If you have shoulder pain and you have been told that you will be having a corticosteroid injection. You must be having questions about the benefits of the injection and the aftercare recovery.
As a diagnostic radiographer I assist and observe radiologists’ perfume shoulder injections and I always hear patients ask my radiography opinion on the effectiveness of shoulder injections.
As usual I have delved deep into the subject by reading scientific publications on this therapy and I also consulted one of my radiologists, an expert in shoulder injections to answer your questions.
My aim is to help you find a clearer understanding of the potential benefits of this therapy.
Happy reading!😀
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: June 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
▶️What exactly is corticosteroid shoulder injection?
Corticosteroid or hydrocortisone are injections that are used to help relieve pain, swelling and irritation in a specific area of your body.
Cortisone is an effective anti-inflammatory medication. It was only discovered as recently as 1950 (earning a Nobel Prize for medicine for Hench and his co-workers) and has been available in an injectable form since 1951.
It acts on both acute and chronic phases of inflammation to reduce both tissue swelling and subsequent scar formation.
They’re most often injected into joints such as the ankle, elbow, hip, knee, shoulder, spine, or wrist.
Even the small joints in the hands or feet might benefit from cortisone shots.
For this article focus will be on shoulder corticosteroid injections.
Cortisone injections make up a very important part of the treatment of shoulder pain or injuries. They are also called Hydrocortisone.
Hydrocortisone is a type of medicine known as steroid or corticosteroid that closely resembles cortisol, a hormone that our adrenal glands produce naturally.
These kinds of joint injections are always considered only after other appropriate therapeutic interventions have been tried. For example:
🟠The use of nonsteroidal anti-inflammatory drugs (NSAIDs)
🟠Physical therapy interventions have been tried.
🟠Modifying medications for rheumatoid arthritis.
Which makes one wonder if they are more effective or better than other methods.
▶️How is the cortisone injection for the shoulder given?
Ultrasound-guided injections or X-ray is used to help locate the specific area for treatment before the steroid is given.
The doctor will give you a lower dose of cortisone in the exact area of discomfort, reducing the risk of side effects while still eliminating pain.
Cortisone injections can be uncomfortable for a couple of days after the medication is administered. To minimise your discomfort, the area will be numbed with a local anaesthetic.
Image: Injection into the subacromial joint: X-ray image showing outcome.
▶️Images :shoulder Injection into the subacromial
Possible side effects after the injection
🟠Pain, swelling or bruising in the injected site.
🟠Flushed face.
🟠Irregular periods in women.
🟠Rush and headache.
Most people have only mild side effects, especially if they take time to recover after an injection, as this reduces the risk of cortisone being absorbed into the blood.
Is cortisone shoulder injection just a painkiller?
The cortisone injection is not just a painkiller. It works by reducing inflammation and pain.
As such it is treating the pathology, not just the pain. It is important that the injection is followed up with appropriate rehabilitation.
How long should a shoulder injection last?
According to specialised doctors and scientific studies cortisone injections can offer shoulder pain relief for up to six months or sometimes a year.
You can have top-up injections no more than every three months if needed.
A planned programme of injections, physiotherapy, and other pain-relieving strategies can help your shoulder joint heal, minimising the need for injections in future.
How long to rest after joint injection?
As a rule, it is advised to rest for a minimum of 2 days after a steroid injection. After 2 days, you can gradually build up your activity levels.
▶️ What happens if I don’t rest after cortisone injection?
Nothing life threatening happens if you do not rest after a cortisone injection, but I will give reasons why resting is important after you have had the injection.
1️⃣Allow the steroid to work -Steroids injections provide rapid relief, but it’s not always instant. Resting your joint(s) for a few days will help the medicine take effect.
2️⃣Prevent systemic absorption- Cortisone injection works best if it remains in the targeted area, so resting can stop the steroid being absorbed by the blood or other tissues in the body.
3️⃣Minimise the risk of cartilage damage- Chondrotoxicity (cartilage damage) is a known side effect of steroid injections, but the risk can be reduced by resting for a few days after the procedure.
It will be ok after a couple of days, after the cortisone injection has taken effect to safely and slowly resume your normal activity levels.
If you did a lot of exercise before your injection, make sure to start slowly and build up to your previous activity levels.
▶️How can we explain the potential benefits of cortisone injections?
Cortisone injections combined by an active rehabilitation program are one of the many treatments proposed to alleviate shoulder problems such as:
🟣Help reduce the need for surgery in shoulder impingement syndrome.
🟣Management of rotator cuff disease (degenerative tendinosis, impingement, partial tears and subacromial bursitis)
🟣Shoulder bursitis happens when the bursa (fluid-filled sacs) around your shoulder joint start to become inflamed.
The shoulder may feel tender, swollen, or warm to the touch, and you’ll often experience a dull pain in the area.
🟣Adhesive capsulitis (frozen shoulder)
If you always have stiffness in your shoulder which is long term, when you go to your doctor you could be told that your condition is frozen shoulder or adhesive capsulitis in medical terms.
🟣Glenohumeral osteoarthritis
The glenohumeral joint is the most mobile joint in the body. Its articulation is stabilised by the soft tissue configurations of a few ligaments and muscles.
Cortisone injections are a common treatment for easing pain and stiffness caused by arthritis.
