What is the typical dose of hydrocortisone (corticosteroid) injection for shoulder tendonitis?

Typical Dose of Hydrocortisone Injection for Shoulder Tendonitis

The typical dose of hydrocortisone injection for shoulder tendonitis is 40-80 mg per injection into the subacromial space, with higher doses showing greater effectiveness for symptom relief.

Dosing Guidelines

The optimal dosing for corticosteroid injections in shoulder tendonitis depends on several factors:

Subacromial Injection (Most Common)

• Standard dose range: 40-80 mg of hydrocortisone
• Volume: Typically mixed with 1-2 ml of 1% lidocaine
• Frequency: Single injection, with potential repeat injection after 4-6 weeks if needed
• Maximum: Generally not more than 3 injections in a 12-month period

Glenohumeral Joint Injection

• For cases with glenohumeral involvement, similar dosing applies
• Triamcinolone acetonide 40 mg has shown better results than lower doses (10 mg) for frozen shoulder 1

Evidence-Based Considerations

Current guidelines provide limited specific recommendations for hydrocortisone dosing in shoulder tendonitis:

• The American Academy of Orthopaedic Surgeons (AAOS) notes that while corticosteroid injections are widely used in clinical practice for shoulder pain, there is insufficient evidence to make a definitive recommendation for or against their use in glenohumeral osteoarthritis 2

• Research evidence suggests that subacromial corticosteroid injections can provide short-term pain relief for rotator cuff tendonitis, with a number needed to treat of approximately 3.3 patients to obtain one improvement 3

• Higher doses (equivalent to 50 mg prednisone or more) appear to be more effective than lower doses, with a relative risk for improvement of 5.9 compared to placebo 3

Administration Technique

For optimal results:

• Use anatomical landmarks or image guidance (ultrasound or fluoroscopy) to ensure accurate placement
• Approach the subacromial space from the lateral aspect of the shoulder
• Ensure sterile technique to minimize infection risk

Duration of Effect and Limitations

It's important to note that corticosteroid injections typically provide only temporary relief:

• Most studies show benefit lasting 4-8 weeks 4
• Multiple injections do not appear to be more effective than a single injection 4
• The effect tends to be transient, with limited ability to modify the natural course of the condition

Potential Adverse Effects

When discussing this treatment with patients, consider these potential risks:

• Local pain at injection site
• Skin depigmentation
• Tendon weakening or rupture with repeated injections
• Transient elevation in blood glucose in diabetic patients
• Facial flushing

Clinical Decision Algorithm

1. First-line therapy: Conservative management (NSAIDs, physical therapy)
2. If persistent symptoms after 4-6 weeks: Consider corticosteroid injection at 40-80 mg hydrocortisone
3. If partial response: May repeat injection after 4-6 weeks
4. If no response after 2 injections: Consider alternative diagnosis or treatment approach

While the evidence for corticosteroid injections in shoulder tendonitis shows short-term benefit, clinicians should be aware that these injections provide primarily symptomatic relief rather than disease modification, and should be used as part of a comprehensive treatment approach.