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 (40-80 mg) or triamcinolone acetonide (40 mg) mixed with a local anesthetic like lidocaine 1% (3-5 ml) recommended. The injection should be delivered into the glenohumeral joint or subacromial space, depending on the specific pathology. A single injection is often sufficient, though some patients may require a repeat injection after 4-6 weeks if symptoms persist. These injections work by reducing inflammation and pain, allowing for better participation in physical therapy, which is crucial for recovery. The procedure should be performed using sterile technique, ideally with ultrasound guidance to ensure accurate placement, as suggested by the EULAR recommendations for intra-articular therapies 1.
Following the injection, patients should continue with a structured physical therapy program focusing on range of motion exercises and gradually progressing to strengthening. Patients should be advised that temporary pain flare-ups can occur for 24-48 hours post-injection, and full benefits may take 3-7 days to develop. Diabetic patients should monitor their blood glucose levels closely as corticosteroids can cause temporary elevations, as noted in the EULAR recommendations 1. It is also important to consider the potential risks and benefits of intra-articular glucocorticoid injections, particularly in patients with diabetes mellitus or those who may be considering total joint arthroplasty, as discussed in the 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons clinical practice guideline 1.
Some key points to consider when performing intra-articular injections include:
- Using aseptic technique to minimize the risk of septic arthritis, with a risk estimate of 0.035% as reported in a recent study 1
- Offering local anesthesia to reduce discomfort during the procedure, with options such as topical anaesthetics or infiltration of local anaesthetic along the needle path into the joint 1
- Avoiding overuse of the injected joint for 24 hours following the injection, but not immobilizing the joint, as immobilization has not been shown to add benefit compared to normal activity after intra-articular injection 1
- Considering the potential risks and benefits of repeat injections, with a general accepted rule of avoiding more than 3-4 glucocorticoid injections in the same joint per year, although high-quality studies on the long-term effects of repetitive intra-articular injections are scarce 1.
From the Research
Best Injection for Peri-Arthritis Shoulder
- The most effective injection for peri-arthritis shoulder is a topic of ongoing research, with various studies investigating the efficacy of different corticosteroid doses and types 2, 3, 4, 5, 6.
- A study published in 2011 found that subacromial injection with triamcinolone acetonide (40mg or 20mg) significantly improved pain, function, and active range of motion in patients with periarticular shoulder disorders, with no significant differences between the high- and low-dose groups 2.
- Another study published in 2025 recommended a dose of 20mg triamcinolone acetonide for both shoulder intra-articular corticosteroid injections and subacromial subdeltoid bursa corticosteroid injections, citing its effectiveness and reduced risk of adverse events 3.
- A 1998 study compared the efficacy of two dose regimens of intra-articular triamcinolone acetonide (10mg and 40mg) in patients with capsulitis of the shoulder, finding that the 40mg dose provided greater symptom relief 4.
- A 2014 randomized controlled trial investigated the effectiveness of subacromial triamcinolone acetonide, hyaluronic acid, and saline injections for shoulder pain, finding that triamcinolone acetonide injections provided the largest decrease in pain on the VAS scores after injection compared to the other groups 5.
- A 2023 study found that 10mg of triamcinolone acetonide was non-inferior to 40mg in improving pain in patients with symptomatic knee osteoarthritis, suggesting that lower doses may be effective and reduce the risk of adverse events 6.
Key Findings
- Triamcinolone acetonide injections are effective in reducing pain and improving function in patients with periarticular shoulder disorders 2, 3, 4, 5.
- Lower doses of triamcinolone acetonide (20mg) may be as effective as higher doses (40mg) in reducing pain and improving function, with a reduced risk of adverse events 2, 3, 6.
- The efficacy of corticosteroid injections may vary depending on the specific condition being treated, with some studies suggesting that lower doses may be effective for certain conditions 6.