Cortisone Injections For The Shoulder

Thanks to the Ajax Pickering Hospital Foundation, our team has developed many educational materials for The Shoulder Centre, now operating out of Durham Bone and Joint Specialists (our office).  Please review this information before your visit.  There is a considerable amount of information (some good, some bad) about Cortisone injections.  Based on our considerable experience with these injections, we hope the information we have provided here will address most of your questions and concerns.

Cortisone is a natural chemical that is produced by your body. Its main purpose is to prevent the release of other chemicals in your body that cause inflammation and pain. There are multiple types of man-made (synthetic) cortisone to allow us to assist the body in reducing swelling and inflammation, thereby eliminating pain. These injections are often done into a joint or into the bursa – a space which is responsible for reducing friction and providing lubrication to the structures surrounding and supporting a joint or tendons, such as the rotator cuff.

Diagnostic Injections:  You may have an injection to help your specialist identify the location of pain and confirm findings. The proper diagnosis may be made through a process of elimination using selective injections.  This is often the case in acromioclavicular joint (AC joint) injections.

Therapeutic Injections:  You may have an injection to reduce swelling, inflammation and pain within the shoulder joint or bursa. These injections are often helpful in early frozen shoulder (adhesive capsulitis). These injections can  reduce pain to allow physiotherapytherapy and home exercises to begin.

Shoulder injections often serve both of these functions. They confirm the location of your pain, and if the injection works then you may experience a long-lasting decrease in your pain.

Your shoulder injection will be performed by a professional health care provider in the clinic or in the diagnostic imaging department by a radiologist.

The skin of your shoulder will be sterilized prior to the injection. The injection will be performed with sterile technique to reduce any chance of infection. The cortisone will be mixed with an anesthetic (usually Lidocaine) to numb the area of injection and to allow the cortisone to be distributed throughout the injected area.  Sometimes more than one area may be injected during your visit.

Radiologists use fluoroscopy (real-time x-rays) and ultrasound to locate injections. Your treating healthcare provider may want a radiologist to perform the procedure in some cases to have proof of the placement of the needle in the correct location.

There are a few minor and rare side effects of shoulder injections that you need to be aware of.

Elevated blood sugar
If you have a history of elevated blood sugars and/or diabetes this is a common occurrence. Closely monitor your blood sugars if you take insulin, as you may require some dose adjustments in the first 48 hours.

Facial flushing
You may experience a facial flushing sensation or redness of the face. This can begin within a few hours of the injection and last a few days.

Pain
Some patients have discomfort after the injection and even experience worsening pain for up to 3 days after the injection. This pain can be minimized by ice packs and analgesics, such as Tylenol or ibuprofen.

Infection
Whenever there is a break in the skin, there is a chance of infection. There is a 1 in 200,000 risk of infection even with the use of sterile equipment and proper cleanse of the skin.

Weakening of tendon
High doses of cortisone and frequent exposure of cortisone can cause weakening of the tendons of the rotator cuff. Ask your specialist what the recommendations are for frequency of cortisone injections to minimize this risk. In general, a maximum of two injections in the subacromial bursa would be given prior to a discussion of other options.