Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica and fracture. Data collection and analysis: Trial inclusion and methodological quality was assessed by two independent reviewers according to predetermined criteria.
Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis. Main results: Twenty-six trials met inclusion criteria.
The number, site and dosage of injections varied widely between studies. The number of participants per trial ranged from 20 to median 52 participants. Methodological quality was variable. For rotator cuff disease, subacromial steroid injection was demonstrated to have a small benefit over placebo in some trials however no benefit of subacromial steroid injection over NSAID was demonstrated based upon the pooled results of three trials. For adhesive capsulitis, two trials suggested a possible early benefit of intra-articular steroid injection over placebo but there was insufficient data for pooling of any of the trials.
It is best treated with local ice packs and simple analgesics. You should only have 3 injections: There is no scientific evidence to support this statement, but it seems to have been set in concrete somewhere along the line.
Common sense would suggest if 3 injections given at week intervals have been unhelpful then further injections are less likely to be beneficial, but having one further injection if progress is being made is not inappropriate, or indeed dangerous. Cortisone injections will make me fat and give me weak bones: Taking oral cortisone or prednisone for long periods of time can certainly have side-effects, which do limit the use of this very effective drug.
These would include weight gain, osteoporosis, diabetes and high blood pressure. A small amount of cortisone is absorbed after an injection, but quickly cleared within days. There are no long term side-effects from repeat local injections of cortisone. It works by reducing inflammation, and thus pain secondarily. As such it is treating the pathology, not just the pain.
It is important that the injection is followed up with appropriate rehabilitation see below. Side Effects Local cortisone injections may cause some side-effects. Cortisone injections make up an important part of treatment of various shoulder conditions. They are, however, not the only method of treatment, but part of an overall management program. 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 x-ray may be used to confirm the needle position. Inadequate follow-up rehabilitation and activity modification is another common reason for failure or limited success of cortisone injections.