy to cortisone, bleeding into joints, and a short-term increase in sugar levels if you are diabetic.

Also, we should avoid repeated cortisone injections into one area as recent evidence suggests that cortisone can weaken the tendon structure.

Should you rest after a cortisone shot in shoulder? 

Generally, we suggest you rest for at least a week after a cortisone shot in shoulder. You can perform lower body weights and run after 24 hours.

Will a cortisone shot help torn shoulder labrum? 

A torn labrum such as a SLAP tear can cause excessive movement or instability of the shoulder. Generally, episodes of instability will cause inflammation and 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 and stop further instability.

Are there other options for injection for shoulder pain apart from steroids?

Platelet-rich plasma injections

So, the simple answer is maybe. Patients with shoulder arthritis injected with hyaluronic acid did better than exercise. Another study found that hyaluronic acid injections for shoulder arthritis were better than cortisone. Overall, it seems that there are other injection options for shoulder arthritis.

You can read more about Platelet-rich Plasma and Hyaluronic acid for arthritis and tendonitis including rotator cuff tendonitis.

Final word from Sportdoctorlondon about steroid injections in shoulder

Overall, cortisone injections for the shoulder reduce inflammation and pain. Different structures are targeted depending on where we think pain is coming from. Importantly, ultrasound increases injection accuracy and effect and is cheaper.

Other common shoulder conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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