Can Cortisone injections help with shoulder pain?

 

Cortisone injections (also known as steroid or corticosteroid injections) are a powerful anti-inflammatory medication that is delivered into the inflamed tissue to reduce pain and inflammation in the shoulder.

Cortisone injections have been used for many years safely and effectively but occasionally gets a bad reputation for causing harm. When used effectively for the right shoulder conditions it may help resolve pain and allow you to return to your normal activities sooner.

Shoulder pain that has not responded to conservative treatment may benefit from a cortisone injection. The most common conditions treated with cortisone are; Shoulder impingement, Frozen shoulder, Bursitis, Acromioclavicular joint injuries, Rotator cuff tendinopathy.

Frozen Shoulder

What the research says.

Burger et al 2016 conducted a systematic review and meta-analysis and concluded steroid injections to be an effective treatment option for decreasing pain and improving shoulder function. The important thing to remember is that a steroid injection alone will not resolve most shoulder pain. It is important that you continue on with your regular rehabilitation plan after the injection to maximise the benefits. The cortisone injection is designed to reduce your pain and give you a pain free window to perform your rehabilitation in.

Frozen shoulder is a painful condition that affects most arm movements and is particularly painful with dressing, reaching and sleeping on that side. Pain medications alone can be unsuccessful at providing enough symptom relief. A recent systemic review and meta-analysis showed that a steroid injection into the shoulder joint was associated with increased short term benefits compared with other treatments and the benefits may last as long as 6 months. This research also suggested that the addition of exercise and mobilisation after the injection may add further benefits.

A systemic review of injections in rotator cuff related shoulder pain by Cook et al demonstrated that in the short term (up to 8 Weeks) a steroid injection is more beneficial than having a local anaesthetic alone. This benefit is likely to reflect the anti-inflammatory effects of the steroid.

How do you get a cortisone injection in the shoulder?

 

The anatomy of the shoulder is complicated and the structures involved are often overlapping each other so it is best to have a cortisone injection with Ultrasound-guidance to ensure the injection is delivered effectively and accurately to the right structure in the shoulder (Bhayana et al 2018).

During an assessment, one of our Clinical Specialists will perform a series of tests and conduct an Ultrasound scan to see inside the shoulder and work out what structures may be causing your pain. If a cortisone injection is an appropriate treatment option for your type of shoulder pain, they will discuss this option with you and let you know the benefits and risks of the procedure. If you are happy to proceed, they will then carry out an Ultrasound-guided injection of cortisone into the shoulder. Have a look at a live demo of a shoulder steroid injection or you can read more about steroid injections here.

Summary

 

In general, for the right individual, cortisone injections are an effective treatment for some forms of shoulder pain. The important thing is to get an accurate diagnosis first which will help direct the right treatment for you. If conservative treatment is not working then you can consider an Ultrasound-guided cortisone injection. If you have been diagnosed with having a Frozen shoulder, then early intervention with a cortisone injection may give you the greatest symptomatic relief.

If you would like more information or would like to book an appointment, please contact us at Steroid injections London on 0207 636 5774 or email reception@oxfordcircusphysio.co.uk

References:

Cook T, Minns Lowe C, Maybury M, et alAre corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic reviewBritish Journal of Sports Medicine 2018;52:497-504.

Lafrance S, Doiron-Cadrin P, Saulnier M, et alIs ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trialsBMJ Open Sport & Exercise Medicine 2019;5:e000506. doi: 10.1136/bmjsem-2018-000506

Bhayana H, Mishra P, Tandon A, Pankaj A, Pandey R, Malhotra R. Ultrasound guided versus landmark guided corticosteroid injection in patients with rotator cuff syndrome: Randomised controlled trial. J Clin Orthop Trauma. 2018;9(Suppl 1):S80–5.

Burger M, Africa C, Droomer K, Norman A, Pheiffe C, Gericke A, et al. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: a systematic review and meta-analysis. S Afr J Physiother. 2016;72(1):318.

Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. doi:10.1001/jamanetworkopen.2020.29581