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I've had two cortisone injections to my shoulder. One time it worked, the next time it didn't. Should I try a third time? It seems like a 50-50 toss-up.

Whether or not steroid injections help with shoulder pain has been debated and studied for quite some time. There is some evidence that certain soft tissue disorders respond well to steroid injections. There is also some proof that injecting the correct site makes a difference in results. Some experts recommend using ultrasound guided steroid injections for shoulder pain. It is relatively easy to perform and less expensive than other imaging methods (e.g., fluoroscopy, CT scans). Placement of the needle head is accurate even when there is fluid in the tendon sheath (lining around the tendon). The patients are not exposed to radiation with ultrasound. And it gives the physician a visual idea of exactly what's going on inside the joint. Anyone who has had a blind injection (physician uses body landmarks without imaging to place the needle) without results might benefit from an ultrasonography-guided injection the second time around. And anytime the first steroid injection doesn't yield a reduction in pain and improved motion and function, it should be considered that there could be other problems going on at the same time. There may be a second (different) problem that hasn't responded to the steroid injection. For example, tendon tears and chronic degenerative conditions don't respond to steroid medications when there's no inflammatory component to the problem. But biceps tendonitis or other inflammatory conditions do respond with decreased pain, which then allows the person to move more freely and function with fewer limitations. For best results, delivery of the steroid medication must be to the proper site. To assure most effective use of steroid injections, some type of imaging such as ultrasonography is advised.

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