Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I really like the new approach to medicine these days -- there has to be evidence that something works to use it. I'm actually being a little sarcastic because it seems like common sense to me. Anyway, what's the evidence for or against steroid injections to the shoulder? I'm researching it for my mother who has bad arthritis and is considering this as her next step.

Answer:

You are not alone in asking this question! In a recent study, researchers from Rush University Medical Center in Chicago, Illinois reviewed the literature from 1948 to 2011 looking for any information, studies, and evidence about the use of shoulder injections. They did not limit their search to articles on just steroid injections but also included hyaluronic acid injections (another form of injection treatment) for shoulder disorders. We won't hold you in suspense about the results. They found very few studies and the level of evidence was very weak. In fact, it turns out that current clinical recommendations are all 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. A closer look at the two different injection approaches (steroids versus hyaluronic acid) revealed little scientific evidence to support steroid injections. Steroid injections seem to work better and more consistently for people with adhesive capsulitis compared with shoulder osteoarthritis. Hyaluronic acid injected into the joint may be more effective for both frozen shoulders and arthritis but some high-quality, well-designed studies are needed to provide evidence of this. Experts agree the benefits of these kinds of injections must be weighed against the potential adverse side effects. 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. With hyaluronic acid injections, pain and swelling in the joint may get worse instead of better at first. Some people even respond with an acute systemic inflammatory response. It looks like they are developing gout or a blood infection but it's just a reaction to the injection. The authors of that review concluded it's not likely that physicians will stop using steroid (or hyaluronic acid) injections for shoulder problems. But they are doing so on the basis of very limited evidence. It's mostly opinion and conjecture and that is not a strong enough recommendation in today's evidence-based practice. 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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