From the Guidelines
For periarthritis of the shoulder, corticosteroid injections are typically the most effective option, with a combination of a corticosteroid such as methylprednisolone or triamcinolone acetonide with a local anesthetic like lidocaine recommended. The injection should be delivered into the glenohumeral joint or subacromial space, depending on the specific pathology. According to the EULAR recommendations for intra-articular therapies 1, the use of imaging guidance, such as ultrasound, may improve accuracy. A single injection often provides significant pain relief, though some patients may require a repeat injection after 3-4 weeks if symptoms persist. These injections work by reducing inflammation in the shoulder capsule and surrounding tissues, thereby decreasing pain and improving range of motion. For optimal results, the injection should be followed by a physical therapy program focusing on stretching and strengthening exercises. Some key points to consider when performing these injections include:
- The use of local anesthetics, such as lidocaine, to reduce pain during the procedure 1
- The importance of accuracy in delivering the injection, which can be improved with imaging guidance 1
- The potential side effects of the injections, including temporary pain at the injection site, skin depigmentation, and rarely, infection or tendon weakening with repeated injections It's worth noting that the evidence for the use of corticosteroid injections in the treatment of glenohumeral osteoarthritis is limited, with one study finding no evidence to support or refute their use 1. However, based on the most recent and highest quality evidence, corticosteroid injections remain the recommended treatment option for periarthritis of the shoulder.
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 best injection for peri arthritis shoulder is triamcinolone acetonide. The recommended dose is:
- 5 mg to 15 mg for larger joints, such as the shoulder
- The injection should be made into the joint space using strict aseptic technique 2
From the Research
Treatment Options for Periarthritis Shoulder
- Intra-articular corticosteroid injections, such as triamcinolone, are commonly used to treat periarthritis shoulder, providing short-term pain relief 3, 4.
- Platelet-rich plasma (PRP) injections have shown promising results in reducing pain and disability scores in patients with periarthritis shoulder, with better long-term outcomes compared to corticosteroid injections 5, 6.
- Ultrasonic therapy is also used to treat periarthritis shoulder, but its effectiveness is limited compared to PRP and corticosteroid injections 6.
Efficacy of Different Injections
- A study comparing PRP and triamcinolone injections found that PRP showed better long-term outcomes in reducing pain and disability scores 5.
- Another study found that PRP treatment resulted in statistically significant improvements over corticosteroid and ultrasonic therapy in active and passive range of motion of the shoulder, as well as pain and function scores 6.
- Triamcinolone injections have been shown to be effective in reducing pain and improving function in patients with periarthritis shoulder, with a dose of 40 mg being more effective than 10 mg 4.
Safety and Adverse Effects
- Corticosteroid injections can have adverse effects, including increased blood glucose, adrenal suppression, and detrimental effects on cartilage and bone mineral density 3.
- PRP injections are generally considered safe, with no major adverse effects reported in studies 5, 6.
- The use of ultrasound guidance can increase the accuracy of injections and reduce procedural pain 3.