What is the best approach for managing a 63-year-old male patient's right shoulder pain who is already undergoing physical therapy (PT) and is scheduled for an intraarticular injection?

Management of Right Shoulder Pain with Intraarticular Injection

Intraarticular corticosteroid injection is an appropriate option for this 63-year-old male patient with right shoulder pain who is already receiving physical therapy. 1

Evidence-Based Approach to Shoulder Injections

Indications for Intraarticular Corticosteroid Injection

• Appropriate for patients with glenohumeral osteoarthritis (OA), adhesive capsulitis, or inflammatory conditions 1, 2
• Can be used as adjunctive therapy for acute exacerbations of shoulder pain 2
• May be particularly beneficial when combined with ongoing physical therapy 1

Injection Technique

• Strict aseptic technique is mandatory 1, 2
• For shoulder joints:
  • Triamcinolone acetonide 5-15 mg is typically appropriate for larger joints like the shoulder 2
  • Doses up to 40 mg may be used for larger areas depending on severity 2
  • Consider using local anesthetic mixed with the corticosteroid to provide immediate pain relief 1

Procedural Considerations

• Position the patient appropriately, ideally on an examination table that can be adjusted 1
• Ensure proper equipment for aseptic procedures is available 1
• While ultrasound guidance is strongly recommended for hip injections, it is optional but may improve accuracy for shoulder injections 1
• Avoid overuse of the injected joint for 24 hours following the procedure, though complete immobilization is discouraged 1

Special Considerations

For Patients with Diabetes

• Inform the patient about the risk of transient increased glycemia following intraarticular glucocorticoid injection 1
• Advise monitoring of glucose levels particularly from the first to third day post-injection 1

Post-Injection Care

• The patient should be informed about potential benefits and risks of the procedure 1
• Explain that pain relief may be temporary and that multiple injections may be needed for adequate symptom control 2, 3
• Continuation of physical therapy is important as part of the comprehensive treatment plan 3

Alternative Injectable Options

• Viscosupplementation (hyaluronic acid) may be considered as an alternative injectable option for glenohumeral OA 1
• However, evidence suggests that intraarticular corticosteroid injections have higher quality evidence supporting their use compared to other injectables 1

Potential Complications

• Local tissue atrophy if injection is not properly administered 2
• Risk of infection is very low but should be discussed with the patient 1
• Transient post-injection pain flare can occur 1
• Multiple repeated injections may potentially contribute to cartilage loss, though the clinical significance of this finding remains uncertain 1

By proceeding with the planned intraarticular injection while continuing physical therapy, you are providing evidence-based care that addresses both the inflammatory component of the patient's shoulder pain while supporting functional rehabilitation through ongoing physical therapy.