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Cortisone injections make up a very important part of the treatment of shoulder injuries. In combination with an active rehabilitation program they may significantly reduced the need for surgery in shoulder impingement syndrome.  

Cortisone is a potent anti-inflammatory medication. It was only discovered as recently as 1950 (earning a Nobel Prize for medicine for Hench and his co-workers), and has been available in an injectable form since 1951. It acts on both acute and chronic phases of inflammation to reduce both tissue swelling and subsequent scar formation.  

Cortisone injections are useful in the treatment of various musculoskeletal conditions, particularly those of acute inflammation (such as acute bursitis), and degenerative joint and tendon conditions.  In the shoulder they are particularly useful in the management of:  Rotator cuff disease (degenerative tendonosis, impingement, partial tears and subacromial bursitis) Adhesive capsulitis (or ‘frozen shoulder’) Glenohumeral osteoarthritis Acromioclavicular joint disease (osteoarthritis or osteolysis) 

Cortisone injections should only be performed in the setting of an appropriate diagnosis based on taking an accurate history, performing a clinical examination and commonly performing investigations. These should include an x-ray as mandatory and may also include an ultrasound or an MRI scan, depending on the indications. They will generally be used after failure of a 4-6 week trial of relative rest, anti-inflammatory modalities and medications and an exercise based physiotherapy program.  

Possible side effects:

Around 1:20 patients may have pain that is worse after the injection. This generally occurs for no more than 2-3 days and is related to irritation of the tissue injected from the cortisone itself. This ‘injection flare’ is much less common now as the modern cortisone injections are more water soluble. It is best treated with local ice packs and simple analgesics.  

This 'flare' can take the form of redness and pain local to the injection site, but may also result in facial flushing and warmth.  Rest assured that the vast majority of these symptoms resolve within 2 or 3 days, with simple painkillers (ibuprofen and paracetamol).  You should however seek medical attention if you become 'unwell' - flu-like symptoms, persistent high temperature.

Care should be taken in diabetics as blood sugar levels may rise for up to a week after the steroid injection.  We would encourage close monitoring of glucose levels in that period and remaining mindful of this possibility if you start to feel unwell in any way.

There is a very small risk of infection within a joint after a steroid injection. The medical literature suggests this occurs in less than 1:20,000 cases.

The cortisone injections do not cure the condition, but provide a window of symptom relief via inflammation reduction. This then allows pain free rehabilitation exercises to be performed, improving joint motion and muscle strength and function, which ultimately prevent the condition from recurring later on. All cortisone injections should ideally be followed up with a physiotherapy program including manual therapy and an exercise prescription.  

Failure of cortisone injections may occur for various reasons. The most important factor to consider is appropriate diagnosis. A rotator cuff injection will not help an acromioclavicular joint problem. This is best addressed by careful taking a careful history and examination, as well as supporting the diagnosis with tests.  Correct placement of the needle is also essential. In some cases an imaging support (such as an ultrasound) may be used to confirm the needle position.