The shoulder is a complex joint that relies on many muscles, tendons and ligaments to hold it together. The shoulder can develop a multitude of conditions. Common ailments that can occur are tendinitis, bursitis, rotator cuff syndrome, frozen shoulder (also known as adhesive capsulitis) and degenerative or inflammatory arthritis. Inevitably, all of these conditions will develop varying degrees of pain, inflammation and stiffness. Unfortunately, these conditions are often a challenge to treat due to the usage of our shoulder joint in all aspects of work and recreation.
All therapy is aimed at reducing pain and inflammation and restoring ranges of motion and functionality. Usually, conservative care is initially prescribed. But, if results are not satisfactory after an appropriate course of conservative care, more invasive medical intervention may be considered. There are varying degrees of “invasiveness” which would tend to range from injection therapy to surgery.
The most common form of injection therapy involves the use of corticosteroids, or just “steroids”. These are synthetic drugs that resemble cortisol, a hormone that you produce in your adrenal glands. Note that steroid injections are not the same as the enhancement drugs that some athletes have used. Corticosteroids have an anti-inflammatory affect and may be given orally. But injections allow for an increased dosage to a specific area of the body. Also, local injection may help avoid the need for oral steroids which could have greater side effects such as stomach irritation.
Steroid injections are readily available and can be administered at your doctor’s or specialist’s office and can often give immediate relief of a local area. This is welcoming when one has suffered with pain for a long period of time. But, as with any therapy, steroid injections may or may not be effective.
What to Expect
When getting an injection, the doctor, nurse of other health practitioner will swab the area with alcohol or iodine-based cleaning solution. They may utilize a numbing lotion or spray over the site or the steroid may be mixed with an anaesthetic solution. There may be slight burning or pressure with the injection. Occasionally, the injection will be administered with the use of ultrasound imaging or a special motion x-ray called fluoroscopy. This allows the practitioner to visualize the tissue on a monitor in order to allow for a more precise injection procedure. After the shot, a bandage will be applied. In the case of injecting a joint, if the joint has too much fluid, the excess may be drawn out using a separate syringe.
The anaesthetic usually wears off after a few hours. After the injection some people experience pain for 24-48 hours – this is known as post-steroidal flare. Ice or over-the-counter medication may be used to relieve this discomfort. You can usually resume full function after you have an injection but your doctor may tell you to avoid strenuous activity for approximately 2 weeks. Some people have a warm feeling in their face and chest after a shot. If you are diabetic, you may have a temporary increase in your blood sugar levels. The corticosteroid usually takes approximately 1-2 days for you to feel its effects with reduced inflammation and decreased pain.
Injection Side Effects
As with any medication, there are possible side effects or risks involved. Common risks from steroid injections include pain at the injection site, bruising due to broken blood vessels, skin discolouration and aggravation of inflammation. Rarer risks include allergic reactions, infection, tendon rupture and serious injury to bones called necrosis. Long term side effects (depending on frequency and dose) include thinning of skin, easy bruising, weight gain, puffiness in the face, higher blood pressure, cataract formation, and osteoporosis (reduced bone density). Steroid injections may be given every 3-4 months but frequent injections may lead to tissue weakening at the injection site and is not recommended. Side effects do not happen in everyone and vary from person to person.
A recent study in the Annals of Internal Medicine, August 2014, compared a one year outcome of steroid injection to physical therapy for shoulder impingement syndrome. Both groups showed the same pain level and disability improvement after 1 year (approximately 50% improvement). But 60% of the injection group had to return to their primary care doctor after 1 year as compared to 37% of the physical therapy group. Also, the injection group were more likely to need more injections or physical therapy after 1 year.
If you happen to be from Ontario, Canada, application of the injection is covered under OHIP (in Ontario) but you must purchase the medication from the pharmacy. This may be covered under private health insurance or the Ontario Drug Benefit Program. Other Canadian provinces will likely have similar benefits.
In conclusion, with any shoulder condition it is best to start a trial of conservative care. If after a reasonable period, this does not prove effective, imaging and further medical intervention should be considered. Steroid injection is a widely used and relatively safe option but, as with any therapy, should be utilized with care.
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Does it hurt?
Yes! I had one today. But it is less than 30 second pain. I hope it works. It has a dull throb right now but they said to expect that; after two days I should be pain free.
