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April 02, 2007

Shoulder Steroid Injection

Steroid injection represents a useful tool in the management of chronic shoulder pain. The doctor will typically use a lateral approach to inject the subchromial space, particularly with rotator cuff problems. At different times, the doctor may use an anterior approach or a posterior approach to actually put steroid in the shoulder joint. This would be less common. Ideally steroid should be thought of as providing temporary relief and when used appropriately, and when used in conjunction with physical therapy, shoulder steroid injections will almost act as a band-aid. They’ll give people a temporary period of time where the physical therapy can really start working. This is primarily because the steroid is a very effective anti-inflammatory, and for a short period of time will relieve pain.

Steroids have multiple actions. They act as anti-inflammatory, and therefore, frequently will reduce pain in an area with inflammation. Also and essentially a side effect is that they will cause destruction of protein. Certainly steroids do have a complication and you can get too many steroid injections into a shoulder. There has been research to suggest that if someone were to get more than 3 steroid injections into the shoulder that the subsequent repair of the rotator cuff that may need to happen is more difficult. Shoulder steroid injections are a beneficial tool when used appropriately. It is again recommended that it is used in conjunction with physical therapy. The doctor will perform the steroid injection under sterile conditions as to not introduce germs into the joint space. Steroids are actually produced by the body in small amounts.

The steroids injected into the joint are generally safe and do not have systemic side affects unlike steroid pills. Steroid injections typically will not rise up blood sugars to a significant degree. Possible side affects/adverse affects of shoulder steroid injection would include an infection, bleeding into the joint if the needle goes through a significant blood vessel, skin can ulcerate if too much steroid is injected closely underneath the skin. Also there can be fat trephine under the skin and essentially leaving a dent in the contour of where the steroid was injected. Additionally, there can be tendon rupture and overall weakening of the structure receiving the steroid.

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Comments

I had a shoulder injury in october of 2006. An mri revealed a tear in the distal supraspinatous tendon. we tried therapy and shots that never really helped the pain. i then had an arthroscope. the doctor said he couldnt find the tear but did subacromial decompression. after therapy i still have the same pre surgery symptoms. i had another mri which revealed the same tear. now the doctor wants to give me another injection. Meanwhile i have been in pain/lack of sleep/on a 2lb restriction at work for nearly a year now. another second opinion doc said to give me a shot and if the pain goes away temporarily then its just the tear causing my pain, if the pain stays the same then i have worse problems. are these docs on the right track????????

Frustrating. For one thing you do not have a full thickness tear of the supraspinatus otherwise they would be able to see it at surgery. Partial tears do sometimes require surgery, but most of them can be rehabilitated with physical therapy. I have never heard of a surgeon not being able to find a tear to repair at surgery. I think because this would be the second surgery for the same problem, I would go to a board certified orthopedic surgeon who is fellowship trained in shoulder surgery.

Finally, I think you do have a chance to avoid another surgery altogether and would give it another 6-8 weeks of therapy. I would recommend the Lifeline USA blue jump rope and do about 400-600 jumps per day. Also I would get the nighttime shoulder immobilizer and wear it at night for one month. You can get that at teterop.com

Let me know if you have any more questions.

Dr. Mike

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Hello,

I had an upper back musscle spasm and my Doctor injected me with steroids. Now I have a huge dent in my back. Is there anything I can do about this? It also created a dull constant pain.

Thanks

This will fill in to some degree over a period of 6-12 months. If the cosmetic appearance is very concerning and you do not want to just wait out the time period, then you should consult with a board certified plastic surgeon. They might be able to inject some filler agent. For the pain in the area I think you should go back to your doctor. Good luck.
Dr. Mike

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