Can You Get a Cortisone Shot in Your Shoulder?

Cortisone shots in the shoulder are among the most frequently performed injections in orthopedic and primary care practice. They are used for a range of common shoulder conditions, from rotator cuff problems to frozen shoulder to arthritis. The procedure itself takes a few minutes, but the questions people have beforehand tend to run much deeper: how well does it actually work, how long does the relief last, what are the risks, and is it better than other options like physical therapy? The answers depend quite a bit on which shoulder problem you have.

Which Shoulder Problems Cortisone Treats

Your shoulder has several distinct anatomical spaces, and different problems call for injections into different areas. The subacromial space, which sits above the rotator cuff, is the most common target. Injections there address rotator cuff tendinitis, impingement syndrome, bursitis, and calcific tendinitis. The glenohumeral joint, the ball-and-socket joint itself, is where injections go for frozen shoulder (adhesive capsulitis) and glenohumeral osteoarthritis. The acromioclavicular joint at the top of the shoulder gets its own injection for AC joint arthritis. Placing the medication in the right space matters because the problem and the injection site need to match for the shot to do much good.

When other first-line measures like rest, anti-inflammatory medications, and activity modification have not provided enough relief, cortisone injections are a standard next step for most of these conditions.¹ The injection delivers a concentrated dose of corticosteroid directly to the inflamed tissue, suppressing the local inflammatory response and reducing pain in a way that oral medications sometimes cannot match.

How Well Cortisone Works for Rotator Cuff Problems

For rotator cuff tendinitis and impingement, the evidence is mixed but generally positive in the short term. A Cochrane systematic review found that subacromial steroid injections provided a small benefit over placebo for rotator cuff disease, though the effect was not dramatically better than taking an oral anti-inflammatory drug.² A separate meta-analysis was more encouraging, concluding that subacromial injections are effective for rotator cuff tendinitis for up to nine months and likely more effective than oral anti-inflammatory medication, with higher doses potentially outperforming lower ones.³

The general pattern across studies is that cortisone provides meaningful pain relief in the first several weeks, with benefits that gradually taper. For many people with rotator cuff issues, that window of reduced pain is enough to engage more effectively in physical therapy and regain function. The shot is rarely a standalone cure; it buys time and comfort so you can work on the underlying problem.

Cortisone for Frozen Shoulder

Frozen shoulder is a distinct condition where the capsule surrounding the shoulder joint becomes thickened and tight, severely limiting range of motion. It tends to follow a natural course of gradually worsening, then slowly resolving on its own over one to three years. Cortisone injections into the glenohumeral joint offer rapid relief of pain and improved range of motion, particularly in the first six weeks, though long-term outcomes tend to be similar to other treatments, likely because the condition eventually resolves regardless of intervention.⁴

A meta-analysis of randomized controlled trials confirmed that people who received intra-articular steroid injections had meaningfully reduced pain scores compared to controls at four to six weeks, and the benefit persisted, though to a lesser degree, at roughly six months. Improvements were also seen in passive range of motion and overall shoulder function scores at each time point measured.⁵ The practical takeaway for frozen shoulder is that cortisone is most valuable during the painful early phase, when stiffness and pain are at their worst and you need relief to participate in stretching exercises.

There is some evidence that the exact injection site within the joint matters. One randomized trial found that injection into the rotator interval (a specific spot on the front of the shoulder capsule) produced faster improvement in pain, range of motion, and functional scores than a standard intra-articular injection, with differences becoming apparent about four weeks after the shot.⁶ This kind of precision is still not standard everywhere, but it suggests the technique is evolving.

Shoulder Arthritis

Glenohumeral osteoarthritis, where the cartilage lining the ball-and-socket joint wears down, is another common reason for a shoulder cortisone shot. A study of patients receiving a single image-guided cortisone injection for glenohumeral arthritis found clinically meaningful improvements in shoulder function and pain lasting up to about four months.⁷ For arthritis, the injection is often a bridge strategy, providing enough symptom control to delay or help you decide about a shoulder replacement while maintaining daily function.

How the Injection Is Given

The traditional approach is a landmark-guided injection, where the clinician uses their knowledge of anatomy and palpable bony landmarks to position the needle. This is how most cortisone shots have been given for decades, and it works well in experienced hands. The alternative is ultrasound guidance, where a real-time image on a screen shows the needle entering the target space.

