Cortisone shots are a common and effective medical treatment for managing shoulder pain. The procedure involves injecting a specialized mixture directly into the affected area to reduce localized inflammation. This mixture combines a potent corticosteroid (often a synthetic version of cortisol) and typically a local anesthetic like lidocaine. The primary function of the corticosteroid is to suppress the immune system’s inflammatory response, which often causes swelling and pain in the joint or surrounding tissues. By targeting the source of inflammation, the shot provides relief that is often stronger and more localized than oral medications.
Shoulder Conditions Treated by Cortisone
Cortisone injections are frequently used to address inflammation associated with several specific shoulder diagnoses. One of the most common applications is for conditions affecting the rotator cuff, such as tendinitis, tendinopathy, and subacromial bursitis (inflammation of the tendons or the cushioning fluid-filled sac). Reducing this swelling helps treat impingement syndrome, where tendons get pinched during arm movement.
Cortisone also treats adhesive capsulitis, or frozen shoulder, which involves inflammation and contraction of the joint capsule. The shot alleviates pain and stiffness, making physical therapy more manageable. It is also a standard treatment for pain caused by osteoarthritis in both the main shoulder joint (glenohumeral joint) and the acromioclavicular joint.
It is important to understand that the injection addresses the inflammation and the resultant pain, not the underlying structural damage itself. While a shot provides temporary relief for a partial rotator cuff tear, it will not repair the tendon. The goal is to alleviate pain long enough for the patient to participate effectively in physical therapy, which strengthens surrounding structures and offers a longer-term solution.
Preparing for and Receiving the Injection
Before receiving the shot, your doctor will provide specific preparatory instructions, including temporarily stopping certain medications. Since injections can cause bruising or bleeding, patients are often advised to stop taking blood thinners or certain dietary supplements beforehand. You must also notify your physician if you have had a fever in the two weeks leading up to the procedure, as this suggests a low-grade infection.
During the procedure, your clinician often uses an imaging technique, such as ultrasound or fluoroscopy, to ensure precise placement of the medication. Ultrasound guidance uses high-frequency sound waves to create real-time images of the internal soft tissues, allowing the doctor to visualize the target area. This guidance helps maximize the effectiveness of the treatment by delivering the corticosteroid exactly where the inflammation is located and avoiding sensitive structures like tendons.
The injection itself is typically a quick, in-office procedure that does not require general anesthesia. A local anesthetic is first administered to numb the injection site, which minimizes discomfort. You may feel a brief sting from this initial numbing, followed by a sensation of pressure or fullness as the medication mixture is injected into the joint or tissue space.
Expectations, Side Effects, and Frequency Limits
Relief from a cortisone shot happens in two distinct phases. Patients feel immediate, temporary numbness and pain relief because of the local anesthetic mixed with the corticosteroid. Once the anesthetic wears off (usually within a few hours), the shoulder may feel sore, sometimes even more painful than before, which is known as a pain flare.
The true anti-inflammatory effect typically begins after one to five days, with maximum relief achieved after one to two weeks. The duration of this relief is highly variable, lasting anywhere from several weeks to a few months, or longer. To manage initial post-injection soreness, patients are instructed to use ice packs and avoid strenuous activity for the first day or two.
Common, temporary side effects include warmth and flushing in the face or chest. For patients with diabetes, the corticosteroid can cause a temporary increase in blood sugar levels, requiring close monitoring. More serious, though rare, risks include joint infection, cartilage damage, or weakening of nearby tendons.
To prevent potential damage from overuse, most physicians recommend a strict limit on the number of injections received in a single joint. The general guideline is no more than three or four shots in the same shoulder within a one-year period. Shots are typically spaced at least 12 weeks apart, and this limit is in place to minimize the risk of complications such as tendon rupture or bone thinning.