Recommended Kenalog Dose for Shoulder Injection
For shoulder injections, use 40 mg of triamcinolone acetonide (Kenalog), which is the standard dose recommended by the American College of Physicians and supported by FDA labeling for intra-articular administration in larger joints. 1, 2
Standard Dosing Protocol
Administer 40 mg triamcinolone acetonide as a single intra-articular injection into either the glenohumeral joint or subacromial space, depending on whether the pathology is primarily articular or involves the rotator cuff/bursa 1, 2
The FDA label specifies that for larger joints, doses ranging from 5 mg to 15 mg are typical, but doses up to 40 mg for larger areas have usually been sufficient 2
This 40 mg dose has demonstrated significant pain reduction in clinical trials, with one high-quality study showing that 40 mg provides superior symptom relief compared to lower doses (10 mg) for capsulitis of the shoulder 3
Evidence Supporting This Dose
The 40 mg dose is consistently supported across multiple evidence sources:
A randomized controlled trial directly comparing 40 mg versus 10 mg triamcinolone acetonide found that the 40 mg group showed significantly greater improvement in pain, sleep disturbance, and functional outcomes 3
Multiple studies examining shoulder pain conditions (subacromial impingement, hemiplegic shoulder pain, rotator cuff pathology) have used 40 mg as the standard dose with demonstrated efficacy 4, 5, 6
The effect is most pronounced for pain relief rather than range of motion improvement 3
Administration Technique
Inject deeply using strict aseptic technique into the target area (glenohumeral joint or subacromial space) 2
If excessive synovial fluid is present, aspirate some (but not all) before injection to aid pain relief and prevent dilution of the steroid 2
Avoid injecting into surrounding tissues, particularly in the deltoid region, as this may lead to tissue atrophy 2
Consider using a local anesthetic prior to injection for patient comfort 2
Repeat Injection Considerations
A single injection is frequently sufficient, though some patients may require additional injections 2
If repeat injections are needed, research suggests the greatest benefit occurs with the first and second injections; a third injection provides minimal additional benefit 6
The FDA allows single injections into several joints up to a total of 80 mg 2
Critical Pitfalls to Avoid
Never inject at sites of active infection (impetigo, herpes, cellulitis) 1, 2
Do not use in patients with previous hypersensitivity to triamcinolone 1
Exercise caution in patients with uncontrolled diabetes, heart failure, or severe hypertension, as systemic absorption can occur 1
Be aware that long-term effectiveness is not well established—corticosteroid injections primarily provide short-term relief (weeks to months), not long-term cure 1
Monitor for local adverse effects with repeated injections: skin atrophy, pigmentary changes, telangiectasias, and subcutaneous fat atrophy if injection is not properly placed 1, 2
Repeated injections can suppress the hypothalamic-pituitary-adrenal axis, particularly with frequent administration 1
Expected Clinical Response
Pain relief typically begins within the first week after injection, with peak effect at 2-6 weeks 4, 6
Approximately 50% improvement in pain and disability scores can be expected, maintained through several months 4
The effect on pain and sleep disturbance is more marked than improvement in range of motion 3
If no response occurs after 1-2 injections, consider alternative diagnoses or treatment modalities 4