Corticosteroid Injections for Shoulder Pain

Q1. What is a corticosteroid injection, and how does it help shoulder pain?

A corticosteroid injection (often called a "cortisone shot") is a localized treatment that delivers a powerful anti-inflammatory medication directly into the painful area of your shoulder. It works by reducing swelling, irritation, and inflammation in the joint, tendons, or bursa. By calming this inflammation, the injection helps relieve pain and restore your ability to move your shoulder.

Q2. What specific shoulder conditions are treated with corticosteroid injections?

Steroid injections are commonly used to treat a variety of inflammatory shoulder conditions, including:

• Rotator cuff tendinitis or bursitis: Inflammation of the tendons or the fluid-filled sac (bursa) in the shoulder.
• Shoulder impingement syndrome: Pinching of the shoulder tendons or bursa during movement.
• Adhesive capsulitis (Frozen shoulder): Pain and stiffness caused by thickening and tightening of the joint capsule.
• Shoulder osteoarthritis: Wear-and-tear arthritis of the main shoulder joint.
• Acromioclavicular (AC) joint arthritis: Wear-and-tear of the joint at the top of the shoulder where the collarbone meets the shoulder blade.

Q3. How quickly does a corticosteroid injection start working, and how long does the relief last?

The timeline for pain relief varies from person to person:

• Onset of relief: You might feel temporary numbness for a few hours due to the local anesthetic mixed with the steroid. The actual steroid medication typically starts working within 2 to 7 days.
• Duration of relief: The pain relief can last anywhere from several weeks to several months. In some cases, such as with frozen shoulder or mild tendinitis, the injection can provide long-lasting or permanent relief when combined with physical therapy.

Q4. What should I expect during the injection procedure?

The procedure is quick, safe, and typically performed in the doctor's office. Here is what you can expect:

• You will sit or lie down in a comfortable position that exposes your shoulder.
• The doctor will clean the skin over the injection site with an antiseptic solution.
• The doctor may apply a numbing spray or inject a small amount of local anesthetic to numb the skin.
• The steroid medication (usually mixed with a local anesthetic for immediate pain relief) is injected into the target area.
• The needle is removed, the area is cleaned, and a small adhesive bandage is applied.

Q5. Is the injection painful?

Most patients experience only mild discomfort during the procedure. You will feel a small pinch as the needle enters the skin, followed by a sensation of pressure or fullness as the medication is injected. The local anesthetic mixed with the steroid helps minimize any immediate pain. Any mild soreness after the injection usually resolves within a couple of days.

Q6. How is the injection guided (e.g., using ultrasound)?

Doctors can perform shoulder injections using two methods:

• Anatomical landmark guidance: The doctor uses their knowledge of anatomy and physical touch to locate the injection site. This is a common and effective method for many standard shoulder injections.
• Ultrasound guidance: The doctor uses a small ultrasound machine to view the internal structures of your shoulder in real-time. This allows them to visualize the needle and ensure the medication is delivered precisely into the targeted joint space, bursa, or tendon sheath.

Q7. What are the potential side effects and risks of a shoulder steroid injection?

Corticosteroid injections are generally very safe, but like any medical procedure, they carry some risks. Potential side effects include:

• Post-injection flare: Temporary increase in pain and inflammation for 24 to 48 hours.
• Skin changes: Temporary thinning or lightening of the skin (depigmentation) around the injection site.
• Infection: A very rare but serious risk (less than 1 in 10,000 injections).
• Bleeding or bruising: Mild bruising at the needle insertion site.
• Tendon weakness: Repeated injections into the same area can potentially weaken tendons.

Q8. What is a "steroid flare," and how should I manage it?

A "steroid flare" (or cortisone flare) is a temporary reaction to the injected medication. The steroid crystals can sometimes irritate the joint tissues, causing increased pain, warmth, and swelling starting a few hours after the injection. This is not an infection and is a common side effect that resolves on its own within 24 to 48 hours. You can manage a flare by:

• Applying an ice pack to the shoulder for 15 to 20 minutes at a time.
• Resting the shoulder and avoiding strenuous activities.
• Taking over-the-counter pain relievers, such as acetaminophen or ibuprofen, if approved by your doctor.

Q9. Are there any restrictions on activity immediately after receiving the injection?

Yes, it is important to protect the shoulder to allow the medication to settle and work effectively:

• First 48 hours: Avoid heavy lifting, overhead reaching, throwing, or strenuous exercise. You may perform light daily activities.
• Resuming therapy: If you are in physical therapy, you should typically wait 3 to 5 days before resuming vigorous exercises, although light stretching is usually fine. Consult your doctor or therapist for specific timing.

Q10. How many corticosteroid injections can I safely receive in my shoulder?

As a general rule, doctors limit the number of steroid injections to avoid damage to the joint tissues. Most specialists recommend no more than 3 to 4 injections in the same joint within a 12-month period, with at least 3 months between injections. If an injection does not provide significant relief, repeating it is rarely helpful, and other treatment options should be explored.

Q11. Can steroid injections cause damage to the shoulder joint or tendons over time?

Yes, frequent or repeated injections can carry risks. High doses of corticosteroids over time can lead to the breakdown of cartilage in the joint or weaken the rotator cuff tendons, increasing the risk of a tendon tear. This is why doctors are cautious about the frequency of injections and use them as part of a broader treatment plan that includes rehabilitation.

Q12. Who is NOT a good candidate for a shoulder corticosteroid injection?

An injection may not be suitable or safe for individuals who have:

• An active infection in the shoulder joint or elsewhere in the body.
• A known allergy to corticosteroids or local anesthetics.
• Uncontrolled diabetes, as steroids can temporarily raise blood sugar levels.
• A severe bleeding disorder or are taking certain blood-thinning medications (some patients may need to temporarily pause these medications under medical supervision).
• A complete rotator cuff tear that requires immediate surgical repair, as steroids can interfere with tendon healing.

Q13. If I have diabetes, how will the injection affect my blood sugar levels?

Corticosteroids are absorbed into your bloodstream and can cause a temporary rise in blood sugar levels, typically lasting for 2 to 5 days after the injection. If you have diabetes, you must monitor your blood glucose levels more frequently during this period. You should consult your primary care doctor before the injection to discuss how to manage your insulin or medication doses if your blood sugar rises.

Q14. What should I do if the corticosteroid injection does not provide pain relief?

If you experience no relief within 2 weeks, it is important to follow up with your doctor. A lack of relief can mean:

• The medication was not deposited in the exact location of the pain source (which is why ultrasound guidance can sometimes help).
• The underlying cause of your pain is not primarily inflammatory (for example, a structural tear or nerve impingement).
• The inflammation is too severe for a single injection to resolve.

Your doctor will re-evaluate your shoulder and discuss other treatment options, such as physical therapy changes, different types of injections, or surgery.

Q15. When should I contact my doctor or seek medical attention after the injection?

While complications are rare, you should contact your doctor immediately or seek medical care if you experience any of the following signs:

• Fever, chills, or sweating.
• Significantly increased pain, swelling, redness, or warmth in the shoulder after 48 hours.
• Pus or drainage at the injection site.
• Signs of an allergic reaction, such as hives, itching, or difficulty breathing.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.