Part 3: Shoulder steroid injections? What are the common ingredients and when is the best time to use them IF you are trying to rehab your shoulder at the same time.

A corticosteroid injection is a commonly used tool to deal with shoulder pain. But it is important to remember that it is just that, a tool to deal with pain, if we do not address the cause of the pain and the pain will return over time.

What Are The Most Common Ingredients?

The most commonly used corticosteroid is Cortisone, and is typically injected using a needle that is guided by an ultrasound image into the subacromial (under the point of the shoulder) space and subacromial bursa of the shoulder joint. Hyaluronic acid is sometimes used in cases where arthritis is the primary cause of pain, because research shows it to be more effective in that population. 

Why Use Cortisone?

Cortisone is a quick acting corticosteroid and powerful anti-inflammatory medication which can reduce the inflammation at the site it is injected to, therefore reducing the pain associated with movements of the shoulder – often involving lifting things over your head.

When Should You Get A Cortisone Injection?

The timing of when to have a corticosteroid injection depends on how you are progressing with your rehab. If, during the early stages, pain is very debilitating and affecting your day to day life, such as reducing sleep and the ability to do your job and finally the necessary exercises to solve the cause of the problem-then an early corticosteroid injection can be extremely useful. 

However, there are other scenarios, such as someone that progresses quite quickly through the rehab with many of the exercises, but reaches a plateau towards the end. As they try to increase their activity back to their normal levels, the pain begins to come back and they are unable to cope with the functions that they need to. For example returning to sport; in this scenario, a corticosteroid injection later may be useful to get through the final stages.

Will Cortisone Fix My Shoulder Pain?

ONLY in one situation: When your strength and range of motion in the shoulder are very close to normal. Sadly this is rarely the time it is used. If you have the injection when you have significant weakness in the muscles of the shoulder, or significant tightness in the shoulder cortisone will either have no effect, or a moderate short term effect only. 

The injection may still be beneficial in the other situations we have previously mentioned, but in those situations the injection will not fix the pain completely, just reduce it. Unless we address these factors through manual therapy, strength training and scientific return to activity planning the pain will return once the Cortisone wears off.

Do I Need A Cortisone Injection?

Maybe. 

But…the majority of our shoulder patients successfully rehab without the need for corticosteroid injection. It is a useful tool that we always consider in the right clinical scenario. 

If you’re wondering if you are in the “right clinical scenario” make an appointment with one of our team for a detailed assessment.