Why Cortisone Injections are Making Your Shoulder Pain Worse

Why Cortisone Injections are Making Your Shoulder Pain Worse

Cortisone injections are commonly administered to alleviate shoulder pain associated with conditions such as rotator cuff tendinopathy and adhesive capsulitis (frozen shoulder). While these injections can offer temporary relief, recent research indicates that their long-term efficacy is limited, and they may carry potential risks.

Efficacy of Cortisone Injections for Shoulder Pain

A meta-analysis published in Clinical Orthopaedics and Related Research evaluated the effectiveness of corticosteroid injections in patients with rotator cuff tendinopathy. The study concluded that these injections provide only small and transient pain relief, with benefits diminishing over time. Specifically, the analysis found that pain relief was modest and not sustained in the long term.

Similarly, in cases of adhesive capsulitis, a systematic review and meta-analysis published in JAMA Network Open assessed various treatment modalities, including intra-articular corticosteroid injections. The findings suggested that while corticosteroid injections may offer short-term improvements in pain and range of motion, these benefits are not maintained over the long term. The study emphasized the need for further research to determine the most effective treatment strategies for this condition.

Potential Risks and Adverse Effects

Beyond their limited long-term efficacy, cortisone injections carry potential risks, especially with repeated use. According to the Mayo Clinic, possible side effects include:

• Cartilage damage
• Death of nearby bone (osteonecrosis)
• Joint infection
• Nerve damage
• Thinning of nearby bone (osteoporosis)
• Tendon weakening or rupture
• Thinning of skin and soft tissue around the injection site
• Temporary flare of pain and inflammation in the joint
• Temporary increase in blood sugar levels

These potential complications underscore the importance of cautious use and thorough patient evaluation before administering cortisone injections.

Alternative Treatment Approaches

Given the limited long-term benefits and potential risks associated with cortisone injections, alternative treatments should be considered for managing shoulder pain. Physical therapy, for instance, has been shown to improve shoulder function and reduce pain through targeted exercises that enhance strength and flexibility. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used to manage pain and inflammation. In some cases, a combination of treatments may be the most effective approach.

While cortisone injections can provide short-term relief for shoulder pain, their long-term efficacy is limited, and they carry potential risks. Patients should engage in a thorough discussion with their healthcare providers to weigh the benefits and risks of cortisone injections and to explore alternative treatment options that may offer more sustainable relief.

References

• Mohamadi, A., Chan, J. J., Claessen, F. M. A. P., Ring, D., & Chen, N. C. (2017). Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis. Clinical Orthopaedics and Related Research, 475(1), 232–243.
• Challoumas, D., Biddle, M., McLean, M., & Millar, N. L. (2020). Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Network Open, 3(12), e2029581.
• Mayo Clinic. (2023). Cortisone shots: Risks. Retrieved from https://www.mayoclinic.org/tests-procedures/cortisone-shots/about/pac-20384794

Patients are encouraged to consider these findings and consult with their healthcare providers to determine the most appropriate treatment plan for their individual circumstances.

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