Steroid Injections - by SOS Shoulder Specialist Mr Richard Sinnerton

---

At the very mention of a steroid injection, many patients pull the sort of face that makes me think they are not very keen on the idea. So, I will try and explain why a steroid injection can be so effective in helping with shoulder pain.

What do you actually inject?

I use ‘depomedrone’ which is the brand name for one of the many types of ‘steroid’ available. Basically the terms steroid and cortisone are interchangeable. I suppose the best way to describe it is as a very strong, concentrated anti-inflammatory which acts to reduce the redness and swelling in the shoulder that causes pain.
This is injected along with a local anaesthetic (either Marcaine or Chirocaine). The local aneasthetic is used mainly to dilute the steroid and allows me to get a bigger volume of the active ingredient into the area injected.

It is actually a purified version of what the body produces anyway as a natural response to trauma so is much more ‘natural’ than other treatments such as arnicha or St Johns Wort

That is correct but is only an issue if you have multiple injections. And if you are having multiple injections then whoever is treating you is missing something that probably needs an operation! Many of the horror stories about steroids are linked to profesional sports people who have chronic injuries and are kept going with repeated injections. And this does lead to long term health problems. But a single injection will not turn you into a Russian weight-lifter or cause any other weird side-effects!

Under my care you will get one, or very occasionally, two injections. And that is it. From the investigations I will have done on your shoulder (x-rays or scans) I will have a good idea whether you can be cured with an injection or will definitely need an operation. So, if your rotator cuff tendons are just inflamed through accident or over-use and the structure of the shoulder is normal (no bone spurs, hooks or arthritis) then a steroid injection and physiotherapy rehabilitation should sort you out. At the other extreme, if you have arthritis or a large spur then you should probably go straight to surgery.
In some patients it is well worth doing one injection even when there are some abnormalities on the scan because they may not be playing a significant role in your symptoms. In this case I would expect your pain to settle but would warn you that, if they return, then you need surgery. So don’t let someone give you mutliple injections: ask to see a shoulder surgeon!

It depends which part of the shoulder is involved. If it is mainly the rotator cuff tendons then I do the injection in the clinic. If it is mainly the Acromi-clavicular Joint (ACJ) then I arrange for you to be injected under ultra-sound guidance. This is because the ACJ is a very small joint with only a narrow space for the needle and thus a difficult target to hit ‘blind’!
By using the Ultra-sound machine, we can guarantee to get the steroid exactly where it needs to go.

I’m afraid so. But nearly as much as most people think and what I often hear people say is ‘was that it?’ It can make your shoulder worse the next day so be wary of that and if you have an active day planned or a long drive, then I suggest you defer the injection until such time as you have a few gentle days following the injection.

That’s right. Used properly, for the right conditions and in the right way, steroid can be the cure for many painful shoulders without any side effects. It is important to have physiotherapy after the injection and use that pain-free honeymoon period to iron out any bad habits that may have helped to cause the problem in the first place.

So, if I suggest a steroid injection I hope you won’t pull ‘that’ face! I don’t expect you to be overjoyed by the thought but it is often a very good way to start getting you better. Oh, and yes, I have had my shoulder injected - and it cured it!