I went to see my doctor for a steroid injection in the shoulder. She put me through an extensive list of tests in her office. When she was done with me, she sent me to radiology for a couple of X-rays. Then I got the injection. Was all this testing really necessary? Or is it just a way to drive up the cost to me?

Steroid injections can be very helpful with some shoulder problems. But a corticosteroid drug is used and it has some potential negative side effects. To avoid injecting the wrong site, a careful examination is essential.

After the physician conducts a history and exam, she probably started in on a list of important tests. Some doctors use a 16-step shoulder exam. This helps them cover all the bases and avoid missing something important.

The physician starts with visually inspecting the area. Any deformities, skin changes, and loss of muscle definition or other changes are noted. The patient is asked to move the shoulder through a series of motions designed to identify areas of weakness, loss of motion, and impingement of the bursae or tendons.

X-rays are an important part of the examination process. X-rays show the joint space. The physician can look for narrowing from arthritis. The presence and severity of arthritic changes are also noted. The shape and position of the bones around the shoulder are examined. Areas where the bones may be pinching the soft tissues may be observed. Calcifications of the tendons may also be seen on X-rays.

All of this information will be used when planning the treatment. Injections are most effective when the affected tissue is accurately targeted and reached.