I had a cortisone shot for frozen shoulder last week. I had not expected any pain beyond that of a typical vaccination. Unfortunately for me, unlike most people’s experience with such shots, my pain from the injection was intense (i.e., not from the needle, but from the increasing pressure in the capsule that felt as if it might burst … I was literally writhing and crying and cursing and shrieking throughout, with the doctor’s assistant gripping my hand and “counting down” the remainder of the injection). The doctor said afterwards this was because my capsule was particularly inflamed and tight. She recommended that I arrange in advance for more effective pain control if I have to do this again.
Over the next two days, my frozen shoulder pain was worse than what I went in with (I assume this was a steroid flare), and then somewhat reduced … but if there’s any improvement in range of motion after thse first 7 days, the improvement is so far slight … and it is still painful to try to push past those limitations. I’m a bit disappointed so far, but am still hoping for improvement.
Does the shot hurt
Yup! But the relief is well worth it. (and doesn’t hurt a lot they mix in lidocaine with the cortisone .)
i fell and broke two bones in my shoulder i have been having physical therapy for about two months i have been in considerable pain with very little relief from oral medication i am now considering the injection but need to know in depth more about this can you advise if this is the way to go. Thank you
I have heard that you should only have one cortisone injection ( rotator cuff ) a year because it could cause heart problems .The one shot I had lasted three months & my doctor wrote a scribe for two more. My pain is tolerable now, but is slowly increasing. I have done physical therapy & I do mild yoga twice a week. Any answers or suggestions ? Thank you
I know a couple of people that have had cortisone in their shoulder and they are fine. They spray an anesthetic as they give the shot. Of course it would hurt if they did not. They say its worth it. One woman had to have three shots. Has had no paid since. I am about to have the same thing. Shoulder grinding six months ago turned into really bad debilitating pain after I started my yard work this spring. I have had shots in my knee before. Let’s hope this helps and lasts as long as the knee has.
I just wanted to ask can i reduce my weight with use of steroids, what is the best option ?
Pain in right shoulder. no relief from physiotherapy. Doctor advised for injection, Iam not interested to go for injection. Should continue with physiotherapy. Problem is about 8 month old. MRI shows impligement. please guide.
My orthopedic surgeon used this freezing/numbing spray before he gave me the shot, and it really wasn’t that bad. Not even as close to as painful as I had worked it up in my mind to be. I had horrible pain for next 24 hours but relief has started now, the day after I’ve gotten the injection in my shoulder. So far I’m glad I got it. My shoulder pain (torn rotator cuff) has been so bad since I fell 2+ months ago.
I have struggled with FM for 20 years now and have recently been referred back to my GP from my physio to have these injections. This would lessen the pain enough to exercise my shoulders to stop them stiffening.
My GPsaid he would normally do them one at a time to see how I went but I said uh uh do em both I ain’t coming back again ! Lol so he said ok.
He did them both they did not hurt one bit! One week later I am feeling that I am able to move my shoulders a little more not much but it’s a start so I can continue to do my physio exercises. So guys don’t be big babies go do it ?
Over the spring I got diagnosed with bursitis, had an MRI done of my neck and I have disc bulge of C3-C7 causing bad pain in my right shoulder radiating down to my right arm. In May, I had steriod injections in 3 trigger point areas in my right shoulder. The injections began wearing off in the fall and I began having intense pain. I was referred to receive a facet injection which injects steriod into the facet joint and the doctor is guided by an Xray taken prior to the injection. I was made aware that 30% of patients don’t receive relief from the factet injection; I happen to be one of these patients in the 30% who receive no relief from the injection. I recently went back to my pain management doctor and requested steriod injections in the 3 trigger points in my shoulder area. It is my second day since the injection and I have already felt some relief of the pain and tingling. Hope this information helps.
I just had 2 cortisone shots in my shoulder for possible sprain / tear. My shoulder has limited range of motion and 6 days after the shot i can notice an improvement in range of motion. Yes. The shot hurts. Would i do it again? A gazillion times yes.
Just had my first cortisone shot today in my left shoulder. Wasn’t expecting to have it immediately but the doctor suggested to do so. The actual shot was a bit painful and now, about 3 hours later, I am in discomfort. I have iced it and will ice it again. I am planning on taking some ibuprofen as well. My shoulder feels “heavy” and stiff. Hope this is helpful.
