What are the indications for a corticosteroid (cortisone) injection in the left shoulder of a 76-year-old male?

From the Guidelines

I strongly recommend against proceeding with a corticosteroid injection for this 76-year-old male's left shoulder without first confirming the diagnosis and identifying the appropriate injection site, as the evidence suggests that corticosteroid injections may only be effective in patients with specific shoulder pathology, such as rotator cuff tendinopathy or subacromial bursitis 1.

Important Considerations

• The patient's shoulder should be properly examined to confirm the diagnosis and identify the appropriate injection site, as the effectiveness of corticosteroid injections depends on the underlying pathology 1.
• The procedure involves cleaning the area with antiseptic solution, using sterile technique, and injecting into the glenohumeral joint or subacromial space depending on the pathology.
• The patient should be informed that he may experience temporary pain flare-up for 24-48 hours after injection, and that relief typically begins within 2-7 days and may last for weeks to months.
• Corticosteroid injections work by reducing inflammation and suppressing immune responses in the affected area, thereby decreasing pain and improving function.
• However, injections should generally be limited to 3-4 per year in the same joint due to potential cartilage damage with repeated use.

Alternative Treatment Options

• Gentle stretching and mobilization techniques, and typically involves increasing external rotation and abduction, may be effective in treating hemiplegic shoulder pain related to limitations in range of motion 1.
• Analgesics, such as acetaminophen or ibuprofen, can be used for pain relief, but their effectiveness may be limited 1.
• Botulinum toxin injections into the shoulder musculature have shown mixed results in the management of shoulder pain, and may be effective in reducing shoulder spasticity and pain associated with spasticity-related joint mobility restrictions 1.
• Suprascapular nerve blocks may be effective in reducing shoulder pain through a reduction of both nociceptive and neuropathic pain mechanisms 1.

From the FDA Drug Label

Intramuscular Where oral therapy is not feasible, injectable corticosteroid therapy, including KENALOG-40 Injection and KENALOG-80 Injection (triamcinolone acetonide injectable suspension, USP) is indicated for intramuscular use as follows: Intra-Articular The intra-articular or soft tissue administration of KENALOG-40 Injection and KENALOG-80 Injection are indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

The patient is requesting a cortisone shot to his left shoulder. Intra-articular administration of triamcinolone is indicated for short-term administration in conditions such as synovitis of osteoarthritis.

• The use of triamcinolone for a cortisone shot in the shoulder is supported by the drug label, as it can be used for intra-articular administration in conditions like osteoarthritis.
• However, the specific diagnosis for the patient's shoulder condition is not provided.
• Given the information available, a cortisone shot with triamcinolone may be considered for the patient's left shoulder, but only if the condition is one of the indicated conditions, such as osteoarthritis, and under the guidance of a healthcare professional 2.

From the Research

Cortisone Shot for Left Shoulder

• A 76-year-old male is requesting a cortisone shot for his left shoulder, which may be related to rotator cuff disease or other musculoskeletal conditions.
• The use of subacromial corticosteroid injections for treating shoulder pain has been questioned by prospective studies, which have compared their efficacy to nonsteroidal anti-inflammatory drugs or local anesthetics 3.
• Accurate diagnosis of the etiology of shoulder pain and proper injection technique are crucial for achieving satisfactory clinical outcomes 3.

Considerations for Corticosteroid Injections

• Corticosteroids are commonly injected into soft tissues, tendon sheaths, bursae, and joints to reduce inflammation, but they carry a low risk of complications and can cause systemic and local adverse effects 4.
• The role of corticosteroid injections in managing rotator cuff disease remains unclear, and strong scientific evidence suggests that they may worsen long-term outcomes for patients with lateral epicondylosis 4.
• Corticosteroid injections may provide short-term pain relief and improvement in function for subacromial impingement syndrome, but their effectiveness for other conditions, such as osteoarthritis, tendinopathy, and bursitis, is less clear 5.

Alternative Treatments

• Magnetic Resonance Therapy (MRT) has shown promise in treating osteoarthritis, with studies demonstrating significant improvements in pain, joint function, and quality of life 6.
• Imaging techniques, such as MRI, can provide valuable information about the joint and its structures, which can inform treatment decisions and monitor disease progression 7.