Next Steps After Successful Corticosteroid Injection for Shoulder Pain
Continue with physical therapy and activity modification now that pain has improved, while avoiding overhead pulley exercises which can worsen shoulder pathology. 1, 2
Immediate Management (24-72 Hours Post-Injection)
Expect continued improvement over the next 2-7 days as the full anti-inflammatory effects of the corticosteroid manifest, since the initial 24-hour relief is primarily from the local anesthetic component rather than the steroid itself. 3
Monitor for post-injection flare: Some patients experience temporary pain increase during the first 24-48 hours before sustained improvement occurs. 3
Initiate or advance physical therapy now that pain control allows better participation in rehabilitation—this is the primary reason for using corticosteroid injections in the first place (rapid symptom control to facilitate rehabilitation). 2
Physical Therapy Recommendations
Strongly recommend active physical therapy interventions (supervised exercise) rather than passive modalities like massage, ultrasound, or heat. 1
Use land-based physical therapy over aquatic therapy interventions. 1
Absolutely avoid overhead pulley exercises, as they encourage uncontrolled abduction and can worsen shoulder pathology—this is a critical contraindication after shoulder injection. 1, 2
Provide patient and family education on proper range of motion exercises and positioning techniques for shoulder care. 1
Expected Duration of Benefit
Short-term benefit (up to 6 weeks) is most consistently demonstrated with corticosteroid shoulder injections. 2, 4
Pain relief typically begins within minutes to hours from the anesthetic, while corticosteroid benefits appear within 2-7 days and can last weeks to months. 3
Research shows that at 0-8 weeks post-injection, corticosteroid injections provide superior pain relief compared to placebo, though this advantage may not persist at 9-24 weeks. 5
Criteria for Repeat Injection (If Needed)
Only consider repeat injection if the patient achieved ≥50% pain relief lasting at least 2 months from this first injection. 2, 6
If pain recurs after a documented period of improvement meeting these criteria, a repeat injection may be medically necessary. 6
Common Pitfalls to Avoid
Do not use systemic glucocorticoids for shoulder conditions—local injection is the appropriate route. 1, 2
Avoid peri-tendon injections due to rupture risk. 2
Recognize that injection alone is insufficient—the therapeutic window created by pain relief must be used for active rehabilitation to achieve lasting functional improvement. 2
Understand that precise needle placement (whether ultrasound-guided or landmark-guided) matters less than previously thought, as multiple studies show no significant difference in clinical outcomes between techniques. 7, 8
Monitoring and Follow-Up
Reassess at 2-4 weeks to evaluate response to combined injection and physical therapy. 4
Document functional improvements including pain scores, range of motion (particularly forward elevation and external rotation), and ability to perform activities of daily living. 4
If inadequate response by 6 weeks despite appropriate physical therapy, consider alternative diagnoses or additional imaging (ultrasound can be useful for diagnosing soft tissue shoulder injuries). 1