From the Guidelines
Corticosteroid injections for shoulder pain should be administered into the subacromial space, specifically targeting the subacromial region, to address pain related to injury or inflammation of the rotator cuff or bursa. This recommendation is based on the most recent and highest quality evidence available, which suggests that subacromial corticosteroid injections can be used in patients when pain is thought to be related to injury or inflammation of the subacromial region (rotator cuff or bursa) in the hemiplegic shoulder 1.
The procedure for administering corticosteroid injections typically involves using sterile technique, often with ultrasound or fluoroscopic guidance to ensure accurate placement. Common medications used include methylprednisolone (40-80mg), triamcinolone (20-40mg), or betamethasone (6-12mg), typically mixed with a local anesthetic like lidocaine (2-10ml of 1%) 1.
Some key points to consider when administering corticosteroid injections for shoulder pain include:
- The subacromial space is a common injection site for conditions like rotator cuff tendinopathy and subacromial bursitis
- The glenohumeral joint and acromioclavicular joint are also potential injection sites, depending on the diagnosis
- Patients should expect some post-injection soreness for 24-48 hours, followed by symptom relief that may last weeks to months
- Moderate evidence supports the use of a single injection of corticosteroid with local anesthetic for short-term improvement in both pain and function for patients with shoulder pain 1.
Overall, the use of corticosteroid injections in the subacromial space can provide effective relief for patients with shoulder pain related to injury or inflammation of the rotator cuff or bursa, and should be considered as a treatment option in conjunction with other therapies, such as gentle stretching and mobilization techniques, and analgesics like acetaminophen or ibuprofen 1.
From the FDA Drug Label
The dose for intra-articular administration depends upon the size of the joint and varies with the severity of the condition in the individual patient. Suitable sites for intra-articular injection are the knee, ankle, wrist, elbow, shoulder, phalangeal, and hip joints The doses in the following table are given as a general guide: Size of Joint Examples Range of Dosage Large Knees Ankles Shoulders 20 mg to 80 mg
The corticosteroid injection goes into the synovial space of the shoulder joint.
- The intra-articular injection is made into the joint space, and the dose for the shoulder joint is in the range of 20 mg to 80 mg.
- The injection site is determined by the location where the synovial cavity is most superficial and most free of large vessels and nerves.
- The proper technique involves inserting a sterile needle into the synovial cavity, aspirating joint fluid to confirm the needle is in the correct space, and then injecting the corticosteroid suspension 2.
From the Research
Location of Corticosteroid Injection in the Shoulder
- The location of corticosteroid injection in the shoulder is in the subacromial space, as indicated by studies 3, 4, 5.
- This space is located below the acromion, a bony projection of the scapula, and above the rotator cuff tendons.
- The subacromial space contains the subacromial bursa, which can become inflamed and cause pain in conditions such as subacromial impingement syndrome.
Conditions Treated with Subacromial Corticosteroid Injections
- Subacromial corticosteroid injections are used to treat various shoulder conditions, including:
- These conditions often involve inflammation and pain in the rotator cuff tendons and subacromial bursa.