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When to Use Cortisone Injections in the Shoulder

Many painful shoulder problems can be managed quite well with a steroid injection. When injected into the right spot, cortisone can reduce inflammation and relieve painful symptoms. The end-result is improved range of motion, strength, and function.

In this article, the authors present a 16-step exam used to guide the diagnosis of shoulder pain. An accurate diagnosis is essential for successful steroid injection. The 16-steps include visual inspection and physical examination of the shoulder.

Physical exam includes specific shoulder tests, active and passive range of motion, and muscle strength testing. The area of focus for strength testing is the rotator cuff (four tendons that envelope the entire shoulder joint). X-rays are always advised in order to improve the accuracy of the injection(s).

What to look for and how to interpret the shoulder tests is presented. The sensitivity and specificity of each test is reported. The authors remind us that previous studies have showed that combining certain shoulder tests can dramatically improve the accuracy of the tests.

For example, combining the painful arc sign with the drop-arm sign and the infraspinatus test is the best predictor of full-thickness rotator cuff tears. And impingement syndrome is tested for by using the painful arc sign, Hawkins-Kennedy impingement sign, and the infraspinatus muscle test.

Special tests for specific conditions such as tendinitis, arthritis, and rotator cuff tears are reviewed. Likewise, tests for strains, sprains, trigger points, and frozen shoulder are also included.

By using the 16-item checklist, physicians can narrow down the diagnosis and target the tissue that can benefit from a corticosteroid injection. Once the injection has been completed, the numbing agent will mask the pain. Then the examiner can sort out which parts of the shoulder joint are affected most. Improving accuracy is the key to limiting steroid injections while increasing effectiveness.

References: John G. Skedros, MD, and Todd C. Pitts. Injectable Corticosteroids for the Painful Shoulder: Patient Evaluation. In The Journal of Musculoskeletal Medicine. May 2008. Vol. 25. No. 5. Pp. 236-245.

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