While they can’t repair the degraded cartilage around your shoulder joint, cortisone injections may reduce any painful swelling.
🟣Acromioclavicular joint disease (osteoarthritis or osteolysis)
🟣Non-specific shoulder pain
▶️Do cortisone shoulder injections really help with shoulder pain?
What do Scientific studies say on cortisone injections and shoulder problems or pain.
There is a vast number of scientific publications on the effectiveness of cortisone injections in treating shoulder problems such as osteoarthritis, frozen shoulder, and rotator cuff disease.
Most publications have limitations and flaws on the effectiveness of these injections due to the limited sample of survey obtained.
However patients who have had these injections testify to significant benefits of cortisone injection for frozen shoulder, osteoarthritis, and shoulder pain.
1️⃣Cortisone injections for frozen shoulders can provide effective short-term relief and increase range of motion.
A study about the effectiveness of cortisone injection was done with the aim of evaluating and comparing the outcome of physiotherapy and corticosteroid injection with physiotherapy alone in terms of reduction in pain and improvement in ROM. (Rashid,2020)
Findings:
The combination of steroid treatment with physiotherapy was found to be more effective than physiotherapy alone for frozen shoulder.
2️⃣The steroid or cortisone reduces inflammation which helps reduce pain. Its effect builds up during the first few days and should last a few months.
3️⃣Still there is Limited data available on the effectiveness of cortisone injections for shoulder joint osteoarthritis.
A study aimed to determine the efficacy of corticosteroid injections for shoulder arthritis which was done on 30 shoulders (29 patients).
Patients who had more severe shoulder dysfunction experience statistically significantly greater symptomatic relief after the injection than patients who had milder dysfunction.
Most studies statistically and clinically identify relevant improvements in shoulder function and pain up to 4 months after injection.
▶️ What should you do or not do after a steroid injection in the shoulder?
🟩You can usually walk around normally after a cortisone injection in your shoulder as long as you’re feeling well.
🟩However, you’ll need to rest your arms and upper body for 1 to 2 days, or 24 hours but this will depend on the state of your health and fitness.
🟩Your shoulder avoid heavy lifting after you have received a cortisone injection for at least 7 days.
🟩You can use ice on the injection site as needed to relieve pain if you feel pain.
🟩 Watch for signs of infection, including increasing pain, redness and swelling lasting more than 48 hours.
🟩Not use a bathtub, hot tub or whirlpool for two days. It’s OK to shower.
▶️How do you sleep after shoulder injection?
⚪Sleep in a way that’s easy on your shoulder.
⚪Use pillows to give your shoulder a little extra love.
⚪Do some simple stretches before bed.
⚪Try a cold pack or something warm on your shoulder.
⚪If you need it, use a gentle pain reliever.
▶️Can I drive after a shoulder injection?
You will not be allowed to drive after a shoulder joint injection because the local anaesthetic used in your shoulder may make your arm weaker than usual and prevent you getting a firm grip on the steering wheel.
The patients who come for these injections are advised to bring someone with them to the appointment, so they don’t need to drive home after their treatment.
You can start to drive as soon as the feeling and strength in your arm returns to normal.
Caution! You should only drive after a cortisone injection if it’s clinically safe for you to do so. If you feel drowsy, numb, or weak following your injection, you shouldn’t drive.
It’s best to bring someone else to your injection appointment with you so you won’t need to drive afterwards.
▶️Do you need time off work after a steroid injection?
You may choose to take a day or two off work after a cortisone injection, especially if you have a physically demanding job.
But it’s not mandatory, if you have the flexibility to rest your affected joints while you’re at work then you can go to work.
But you should not be hard on yourself, take it easy, life is all about you. Work can wait until you feel better because when you leave you will be replaced straight away.
I wish you a quick recovery,🙋 hope I have answered some of your questions.
📚Sources:
De Beer J. Corticosteroid injections in the shoulder. Pain Med. 2011 Oct;12(10):1449. Doi: 10.1111/j.1526-4637.2011.01236. x. PMID: 22018027.
Greenfield G, Stanish WD. Relieving Shoulder Pain Without Surgery. Phys Sportsmen. 1994 Apr;22(4):66-82. Doi: 10.1080/00913847.1994.11947626. PMID: 29281458.
Rashid A, Jatin A, Rakesh G, Subodh P and Aryan S. Evaluating the Outcome of Two Different Regimes in Adhesive Capsulitis: A Prospective Clinical Study: Med Princ Pract (2020) 29 (3): 225–230.https://doi.org/10.1159/000503317
Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboom-de Jong B. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study BMJ. 1997 May 3;314(7090):1320-5. doi: 10.1136/bmj.314.7090.1320. PMID: 9158469; PMCID: PMC2126546.
Bak K, Isaksson F. [Frozen shoulder]. Ugeskr Laeger. 2019 Feb 11;181(7):V03180207. Danish. PMID: 30777592.
Metzger CM, Farooq H, Merrell GA, Kaplan FTD, Greenberg JA, Crosby NE, Peck KM, Hoyer RW. Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis. J Shoulder Elbow Surg. 2021 May;30(5):1128-1134. doi: 10.1016/j.jse.2020.08.008. Epub 2020 Aug 25. PMID: 32858193.