Shoulder Injection Dosing with Triamcinolone 40 mg/mL
For shoulder injections, use 1 mL of triamcinolone acetonide 40 mg/mL suspension (total dose: 40 mg) administered intra-articularly into the glenohumeral joint or subacromial space. 1
Standard Dosing Protocol
The 40 mg dose is the established standard for shoulder pathology based on multiple sources:
- The American Academy of Dermatology recommends 40 mg of triamcinolone acetonide for shoulder injections, which translates to 1 mL when using the 40 mg/mL concentration 1
- The FDA-approved formulation (Kenalog-40) is specifically designed at 40 mg/mL for intra-articular use 2
- Clinical trials consistently demonstrate that 40 mg provides superior pain relief compared to lower doses (10 mg or 20 mg) for shoulder conditions including capsulitis and frozen shoulder 3, 4
Evidence Supporting 40 mg Dose
The 40 mg dose has proven superiority over lower doses:
- A randomized trial showed patients receiving 40 mg triamcinolone acetonide had significantly greater improvement in pain, sleep disturbance, and functional impairment compared to those receiving 10 mg 3
- Another prospective randomized trial comparing 40 mg versus 20 mg found both doses effective, but the 40 mg dose showed faster pain reduction in the first week after injection 4, 5
- For hemiplegic shoulder pain specifically, 40 mg intra-articular injections demonstrated measurable effects on pain reduction 1, 6
Administration Technique
Inject into either the glenohumeral joint or subacromial space depending on the underlying pathology (rotator cuff tendinopathy favors subacromial; adhesive capsulitis favors glenohumeral) 1
Repeat Injection Considerations
- Maximum benefit occurs with the first and second injections; a third injection provides minimal additional benefit 5
- The American Academy of Dermatology recommends spacing injections every 3-4 weeks as needed 1
- Pain relief typically begins within the first week and peaks at 4-6 weeks 5
Critical Precautions
Avoid injection in these situations:
- Active infection at the injection site 1
- Previous hypersensitivity to triamcinolone 1
- Uncontrolled diabetes (the 40 mg dose causes higher short-term glucose elevation at 6 weeks compared to 20 mg in diabetic patients) 4
- Active tuberculosis or systemic fungal infections 1
Monitor for local adverse effects including skin atrophy at the injection site, pigmentary changes, and telangiectasias 1
Practical Summary
Using your 40 mg/mL formulation: Draw up and inject 1 mL (40 mg total dose) into the affected shoulder joint or subacromial space. This is the evidence-based standard dose that provides optimal pain relief with acceptable safety profile for most shoulder pathology.