Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

What's the best way to treat a painful shoulder (from arthritis)? Should I go to physical therapy for a few weeks (longer time to recovery?) or just get the steroid shots and be done with it?

Answer:

Up to one-third of the adult population in America suffers from shoulder disorders on any given day. So, it's a problem that affects many people every day. A conservative approach is usually always recommended first. Physical therapy, antiinflammatory medications, acupuncture, and/or any of the other alternative approaches (e.g., massage, Reiki, BodyTalk, physiologic quieting) are recommended. These may be tried individually or in combination until the right mix with the best results is found for each patient. When shoulder pain from arthritis becomes unbearable and nothing else will touch it, surgeons may recommend steroid injections. But in today's evidence-based medicine, the question comes up: what's the evidence that injections directly into the shoulder joint (intra-articular) really reduce shoulder pain and stiffness associated with arthritis or adhesive capsulitis (frozen shoulder)? According to the latest research, there are very few studies to support the use of steroid injections for shoulder arthritis. And the level of evidence that is available is very weak. Current clinical recommendations are based on expert opinion and consensus (agreement among physicians). Consensus is also based on expert opinion but with experience and case series added in to assist in coming to agreement. There are studies that show physical therapy alone provides better pain relief, increased shoulder motion, and improved function compared with steroid injection (for patients with shoulder osteoarthritis). People with adhesive capsulitis (frozen shoulder) have slightly different results and seem to do better with physical therapy when it is combined with both steroid and hyaluronic acid injections. When comparing different treatment approaches for painful, limiting shoulder arthritis, it is important to weigh the benefits against the potential adverse side effects. Physical therapy does take longer but may have more lasting value. In addition to pain relief, the therapist will address loss of strength, motion, and function while paying attention to other important factors such as posture, osteoporosis, and falls and fracture prevention. Steroid injection may provide pain relief in the first 24 hours but with any injection, there's the pain of the injection itself -- both during and afterwards. Most of the time, this is temporary and only lasts a short time. Joint infection can occur when bacteria is introduced into the joint by the needle pushing through the skin. Anyone with infectious arthritis, a joint replacement implant, or fracture is not a candidate for injection therapy. With steroid injections, some people have a flare-up reaction that can last several days. Sometimes the protective fat around the joint is lost. It takes the body up to six months to replace or restore this fat. And studies clearly show that steroid injection provides short-term pain relief but not long-term change. Christopher Gross, MD, et al. Glenohumeral Joint Injections: A Review. In Sports Health. March/April 2013. Vol. 5. No. 2. Pp. 153-159.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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