I had shot in shoulder wasn’t bad at all afterwords burning in face 2nd day that’s the worst so far
The shot hurts like hell and is nauseating..waiting to feel the effects. Now I know why babies cry with shots! And I’m a nurse for crying out loud! Live by the sword…die by the sword!
Receive cortisone shot in right shoulder for frozen shoulder.
As soon after I got shot ringing in my ears started also body started convulsing, coughing.
I had same cortisone shot in left shoulder in Feb 2018 no problems occurred
I am type 1 diabetic blood was checked it was 134
They called paramedics went to Er
Can you get back to me
Just don’t understand why this happened this time
I have a broken shoulder from a fall. Three days ago, I had the injection: it hurt at the time and it hurts MORE now than before. The doctor did not use imaging: he combined the steroid with anesthetic. It is effective for some people but not everyone, I guess.
I had the injection for my right shoulder for rota cuff it done nothink for me in fact it made it a lot worse would never have another one my doctor said your only allowed one injectoin. So im left with severe pain and hardly any movement in my shoulder.
Today I had a corticosteroid florascopic injection very very painful enough to make me cry. Unexpected experience.
had shot in right shoulder blade yesterday, did not hurt, and I feel much better today! pain was radiating to my neck. my family doc poked around until he found place that hurt by touch. shot was lidocaine and steroid and feels great today! No pain with injection.
I got one and I’ll never get it again. I hurt myself after nobody told me not to use my shoulder. The injection I literally screamed in the hospital I hate needles and their big giant long needles just like on TV. It did not help me instead I’ve hurt my shoulder even worse. I have a tendon torn right off the bone. The bone in my shoulders keep moving and ripping muscles underneath that never heal and I’m always in chronic pain and anti-inflammatories never helped me orally so I don’t know why they made me get this never again. They say I also have arthritis throughout this rotator cuff but arthritis doesn’t bother me it’s the muscles that are always aching and hurting cuz you got to use your arm need surgery
Yes it hurts. I screamed
I had a steriod shot in my shoulder and for 2 days I have been having shooting pain down my arm. Does that happen often? I have been using ice and heat and some pain relievers. Wondering how long this will last???
I. recently had a cortisone shot in my left shoulder. My cholesterol level increased slightly. However, the shot did relieve my pain.. I was told at the time of injection that my cholesterol level would increase. I also gained weight
I fractured my shoulder as result of a fall. Also had rotator cuff tear. After two 1/2 months of pain, with little relief from pain meds and no sleep, I agreed to a cortisone shot. The shot hurt, though not as bad as I had feared. Took 5 days, but blessed relief arrived. I am praying the effects do not wear off. It’s been 3 weeks, so far. Yes, I would have another shot should pain return. Without hesitation.
I have frozen left shoulder. I. Extreme pain. Got a cortisone Injection into my left shoulder. Didn’t feel it at all until the medicine was injected. End result I am able to go to PT and I’m gaining range of motion and strength; whereas before the injection I couldn’t even move my arm or sleep. I would do it again rather than have surgery or a shoulder replacement as the dr said I’m facing. I had a knee replacement and would not suggest that to anyone. Over a year later and I have as much if not more knee pain. Stem cell Injections might be the better alternative to replacement.
Does injections from cortisone affect gluten in your system, as I am I tollerent to fructose?
My primary dr advised advised to refrain from taking steroids because while servin in military was exposed to TB, &use of steroids could re generate TB?
I have Torn rotor cuff from a fall..need surgery. I got 2nd opinion. That doc wants to try these shots . mind u I been in bad arm pain with no help except ibuprofen for 5 MONTHS waiting for Workers comp to approve me. Well 2nd doc give me this shot on front side of shoulder where my tear is. The shot wasn’t so bad.. But 1 HOUR LATER. ALL HELL BROKE LOOSE. I GOT THIS YESTERDAY.I HAVE BEEN HATD CRYING EVEN TILL NOW. PAIN IS HORRIFIC.
I had this shot in my shoulder as i suffer from labrum tear,
The shot was taken 3 weeks ago, i still feel the side effect of the shot and feel my shoulder is heavy with burning sensation :((
Great Article. Thank you very much for sharing this informative article. It really helps a lot.