What is the recommended frequency of steroid injections per year for shoulder bursitis?

Recommended Frequency of Steroid Injections for Shoulder Bursitis

For shoulder bursitis, corticosteroid injections should be limited to no more than 3-4 injections per year, with a minimum interval of 6-8 weeks between injections to minimize potential adverse effects on joint tissues.

Understanding Shoulder Bursitis and Steroid Injections

Shoulder bursitis is an inflammatory condition affecting the subacromial bursa that can cause significant pain and functional limitation. Corticosteroid injections are a common treatment approach when conservative measures fail to provide adequate relief.

Efficacy of Corticosteroid Injections

Corticosteroid injections into the subacromial space have been shown to provide significant short-term pain reduction compared to standard care for shoulder bursitis 1. These injections can effectively reduce inflammation and provide pain relief, allowing patients to participate more effectively in rehabilitation exercises.

Recommended Frequency and Timing

When determining the appropriate frequency of steroid injections for shoulder bursitis, consider the following:

1. Maximum yearly limit:

   • No more than 3-4 injections per year to minimize potential adverse effects
   • This limit helps prevent potential cartilage damage from repeated injections

2. Minimum interval between injections:

   • At least 6-8 weeks between injections
   • Research suggests that injections with a 2-week interval may be more effective than single injections for pain relief 2, but maintaining longer intervals between subsequent injections is important for tissue health

3. Duration of effect:

   • Effects typically last 4-8 weeks
   • Repeated injections should only be considered if previous injections provided meaningful relief

Administration Considerations

• Technique: Ultrasound guidance may improve accuracy of injection placement 3
• Formulation: Typically 40mg triamcinolone or equivalent mixed with local anesthetic 4, 2
• Post-injection care: Avoid overuse of the injected joint for 24 hours following the procedure, though complete immobilization is discouraged 4

Risks and Precautions

Potential Complications

• Infection: Though rare, septic bursitis is a serious potential complication, including risk of methicillin-resistant Staphylococcus aureus (MRSA) infection 5
• Tissue damage: Multiple repeated injections may potentially contribute to cartilage loss over time 4
• Transient effects: Post-injection pain flare can occur in some patients 4
• Systemic effects: Transient increased blood glucose levels, particularly in diabetic patients 4

Integrating with Other Treatments

Corticosteroid injections should be part of a comprehensive treatment approach:

• Physical therapy should be continued during and after injection therapy 4
• NSAIDs and analgesics may be used concurrently for pain management 1
• Consider alternative injectable treatments such as hyaluronic acid if corticosteroid injections fail, though evidence suggests corticosteroids are more effective 4, 6

Special Considerations

For patients with hemiplegic shoulder pain following stroke, subacromial corticosteroid injections have shown efficacy when shoulder pain is related to injury or inflammation of the subacromial region 1.

For patients on immunosuppressive therapy or with other medical conditions, the standard frequency limitations still apply, but additional caution may be warranted based on individual risk factors.