From the Guidelines
Corticosteroid injections into the shoulder are indicated for several painful shoulder conditions, including rotator cuff tears, that have not responded to conservative management, with moderate evidence supporting their use for short-term improvement in both pain and function 1.
Indications for Corticosteroid Injections
- Adhesive capsulitis (frozen shoulder)
- Subacromial impingement syndrome
- Rotator cuff tendinopathy
- Acromioclavicular joint arthritis
- Glenohumeral osteoarthritis
Procedure and Technique
The procedure typically involves injecting a mixture of a corticosteroid with a local anesthetic, using sterile technique, and ultrasound guidance can improve accuracy, particularly for glenohumeral joint injections.
Potential Side Effects and Limitations
Patients should be informed that they may experience a temporary increase in pain for 24-48 hours after the injection, followed by relief that can last weeks to months. The number of injections should generally be limited to 3-4 per year in the same location to minimize potential side effects such as tendon weakening, skin atrophy, or cartilage damage.
Evidence and Recommendations
While there is debate about the use of locally injected corticosteroids, with some studies suggesting potential deleterious effects on the tendon 1, the most recent and highest quality study supports their use for short-term improvement in pain and function 1. Additionally, subacromial corticosteroid injections can be used in patients with hemiplegic shoulder pain thought to be related to injury or inflammation of the subacromial region 1.
Key Considerations
- Corticosteroid injections work by reducing inflammation and suppressing the immune response in the affected area, thereby decreasing pain and improving function.
- They are most effective when combined with appropriate physical therapy and rehabilitation exercises.
- The optimal drugs, dosages, techniques, intervals, and post-injection care remain unknown, and more research in this area is needed 1.
From the Research
Indications for Infiltration of the Shoulder with Corticosteroids
The indications for infiltration of the shoulder with corticosteroids include:
- Osteoarthritis, adhesive capsulitis, and rheumatoid arthritis for glenohumeral joint injection 2
- Osteoarthritis and distal clavicular osteolysis for acromioclavicular joint injection 2
- Adhesive capsulitis, subdeltoid bursitis, impingement syndrome, and rotator cuff tendinosis for subacromial injections 2
- Inflammation of the involved bursa for scapulothoracic injections 2
- Persistent pain related to inflammatory conditions of the long head of the biceps 2
- Glenohumeral arthrosis and rotator cuff tendinopathy for glenohumeral and subacromial infiltration, respectively 3
- Adhesive capsulitis, with corticosteroid injection being superior to placebo and physiotherapy in the short-term 4
- Rotator cuff tear patients unresponsive to conservative management, with combined bursal aspiration and corticosteroid injection being a recommended treatment 5
Specific Conditions and Injection Sites
- Adhesive capsulitis: intra-articular and subacromial corticosteroid injections have similar efficacy, with no significant difference in primary outcomes between the two injection sites 6
- Rotator cuff tendinopathy: subacromial infiltration is indicated, especially for the treatment of rotator cuff tendinopathies and bursitis 3
- Glenohumeral arthrosis: glenohumeral infiltration is indicated, especially for the treatment of glenohumeral arthrosis, with a combination of a corticoid and anesthetic 3