Intra-Articular Injections for the Treatment of Shoulder Pain

Shoulder Pain

Shoulder pain refers to any form of pain felt in the shoulder or around the shoulder joint. The shoulder joint is the most mobile joint in the human body, including four tendons that have the function of holding the muscle to the bone. Any swelling, inflammation, tearing or bony changes around the tendons in the shoulder causes pain when a person tries to move the arm upwards, backwards, straight out or in front.

Common causes include bursitis, rotator cuff tendonitis and tears or ruptures to any of the four tendons. Shoulder instability and dislocation is very common, leading to a host of conditions in this complex area of the body. As with any of the major joints of the body, osteoarthritis can become prevalent with age.

 

Intra-Articular Injections

Intra-articular steroid injections are a prescribed line of treatment for relief from joint-pain. Intra-articular injections with local anesthetics or corticosteroids can be used for the treatment of inflammation in the joint.

Shoulder Pain Treatment

 

Procedure

There are various types of steroids that can be used with intra-articular injections, which have a different duration of effect and action. The guiding principle which determines the effectiveness of each of these preparations is their solubility.

The insoluble preparations are known to have a longer duration of effect and are the most preferred.  Aristospan is the most soluble and preferred preparation for intra-articular injections and its duration of effect is usually six months. Aristocort is also highly insoluble, and is usually second choice to Aristopan. This particular preparation normally has a duration of three months. Finally, Depo-Medrol is a highly soluble steroid that should only be used as a last resort. It only lasts for five weeks.

Before the procedure, the appropriate steroid is selected after careful consideration of the extent of the problem and patient history. A local anaesthetic (Lidocaine 1%) is administered and the steroid is then injected into the joint. Once completed, an iodinated contrast is injected to observe immediate distribution of the steroid and local anaesthetic and confirm which joints are being treated.

Specialists dealing with intra-articular steroid injections generally instruct their patients to maintain a simple diary of pain for at least a week’s duration after the injection. The commonly recommended entry in the diary is pain vs. previously expected pain or same physical workload.

 

Outcomes

The intra-articular steroid injections are administered with the aim of providing two to six weeks of pain relief. However, the higher-dose steroids with or without joint lavage can provide pain relief for a period as long as 24 weeks.