Aug 10
13
Injections of steroid into the shoulder are an increasingly popular way of treating shoulder pain and inflammation. But how keen are you on the idea? Many shoulder pain sufferers aren’t keen on the idea at all and are often unsure as to what they actually do and what to expect as a result of having an injection.
I am hoping that the following article with help put your mind at ease through a better understanding of how and why steroids work to reduce your shoulder pain. However, unfortunately to ad insult to injury (pardon the pun), there is no clear significant evidence for the benefit of steroid injections for shoulder problems.
But my clinical experience and through the observation of literally hundreds of patients who have received injections whilst under my care, I have observed that the majority of patients have benefited from injections into the shoulder joint for a number of shoulder conditions.
The degree of benefit however is the great unknown factor here and difficult to predict. It is therefore important to accurately diagnose the shoulder condition and the potential reasons why an injection would be beneficial.
From my perspective, as a Shoulder Guy, I use injections where indicated both as a way of diagnosing a potential cause and location of symptoms and as a way of reducing pain and inflammation so that my techniques for improving shoulder strength, flexibility and function can be introduced on a relatively pain free shoulder.
If the injection is successful in reducing your pain and dysfunction then this provides you with a great opportunity to start the recovery process in less pain and can help speed up the eventual outcome of having no shoulder pain at all.
So how do they work and are they safe?
Corticosteroids are relatively safe, potent anti-inflammatory and pain modulating drugs with both systemic and local effects. The precise mechanism is not well understood but possible mechanisms include anti-inflammatory effects due to influences on local tissue metabolism and pain mediators and of course the possibility of a a placebo effect.
Injection techniques are now usually Xray or Ultrasound guided to hopefully increase the accuracy of drug delivery into the right spot.
Recent research (BMJ, 2010) reported that up to 1/3 of patients with shoulder impingement and moderate to severe shoulder pain will not respond adequately to 3 months of exercise therapy alone and may then require an injection. The study suggested that when shoulder pain was severe an early steroid injection coupled with physiotherapy provided good early results when quick pain reduction was focus.
Steroid injections can be used on a number of shoulder conditions including for example chronic rotator cuff tendonitis, biceps tendonitis, impingement with subacromial bursitis and AC joint degenerative joint disease.
Hi Luke
I fractured my greater tuberosity area of the humerus 7 weeks ago. Had x-rays to identify this, and limited ultrasound pics due to fracture, which identified no visible tears. The verdict of sports medico was to wait 6 weeks for a complete healing. Movement of shoulder was very limited initially, improved VERY gradually over the weeks, but by week 4-5 it was clear it was not going to be all over by 6 weeks. I have had little or no pain,but cannot raise R arm (dominant)above shoulder height, and since week 7 can no longer fasten bra at back. Verdict today at Week 7 was frozen shoulder. I was sent for a cortisone injection into the joint (CT scan guided), and told physio was not needed. Radiographer suggested physio may be helpful to restore motion after 2nd day following cortisone injection, especially since pain is not my issue, just lack of full range of mobility. I am 57, am not aware of any osteoporosis signs and this has not been mentioned. Any suggestions you have for facilitating recovery of movement would be greatly appreciated. I have had to give up yoga for past 7 weeks (not happy!), but otherwise have gradually increased use of R arm. Can wash & dry my hair properly now.
Any feedback, advice gratefully received. Cheers.
Hi Pam, if a lack of range of motion is your issue then I would recommend that you start focusing on that both at home and with the help of a physiotherapist who knows about shoulder rehabilitation. In my opinion, if the fracture of the tuberosity was un-displaced then you should have been mobilising your arm much earlier than 6 weeks. I am hopeful for you that your shoulder is just stiff but not frozen as suggested to you. Following a fracture is this region there will be swelling and callous which will make the shoulder tight and also the rotator cuff which attaches along the tuberosity will be significantly inhibited and swollen. This will significantly disable the shoulder especially when lifting above you head. I think the radiographer is right. Get this shoulder moving asap following the injection trying movements like hand behind your head, hands behind your back, rotation of the arm away from your tummy with a bent elbow and elevation above your head when lying down. Keep using the arm with particular focus on using the hand for normal tasks. The recovery will take longer than you think, potentially up to 6 months to get full use and strength back in the rotator cuff and shoulder overall.
I hope this helps.
All the best and post here again to let me know how you are doing.
Cheers
Luke
The Shoulder Guy