No, a Shoulder Injection Will Not Alleviate Dorsal Forearm Pain
A shoulder injection is not indicated for dorsal forearm pain, as the shoulder joint and its surrounding structures do not have anatomical or neurological connections that would explain referred pain to the dorsal aspect of the forearm. This pain distribution suggests a different source of pathology that requires separate evaluation.
Anatomical Mismatch
- Shoulder injections (glenohumeral, subacromial, or acromioclavicular) target pathology within or around the shoulder joint itself 1, 2, 3
- The dorsal forearm is innervated primarily by the radial nerve and posterior interosseous nerve, which do not originate from shoulder joint structures 4
- Shoulder pathology typically produces pain localized to the deltoid region, lateral upper arm, or occasionally radiating down the lateral aspect of the arm—not the dorsal forearm 1, 3
Appropriate Pain Patterns for Shoulder Injections
Shoulder injections are effective for specific shoulder-related conditions with characteristic pain distributions:
- Rotator cuff tendinopathy: Pain in the lateral shoulder and upper arm, with subacromial corticosteroid injection showing a relative risk of 3.08 for improvement (NNT = 3.3) 5
- Adhesive capsulitis (frozen shoulder): Diffuse shoulder pain with restricted range of motion, where intra-articular triamcinolone injections provide significant pain relief 1, 2
- Post-stroke hemiplegic shoulder pain: Localized shoulder pain where intra-articular injections have demonstrated significant effects 1, 3
Alternative Diagnostic Considerations for Dorsal Forearm Pain
The dorsal forearm pain pattern suggests alternative pathology requiring different evaluation:
- Lateral epicondylitis (tennis elbow): Pain originating at the lateral elbow radiating to the dorsal forearm
- Posterior interosseous nerve syndrome: Compression causing dorsal forearm pain without sensory loss
- Radial tunnel syndrome: Deep aching pain in the proximal dorsal forearm
- Cervical radiculopathy (C6-C7): Neck pathology causing radiating pain down the dorsal forearm
- De Quervain's tenosynovitis: Wrist pathology that can cause pain extending up the dorsal forearm
Clinical Pitfall to Avoid
- Do not perform shoulder injections based solely on upper extremity pain without confirming the pain originates from shoulder structures 1, 3
- The accuracy of shoulder injections depends on proper patient selection with confirmed shoulder pathology, not simply upper extremity pain location 6
- Misattributing dorsal forearm pain to the shoulder will delay appropriate diagnosis and treatment of the actual pain source 1
Recommended Approach
- Examine the elbow, forearm, and wrist for local tenderness, provocative maneuvers, and range of motion limitations
- Assess for cervical spine pathology with Spurling's test and neurological examination 1
- Consider nerve conduction studies if nerve compression is suspected
- Target injections or other interventions to the actual anatomical source of pain rather than the shoulder 4, 7