Corticosteroid Injections for Rotator Cuff Related Shoulder Pain?

Are Corticosteroid Injections the Answer to Rotator Cuff Pain? Let's Talk!

Rotator cuff-related shoulder pain is a frequent challenge in clinical practice. With up to 67% of individuals experiencing it at some point, finding the most effective management strategy is crucial for healthcare providers.

Corticosteroid injections are a widely used treatment option, but their long-term effectiveness is still debated. Let’s take a closer look at the evidence and how these injections fit into clinical management.

Understanding Corticosteroid Injections

Corticosteroid injections are often recommended for their anti-inflammatory properties, targeting the subacromial space to alleviate pain and improve range of motion. While they are a popular intervention, their long-term efficacy remains uncertain.

Short-Term Benefits: Pain Relief and Improved Function

Many studies support the short-term benefits of corticosteroid injections. A randomized controlled trial by Gialanella and Prometti (2011) found that a single injection significantly reduced nighttime and activity-related pain for up to three months.

Similar findings from Yu et al. (2006) and Hsieh et al. (2023) highlight improvements in pain and function post-injection. Short-term relief can be particularly valuable in enhancing patient adherence to rehabilitation programs.

However, it is essential to consider patient selection carefully. The response to corticosteroid injections can vary, and some individuals may experience only minimal relief. Additionally, repeated injections should be approached with caution due to potential adverse effects on tendon health, including weakening and increased risk of rupture.

Limited Long-Term Effectiveness

Despite their initial benefits, corticosteroid injections don’t seem to offer sustained relief. A meta-analysis by Mohamadi et al. (2016) found no significant long-term advantage over placebo treatments beyond three months.

The UK-based Hopewell et al. (2021) study further supports this, showing that while pain and function improved initially, long-term outcomes were comparable to alternative treatments.

From a clinical perspective, educating patients on the transient nature of corticosteroid benefits and the importance of a structured rehabilitation plan is key to managing expectations and encouraging active participation in their recovery.

Corticosteroids vs. Physiotherapy: Which Works Best?

Physiotherapy is a cornerstone of rotator cuff pain management, but how does it compare to corticosteroid injections?

Research by Daghiani et al. (2023) and Hopewell et al. (2021) suggests that physiotherapy alone may be more effective over the long term. However, some studies propose that combining corticosteroid injections with physiotherapy may optimize results, as pain relief can improve engagement in rehabilitation (Jack et al., 2010).

Physiotherapy offers multiple benefits beyond pain relief. It focuses on restoring strength, flexibility, and motor control, addressing the underlying biomechanical factors contributing to shoulder dysfunction. Techniques such as targeted exercise, manual therapy, and neuromuscular retraining can improve long-term outcomes, reducing the risk of recurrence.

However, adherence to physiotherapy remains a challenge. Patients struggling with pain may find it difficult to perform prescribed exercises effectively, leading to suboptimal results. In such cases, a corticosteroid injection can serve as an adjunct to facilitate early engagement in rehabilitation by temporarily alleviating pain and inflammation.

Clinicians should consider an individualised approach when deciding on treatment pathways. For patients with significant functional limitations due to pain, an initial corticosteroid injection may improve tolerance to physiotherapy. On the other hand, for patients who can manage pain through conservative approaches, structured physiotherapy alone may provide equal or superior outcomes over time.

Ultimately, the decision should be guided by patient-specific factors, including severity of symptoms, functional goals, and previous response to treatment. A multidisciplinary approach, involving shared decision-making with patients, can help determine the best strategy for long-term recovery.

Clinicians should consider an individualized approach when deciding on treatment pathways. For patients with significant functional limitations due to pain, an initial corticosteroid injection may improve tolerance to physiotherapy. On the other hand, for patients who can manage pain through conservative approaches, structured physiotherapy alone may provide equal or superior outcomes over time.

Clinical Takeaways: When Should You Consider Corticosteroid Injections?

For clinicians, the decision to use corticosteroid injections should be guided by patient-specific factors. If short-term pain relief is necessary to facilitate physiotherapy participation, injections can be a useful tool. However, for long-term symptom management, physiotherapy remains the preferred approach.

The key takeaway? Corticosteroid injections should not be used in isolation but rather as part of a broader treatment plan that includes rehabilitation and patient education.

Looking Ahead: Future Considerations in Shoulder Pain Management

There’s a growing need for research on how corticosteroid injections can be integrated with physiotherapy and other treatments in routine clinical practice. Future studies should assess how best to combine these approaches to improve long-term patient outcomes.

As always, shared decision-making is essential—clinicians should work with patients to tailor treatments that align with their needs, expectations, and long-term recovery goals.

Let us know in the comments below your experiences with treating rotator cuff related shoulder pain in practice! Do you routinely offer an injection? Why or why not?

References

• Gialanella, B. and Prometti, P. (2011) ‘Effects of corticosteroid injection in rotator cuff tears’, Pain Medicine, 12, pp. 1559–1565.
• Yu, C.-M. et al. (2006) ‘Subacromial injections of corticosteroids and xylocaine for painful subacromial impingement syndrome’, Chang Gung Medical Journal, 29, pp. 474–479.
• Hsieh, L.-F. et al. (2023) ‘Comparison of corticosteroid injection, physiotherapy and combined treatment for patients with chronic subacromial bursitis – A randomised controlled trial’, Clinical Rehabilitation, 37, pp. 1189.
• Mohamadi, A. et al. (2016) ‘Corticosteroid injections give small and transient pain relief in rotator cuff tendinosis: a meta-analysis’, Clinical Orthopaedics & Related Research, 475, pp. 232.
• Hopewell, S. et al. (2021) ‘Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2×2 factorial, randomised controlled trial’, Lancet, 398, pp. 416–428.
• Daghiani, M. et al. (2023) ‘The effectiveness of comprehensive physiotherapy compared with corticosteroid injection on pain, disability, treatment effectiveness, and quality of life in patients with subacromial pain syndrome: a parallel, single-blind, randomized controlled trial’, Physiotherapy Theory and Practice, 39, pp. 1591–1605.
• Jack, K. et al. (2010) ‘Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review’, Manual Therapy, 15, pp. 220–228.
• Zheng, X.-Q. et al. (2014) ‘Nonsteroidal Anti-Inflammatory Drugs Versus Corticosteroid for Treatment of Shoulder Pain: A Systematic Review and Meta-Analysis’, Archives of Physical Medicine and Rehabilitation, 95, pp. 1824–1831.
• Min, K.S. et al. (2013) ‘A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome’, Journal of Shoulder and Elbow Surgery, 22, pp. 595–601.