From the FDA Drug Label
A single local injection of triamcinolone acetonide is frequently sufficient, but several injections may be needed for adequate relief of symptoms. Initial dose: 2. 5 mg to 5 mg for smaller joints and from 5 mg to 15 mg for larger joints, depending on the specific disease entity being treated. For adults, doses up to 10 mg for smaller areas and up to 40 mg for larger areas have usually been sufficient.
The recommended volume of steroid to inject in a shoulder joint is 2.5 mg to 5 mg for smaller joints and 5 mg to 15 mg for larger joints, with a maximum dose of up to 40 mg for larger areas 1.
- The dose may vary depending on the specific disease entity being treated.
- The injection should be made using strict aseptic technique to avoid infection.
- It is also important to avoid injecting the suspension into the tissues surrounding the site to prevent tissue atrophy.
From the Research
The recommended volume of steroid to inject in a shoulder joint is 1 ml of corticosteroid, commonly using medications such as triamcinolone acetonide (20-40 mg/ml), as this dose has been shown to be as effective as higher doses while minimizing potential side effects 2, 3. When performing the injection, it is essential to consider the total volume of the injectate, which should generally not exceed 5-7 ml to avoid excessive pressure in the joint space.
- The procedure should be performed using sterile technique, and ultrasound or fluoroscopic guidance may be used to ensure accurate placement.
- Patients should be informed that they might experience increased pain for 24-48 hours after the injection (post-injection flare) before the anti-inflammatory effects begin.
- The steroid's therapeutic effect typically lasts 3-6 months, and injections are usually limited to 3-4 per year in the same joint to minimize potential side effects such as cartilage damage, tendon weakening, and systemic absorption. The choice of corticosteroid and dose should be individualized based on the patient's specific condition and medical history, and the potential benefits and risks of the injection should be carefully weighed 2.
- A dose of 20 mg triamcinolone is as effective as 40 mg for both shoulder intra-articular corticosteroid injections and subacromial subdeltoid bursa corticosteroid injections 2.
- Ultrasound guidance increases the accuracy of injections and reduces procedural pain 2. The use of corticosteroid injections in joints and musculoskeletal soft tissue is a common practice, and the guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society provide recommendations on the safe use of these injections 2.