Is another steroid injection beneficial for my chronic shoulder pain due to supraspinatus tendon (mild rotator cuff tear) impingement, given my history of inconsistent physical therapy and previous relief from a steroid injection, while considering the risk of tendon weakening?

Should You Get Another Steroid Injection?

Your orthopedic surgeon is correct that repeated steroid injections carry risks of tendon weakening, and given your mild rotator cuff tear with previous injection response, you should prioritize consistent physical therapy over another injection—but if you remain symptomatic despite proper rehabilitation, one additional injection may provide short-term relief while you work toward either sustained conservative management or surgical repair. 1

The Evidence on Repeat Injections

The American Academy of Orthopaedic Surgeons explicitly advises against repeated steroid injections without clear sustained benefit, as evidence shows no long-term efficacy beyond 6 weeks and potential adverse effects on tendon healing. 1 The guideline states they "cannot recommend for or against subacromial corticosteroid injections specifically for full-thickness tears due to inconsistent study results." 2

Your surgeon's warning about tendon weakening is evidence-based: A prospective study found that 17% of patients developed full-thickness rotator cuff tears within 12 weeks after a subacromial corticosteroid injection, with 66.6% of these occurring in patients who already had partial-thickness tears like yours. 3 This is a critical finding—you already have a mild tear, placing you in the higher-risk category for progression.

Why Physical Therapy Must Come First

The key issue here is your inconsistent physical therapy adherence. Recent meta-analysis evidence from 2025 shows that corticosteroid injections coupled with physical therapy interventions resulted in small to moderate improvements in pain and function at short term, but corticosteroid injection alone was not more effective than physical therapy interventions in most studies. 4

The American Academy of Orthopaedic Surgeons notes that while they cannot make a strong recommendation for or against exercise programs due to limited evidence quality, the primary objectives of nonsurgical management are to decrease pain, increase function, and enhance activities of daily living. 2

Your Decision Algorithm

Step 1: Commit to 6-8 weeks of consistent, supervised physical therapy first

• Focus on rotator cuff strengthening and scapular stabilization exercises 4
• This addresses the root cause rather than just masking symptoms
• If you achieve adequate pain control and functional improvement, continue conservative management 2

Step 2: If you remain significantly symptomatic after proper physical therapy trial

• Consider ONE additional steroid injection combined with continued physical therapy 1, 4
• This may provide 6 weeks of symptom relief to allow better participation in rehabilitation 2
• Understand this is a bridge strategy, not a long-term solution

Step 3: If symptoms persist despite injection plus proper physical therapy

• Surgical rotator cuff repair becomes the primary recommendation 1
• Surgery shows significantly less pain with shoulder range of motion and at night, with 81% of surgical patients achieving excellent results compared to 37% with nonsurgical treatment 2, 1

Critical Pitfalls to Avoid

Do not pursue multiple repeated injections without addressing the underlying problem through physical therapy. 1 The evidence shows no benefit beyond 6 weeks, and you risk progression of your tear. 3

Do not use opioids as first-line treatment—they should be reserved strictly for rescue analgesia only. 1, 5

Do not delay surgical evaluation indefinitely if conservative management truly fails. While you want to avoid surgery, chronic symptomatic full-thickness tears that persist despite proper conservative treatment have better outcomes when repaired rather than allowed to progress. 2, 1

The Bottom Line on Your Specific Situation

Your previous positive response to injection suggests you may benefit from another one, but the real problem is your inconsistent physical therapy. 4 A second injection without addressing this will likely lead to the same cycle—temporary relief followed by return of symptoms. The injection didn't fail you; the incomplete rehabilitation did.

If you genuinely cannot commit to consistent physical therapy, then repeated injections are not the answer—you should discuss surgical timing with your orthopedic surgeon instead. 1 Surgery is indicated when chronic symptomatic tears persist despite prior conservative measures, which includes both injections AND proper physical therapy. 2, 1