Steroid injection represents a useful tool in the management of chronic shoulder pain. Ideally, steroids should be thought of as providing temporary relief. When injections are used appropriately, and in conjunction with physical therapy, they can serve as a sort of Band-Aid for the shoulder pain. In this way, steroids will give people a temporary period of time in which physical therapy can really start working. This is because steroids act as an effective anti-inflammatory, which will relieve the pain that is caused by normal use of the joint.
If a doctor deems steroid injections to be of use to the patient, they will typically use a lateral approach to inject the subchromial space, particularly with rotator cuff problems. At different times, the doctor may use an anterior approach or a posterior approach to actually put steroid into the shoulder joint. To conduct these straight injections would be less common though.
Steroids have multiple actions. As an anti-inflammatory agent they frequently will reduce pain in an area affected with inflammation. Also, and essentially a side effect is that, they will cause destruction of protein.
This means that steroid injections do include a risk of complication, and it is possible to get too many steroid injections into a shoulder. Where previously it was unknown as to the exact number of injections which equated this "too many", recently, there has been research to suggest that if someone were to get more than 3 steroid injections into the shoulder, it could make the subsequent rotator cuff repair surgery more difficult.
When it comes to making a decision with regards to the use of steroid injections, one should realize the possible benefit of the drug when it is used appropriately. When used in conjunction with physical therapy, they can be a very effective tool in alleviating shoulder pain. Further, the doctor will perform the steroid injection under sterile conditions as to not introduce germs into the joint space, which further decreases the chance that a problem will arise. One should also consider the fact that steroids are actually created naturally in the body before the simple fear of the injection causes them to discard the treatment.
The steroids injected into the joint are generally safe and do not have the systemic side affects normally associated with steroid pills. For those concerned, steroid injections typically will not increase blood sugar levels to a significant degree.
However, possible side affects/adverse affects of shoulder steroid injection would include bleeding into the joint if the needle goes through a significant blood vessel, an infection, and skin ulcerations if too much is injected closely underneath the skin. Another side affect could be a "dent" that is formed where the steroid was injected. Additionally, there can be tendon rupture and overall weakening of the structure receiving the steroid.
Michael Carroll, MD is a board certified family physician with a special interest in sportsmedicine. He is the founding partner of Creekside Clinic, LLC, a progressive primary care center in Traverse City, Michigan. He is a member of the American College of Sportsmedicine, and the American Academy of Family Physicians. He also has a special interest in shoulder pain and rotator cuff injuries, specifically with regard to cutting-edge treatments.