A systematic review and meta-analysis found that ultrasound-guided injections were more accurate than landmark-guided injections for most shoulder targets. For the glenohumeral joint, accuracy was roughly 93% with ultrasound versus 73% without. For the acromioclavicular joint, it was about 94% versus 68%. For the biceps tendon sheath, the gap was even larger. For subacromial injections, interestingly, accuracy was similar between the two methods.⁸ Greater accuracy translated into better pain reduction and functional improvement for subacromial and biceps sheath injections at six weeks.

That said, a randomized trial comparing ultrasound-guided versus landmark-guided subacromial injections for rotator cuff problems found that while ultrasound was technically more accurate (100% versus about 93%), both groups improved significantly in pain and function over three months, with no meaningful clinical difference between them.⁹ Similarly, for adhesive capsulitis, a study found trends favoring ultrasound guidance for pain, range of motion, and function, but most differences were not statistically significant.¹⁰ Ultrasound guidance costs more and takes longer, so its benefit depends partly on which shoulder structure is being targeted. For deeper or harder-to-reach spaces, the accuracy advantage is more likely to matter clinically.

Side Effects and Risks

Most people tolerate shoulder cortisone injections well, but side effects do occur. The most common local side effects include:

Post-injection flare: A temporary increase in pain lasting a day or two after the shot, caused by a reaction to the steroid crystals.
Skin changes: Lightening of the skin (hypopigmentation) or thinning (atrophy) near the injection site, which is more noticeable in people with darker skin.
Infection: Rare but serious. The risk is very low with proper sterile technique.
Tendon effects: Corticosteroid exposure can temporarily weaken tendon tissue at a cellular level.

These are recognized complications across musculoskeletal corticosteroid injections in general.¹¹

On the tendon side specifically, basic science research has shown that corticosteroids reduce cell growth in tendon tissue, alter collagen composition, and increase cell death. These changes can appear within 24 hours and last two to three weeks, and they get worse with higher doses or shorter intervals between injections.¹² One study found that steroid treatment shifted the ratio of collagen types in injured rotator cuff tendon, a change associated with weaker tissue, though this shift returned to normal by three weeks.¹³ This is why providers typically advise against strenuous shoulder use in the first couple of weeks after a shot.

A concern you sometimes hear is whether cortisone damages the cartilage in your shoulder joint. For frozen shoulder patients who received cortisone-anesthetic injections, one study found no radiographic evidence of cartilage destruction (chondrolysis) in any patient.¹⁴ That is reassuring, though the broader guidelines still list potential cartilage effects as a recognized risk of joint injections.¹⁵ Repeated injections over many years likely carry more risk than a single shot or a short series.

Blood Sugar Effects If You Have Diabetes

If you have diabetes, a cortisone shot in the shoulder will temporarily raise your blood sugar. In one study, fasting blood glucose levels were significantly higher one day after injection but returned to baseline by seven days in both diabetic and non-diabetic patients.¹⁶ Another study confirmed that blood glucose rose significantly on day one but was no longer elevated by day two in a mixed group of musculoskeletal patients.¹⁷

The size of the spike depends on how well controlled your diabetes is. People with well-controlled diabetes (HbA1c below 7%) had an average blood sugar increase of about 38 mg/dL, while those with poorly controlled diabetes saw a rise averaging around 98 mg/dL. Insulin-dependent patients had larger spikes than those managed without insulin. Well-controlled patients’ glucose levels returned to near baseline around eight days after the injection, while poorly controlled patients’ levels stayed elevated longer.¹⁸ None of this means you cannot get the injection, but your doctor should know about your diabetes so you can plan for closer blood sugar monitoring in the days afterward.

How Many Shots You Can Get

There is no single universal rule, but the evidence provides some guideposts. For frozen shoulder specifically, a systematic review found that up to three injections were clearly beneficial, with limited evidence supporting four to six, and no evidence supporting more than six.¹⁹

For rotator cuff tears that might eventually need surgical repair, the number of preoperative injections matters. A database study found that a single cortisone injection in the year before arthroscopic rotator cuff repair was not associated with increased risk of needing a repeat surgery. However, two or more injections in that year were associated with a substantially increased risk of revision surgery, with the odds roughly two and a half to three times higher.²⁰ That finding does not prove the injections caused the surgical failures, but it is a reason for caution if surgery is on the horizon. Most clinicians limit cortisone shots to roughly three per year in the same shoulder, spacing them at least several weeks apart.

