Corticosteroid injections for rotator cuff disorders

Examples

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Brand Name	Generic Name
Celestone Soluspan	betamethasone sodium phosphate

Brand Name	Generic Name
Celestone Soluspan	methylprednisolone acetate

Brand Name	Generic Name
Hydeltra-TBA	prednisolone tebutate

Brand Name	Generic Name
Aristospan	triamcinolone

Corticosteroid injections help diagnose or treat rotator cuff disorders. Your health professional may give you an injection of corticosteroid mixed with anesthetic (often lidocaine) or may give you a shot of anesthetic before a shot of corticosteroid.

How It Works

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Corticosteroids may decrease inflammation and pain, but they probably do not cure rotator cuff disorders.

Why It Is Used

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Your health professional may inject a shot of anesthetic into your shoulder (subacromial space injection) to help find out whether the limited movement is caused by pain or weakness. If the anesthetic relieves the pain and allows you to move your shoulder normally, the diagnosis is most likely some form of rotator cuff disease. Your health professional may then inject corticosteroids into the area to reduce inflammation. But if your shoulder is still weak after the injection of anesthetic, the problem is probably a rotator cuff tear.

Corticosteroid injections help relieve pain and inflammation in the shoulder due to tendinitis or bursitis in or around the rotator cuff. They usually are used after other treatment (such as rest, ice or heat, nonsteroidal anti-inflammatory drugs, and physical therapy) has failed to improve the problem.

How Well It Works

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After the anesthetic wears off (usually 4 to 6 hours after the shot), you are likely to experience discomfort for a few days. The corticosteroid will take effect and begin to relieve inflammation and pain after 1 to 2 days.

The effectiveness of corticosteroid injections can vary. In some cases, the relief from inflammation and pain may last for several weeks or more. In other cases, the shot may help for only a short time (about a week). And some people do not gain much relief from inflammation and pain.¹

If pain is not relieved by the corticosteroid injection, it may be caused by another problem.

Side Effects

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Corticosteroids have potential side effects and should be used with caution. Although they may provide relief from pain and inflammation, corticosteroids can also slow healing and weaken tendons. Other side effects include:

• Increased pain during the first few days after an injection.
• Tendon degeneration.
• Skin color (pigmentation) changes.
• Dimpling of the skin (subcutaneous atrophy).
• Infection at the injection site, although this is rare.
• Elevated blood sugar levels if you have diabetes.

Your rotator cuff may be weaker shortly after a corticosteroid injection. You should avoid strengthening exercises for a few days after your injection.² You should also avoid contact sports for a few days after a corticosteroid injection, or else you risk damaging an already weakened or damaged rotator cuff.

Repeated use of corticosteroids may weaken tendons. Corticosteroid injections should not be given frequently (usually no more than a total of 4 injections over 12 months). If an initial corticosteroid injection does not provide significant relief, a second shot may be given to ensure it was given in the correct place.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Corticosteroid injections should not be given if there is any sign of infection.

Applying an ice pack to the shoulder after the anesthetic has worn off and before the corticosteroid takes effect often helps reduce pain.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Speed C (2006). Shoulder pain, search date February 2006. Online version of BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.

2. Mantone JK, et al. (2000). Nonoperative treatment of rotator cuff tears. Orthopedic Clinics of North America, 31(2): 295–311.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Patrick J. McMahon, MD - Orthopedics
Last Updated	February 8, 2008