Shoulder pain and steroid injections: When is it appropriate?
A steroid injection, also referred to as a cortisone injection, can help relieve shoulder pain in the right circumstances. The most important part before having an injection, is understanding where the pain is coming from so it can be treated effectively.
If your shoulder injury has not responded to conservative treatment like Physiotherapy, it may benefit from a steroid injection to break the inflammatory cycle and give you a window of opportunity to rehabilitate in. The most common conditions treated with a steroid injection are; Shoulder impingement, Frozen shoulder, Bursitis, Acromioclavicular joint injuries, Rotator cuff tendinopathy.
We are often asked about having a steroid injection for persistent shoulder pain that has not eased with conservative treatment like strengthening. The location of your pain is usually an easy place to start to identify if a steroid injection in the shoulder is right for you.
Where is the pain located?
If your pain is on the outside of the arm (like in the picture above) and is present with activities when moving the arm like reaching above the head or behind, dressing or doing exercises in the gym like press ups, bench press etc then a steroid injection may help. You should only consider this though if you have done adequate rehabilitation and things re not improving. Pain in these situations usually present as pain located on the outside of the upper arm or in the front of the shoulder and is often reported as a line of pain that is present on movement and eases when you get out of that position. Some will describe it as a pinching and others as a sharp shooting pain. The key is that it is intermittent and easily reproducible with activity.
You may also get pain in a very specific location on top of the shoulder over a small joint called the acromioclavicular joint (ACJ). Pain in this region is very localised and is usually point tender to touch. In this instance, irritation of the ACJ may be the cause of the shoulder pain and may also benefit from an injection if conservative treatment fails.
When is shoulder pain not shoulder pain?
Pain over the upper shoulder area and neck ie over the muscle that is called the upper trapezius muscle may not be originating in the shoulder (See pic below). Pain in this location is more likely to be originating from the neck. If you can reproduce your pain with movements of the neck and less so with movements of the arm, a steroid injection in the shoulder may not be indicated and you may need a Physiotherapist to assess your neck.
What about type of pain in the shoulder?
The type of pain may also help identify if a steroid injection in the shoulder will be of therapeutic benefit. Most shoulder pain is mechanical and is related to movement. The pain can be sharp, pinching or aching. If the pain is numbness, tingling, weakness or a dead arm feeling, and often referring into the hand (and specific fingers in the hand), it may be originating from a nerve in the neck, so may not require any injection intervention into the shoulder.
There are some shoulder pathologies that can have a mixed appearance too. A frozen shoulder (adhesive capsulitis) for example or an acute rotator cuff calcific tendinopathy may cause an ache that is present through the day even at rest and especially at night in bed. Movement of the arm is very painful in multiple directions and the pain can travel all the way down the arm to the hand and can feel tight up into the neck. These pathologies will usually respond well to a steroid injection.
Summary
In summary, it is important to get the diagnosis accurate so your treatment can be targeted to the right location. If you are unsure if it is a shoulder or neck pathology, then book in with one of our team to get a through assessment and they can advise you further.
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