Cortisone Versus Physical Therapy

One of the most practical questions is whether cortisone injections outperform physical therapy. A randomized trial of patients with shoulder impingement compared a course of subacromial cortisone injections with manual physical therapy. Both groups improved by about 50% over one year, and there was no significant difference between them at the end.²¹ One revealing detail: patients who received cortisone injections needed more follow-up visits to their primary care provider and were more likely to require additional injections or eventual physical therapy, suggesting the shot alone did not fully resolve their problem as often.

For painful stiff shoulders, another randomized trial found that injections produced faster initial relief, with about 77% of injection patients considered treatment successes at seven weeks compared to 46% of physiotherapy patients. By six months and one year, though, the gap had largely closed.²² The pattern is consistent: cortisone wins in the short term, physical therapy catches up over the long term, and in practice many people benefit most from combining both.

Platelet-Rich Plasma and Other Alternatives

Platelet-rich plasma (PRP) injections have generated considerable interest as an alternative or competitor to cortisone for shoulder problems. For rotator cuff tendinopathy, a comparative study found that both PRP and cortisone produced similar improvements in pain, function, and range of motion over 18 months, with no significant differences at any time point.²³ One smaller trial found PRP outperformed cortisone in range of motion and function at 12 weeks for periarthritis of the shoulder.²⁴

For frozen shoulder, a recent meta-analysis found that PRP and hyaluronic acid injections showed better long-term pain reduction and range of motion improvements compared to cortisone at six months, though three-month outcomes were similar between all groups.²⁵ The emerging picture is that cortisone provides faster early relief but PRP may hold an edge further down the line for some conditions. PRP is typically not covered by insurance for shoulder use, which keeps cortisone as the practical first choice for most people.

Timing Before Shoulder Surgery

If shoulder surgery is being considered, the timing of a cortisone injection matters more than many patients realize. A systematic review found that patients who received a cortisone injection within three months before shoulder replacement surgery had a higher incidence of infection. For shoulder arthroscopy specifically, injections within two weeks of surgery carried the greatest risk of postoperative infection.²⁶ A large database study confirmed that the infection risk was greatest within two weeks and still elevated at two to four weeks, but returned to baseline when the injection was given more than a month before arthroscopic surgery.²⁷ If you are considering surgery, mention any recent cortisone shots to your surgeon so scheduling can account for this window.

What to Do After the Shot

Post-injection advice is fairly straightforward. Standard recommendations include avoiding activities that provoke pain, stopping sports and overhead arm use, and steering clear of repetitive movements that contributed to your shoulder symptoms for about one week. Resistive exercises, such as strengthening work, are typically avoided for two weeks after the injection.²⁸ Gentle range-of-motion exercises are usually fine during this period. You can apply ice to the injection site if it is sore. The cortisone typically begins working within a few days, though some people notice improvement within 24 hours and others take closer to a week.

If you take blood thinners, the injection is still generally safe but worth discussing with your provider. A practice survey found that bleeding events were rare in patients on aspirin (observed by only about 1% of surveyed rheumatologists) but somewhat more common in patients on vitamin K antagonists like warfarin, where about 10% of rheumatologists reported having seen bleeding events.²⁹ For most people on standard antiplatelet therapy, stopping the medication beforehand is not necessary, but the decision depends on which blood thinner you take and why.

Adrenal Suppression From a Single Injection

A concern that sometimes arises is whether a single cortisone shot can suppress your body’s own cortisol production. Corticosteroids are, after all, a synthetic version of a hormone your adrenal glands make. A systematic review and meta-analysis looked at this question for injections into the arms and legs (the “appendicular skeleton,” which includes the shoulder) and found that average cortisol levels after injection remained within a range suggesting the body’s hormonal axis stayed intact.³⁰ Individual responses vary, and some degree of temporary cortisol dip can occur, but clinically significant adrenal insufficiency from a single shoulder injection is uncommon. Repeated injections at short intervals carry more risk, which is another reason providers space them out.