Should I have a shoulder cortisone injection for pain relief?

If you or one of your clients is thinking of having an injection due to shoulder pain, then read this blog or watch this video first.

Shoulder pain is the third most common muscle and joint problem in adults over the age of 45. Injections, physical therapy, and surgery are the most common treatments offered for shoulder pain by healthcare providers.

Let's quickly review a few facts about shoulder injections. Starting with what substance do they inject?

In most cases, the preparation in the syringe will contain two different medications:

• For more immediate pain relief, a local anesthetic is added to a slower-acting anti-inflammatory steroid.
• The faster-acting local anesthetic helps to identify the problem because if the pain reduces after the injection, it indicates that the correct area or structure was injected and was the possible cause of the pain.

Shoulder injections may also contain one of these other compounds:

• Hyaluronic acid: This is a natural substance found in your body, especially in your skin, eyes, and joints. Some evidence suggests that it can reduce shoulder pain for osteoarthritis (Merolla et al., 2011).
• Platelet-rich plasma (PRP): Here, a sample of blood is taken and spun around to separate and concentrate the blood platelets before being injected into the joint. PRP injections for knee Osteoarthritis show positive results (Chen et al., 2019), but research is lacking for its use in shoulder pain (Fernández-de-las-Peñas & Lewis, 2022).
• Saline Solution: In some cases, you may be offered an injection to dilate and expand the joint capsule. Saline solution is used for this purpose.
  • Text: Saline solution is salty water with a natural concentration so that it does not cause irritation in the body.

Next, we will identify the different types of shoulder injection, starting with the most common:

• The subacromial injection is delivered into the joint space between the top of your arm and below your acromion. It is usually performed if you have been diagnosed with rotator cuff tendon pain or subacromial bursitis.
• A more direct injection into the joint is recommended for a diagnosis of frozen shoulder or osteoarthritis. This is called an intra-articular injection.
• Another type of direct joint injection aims to expand the joint capsule by dilating it with a high amount of injection fluid, as mentioned previously, this would be achieved by adding a high volume of saline solution.
• An injection may also be offered for the acromioclavicular (AC) joint or sternoclavicular joint. These are less common.
• A suprascapular nerve block can be effective at reducing pain from a range of causes, including osteoarthritis, subacromial shoulder pain, and frozen shoulder. This technique aims to reduce the nerve signals from the shoulder to the brain.

How to Guide

Shoulder Injections can be performed using bony landmarks or ultrasound guidance. Electrostimulation and Fluoroscopy are two additional but less common options.

Risks

All medical procedures, including injections, carry known risks. You should be made aware of these before receiving a shoulder injection. They can include nerve damage, tendon damage, cardiovascular problems, and some procedures carry a small risk of a punctured lung, known as a pneumothorax.

Before we finish, I'll give my opinion on the available evidence for shoulder injections:

• Injections for subacromial pain syndrome and rotator cuff-related shoulder problems are likely to offer short-term relief, but there is not enough evidence for us to have a clear understanding of the long-term effects of these injections. You would normally be offered 1-3 injections, but repeated injections beyond this are not advised due to the risk of tissue degeneration from prolonged exposure to corticosteroids.
• Direct joint intra-articular injections may help to reduce the duration of a frozen shoulder condition if they are injected early after the diagnosis.
• Suprascapular nerve blocks can be effective at reducing pain from glenohumeral joint osteoarthritis, subacromial shoulder pain, and frozen shoulder. More skill is required to deliver this intervention, and more risk factors exist, including the proximity to the top of the lung.

If you have shoulder pain, please consider other treatment options, including exercise and manual therapy.

Reference List

• Chen, P., Huang, L., Ma, Y., Zhang, D., Zhang, X., Zhou, J., Ruan, A., & Wang, Q. (2019). Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. Journal of orthopaedic surgery and research, 14, 1-11.
• Fernández-de-las-Peñas, C., & Lewis, J. (2022). The shoulder: theory and practice. Jessica Kingsley Publishers.
• Merolla, G., Sperling, J.W., Paladini, P., & Porcellini, G. (2011). Efficacy of Hylan GF 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskeletal surgery, 95, 215-224.

Disclaimer: This blog post is for informational purposes only and should not be considered medical advice. Always consult