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 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?

Diseased tendons 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 effectively reduces shoulder pain and inflammation. 

Steroid injections in the 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 rotator cuff tendonitis.
  • The long head of biceps tendon injection is used to treat biceps tendonitis. The long head of biceps tendonitis can cause pain in the front of the shoulder.
  • Suprascapular nerve block targets the suprascapular nerve at the back of the shoulder. This injection treats shoulder arthritis and rotator cuff tears that are inoperable.

 

Also, a cortisone shot in the shoulder can treat calcium build-up in the shoulder tendons. Calcific tendonitis in the shoulder can lead to 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?  

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 typical. You can find further information on cortisone injections in this blog.

How long does a cortisone shot in the shoulder last?

Generally, cortisone shots in the shoulder reduce pain and improve movement. However, these effects are short-lived -ususally lasting a few months. Nevertheless, a careful injection helps to keep patients engaged with exercise, especially if the pain is severe.

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?

ultrasound-guided shoulder joint injection - cortisone shot or PRP injection in shoulder

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 impact of an injection. Finally, we do ultrasound injections in a clean office rather than a surgical room, meaning these injections are generally cheaper. 

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 please do your homework and ensure your practitioner has a medical degree and 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 injection 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. We think that if two injections don’t work, it is unlikely that more injections 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 numerous and include the wrong diagnosis or inaccurate placement of the cortisone. 

Cortisone shot in shoulder side effects: Are they common? 

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 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 have diabetes.

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 the shoulder? 

Generally, we suggest you rest for at least a week after a cortisone shot in the shoulder.

Often, patients want more specific guidance regarding a return to activity and 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 and help you regain full function.

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 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.

Hydrodistension for frozen shoulder: Is it better than a cortisone shot? 

Yes, we think so.

Studies suggest that hydrodistension is better than a simple cortisone shot. Generally, a hydrodistension means injecting a higher volume containing cortisone, local anaesthetic and sterile water rather than just cortisone.

We can inject either a moderate volume (20-40mls) or a high volume (over 40mls). Often, high volumes rupture the capsule of the shoulder joint. We think that shoulder hydrodistension with moderate volume that stretches the capsule is better than high volumes that rupture the capsule. 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 a 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. 

A recent study found that a cortisone injection for shoulder arthritis relieves pain for up to four months. 

Is there an alternative to a cortisone injection in the shoulder?

Platelet-rich plasma injections - alternative to cortisone injection in shoulder

So, the simple answer is yes to an alternative to a cortisone injection in the shoulder. Options include gel treatment called hyaluronic acid and PRP or platelet-rich plasma. 

For example, people with shoulder arthritis injected with hyaluronic acid did 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 six and twelve months. So, PRP might be an excellent alternative to cortisone injection in shoulder tendonitis, especially if you’ve already tried cortisone. We outline PRP options for shoulder pathology in this recent blog. 

Click on the location of your shoulder pain to find out possible causes: 

shoulder pain map
Clavicle pain AC joint pain Front of shoulder Biceps tendon pain Pectoralis pain Trapezius pain Chest wall pain

Clavicle pain

Biceps tendon pain

Pectoralis pain

Trapezius pain

Chest wall pain

picture of upper back in young man
Trapezius pain Scapular pain Back of shoulder Triceps Pain

Trapezius pain

Scapular pain

Triceps Pain

Final word from Sportdoctorlondon about a cortisone shot in the shoulder

Overall, cortisone injections for the shoulder reduce inflammation and pain. Different structures are targeted depending on where we think pain is coming from. Moreover, using 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.