Corticosteroid injections for rotator cuff disorders

Examples

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Brand Name	Chemical Name
Celestone Soluspan	betamethasone sodium phosphate

Brand Name	Chemical Name
Celestone Soluspan	methylprednisolone acetate

Brand Name	Chemical Name
Hydeltra-TBA	prednisolone tebutate

Brand Name	Chemical 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 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 determine whether the limited movement is due to 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. However, 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 only used after other treatment (such as rest, ice, nonsteroidal anti-inflammatory drugs, and physical therapy) has failed to improve the problem.

Corticosteroid injections are not used to treat sudden, severe (acute) rotator cuff injuries.

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, and some people do not gain much relief from inflammation and pain.
• In some cases, the shot may help for only a short time (about a week). In other cases, the relief from inflammation and pain may last for a longer time.
• 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 and scarring, causing loss of strength and movement.
• Skin color (pigmentation) changes.
• Dimpling of the skin (subcutaneous atrophy).
• Infection at the injection site.
• Elevated blood sugar levels if you have diabetes.

Your rotator cuff may be significantly weaker for as long as 2 weeks after a corticosteroid injection. You should avoid strengthening exercises during this time.¹ 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 and harm other soft tissues in the shoulder. Progressive loss of strength and movement, degeneration, and tearing may occur. Corticosteroid injections should not be given frequently (usually no more than a total of 3 injections over 12 months) because of these potentially serious side effects. 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.

Avoid strenuous activities involving the shoulder for as long as 2 weeks after an injection to prevent further injury to the rotator cuff tendons. If there is pain or discomfort, avoid strenuous activities for a longer period of time.

Corticosteroid injections should not be given excessively (usually no more than a total of 3 injections over 12 months) because of rare but potentially harmful side effects.

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References

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Citations

1. 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	Colleen Cronin
Author	Lila Havens
Editor	Katy E. Magee, MA
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Kathie Hummel-Berry, PT, PhD - Physical Therapy
Last Updated	February 10, 2006