Hey guys! Dr. Lell here, your family Chiropractor helping patients from Sellwood to Oregon City and I’m back to talk about corticosteroid shots.
Are you or someone you know considering a steroid shot for rotator cuff tendonitis? Chances are, someone at one point has asked, “will this work?” and the results from a recent meta-analysis (a higher quality study) of 11 studies gives a pretty surprising answer.
What is a corticosteroid shot?
Before we get into what this study found and what it means to you, let’s cover some basic questions. Corticosteroid shots have been used since the 1950’s for various acute and chronic injuries and conditions. It’s a very common procedure and often a first choice in the management of musculoskeletal condition by general practitioners and orthopedists. But how do these “magic” shots work?
I won’t get too technical here. But when a part of your body is injured, it sends up a flag for help. The help comes in things like white blood cells, stem cells, macrophages, etc. All the stuff that your body needs to clean up the mess and heal injured tissues. A lot of extra fluid comes in as well possibly causing swelling, warmth, and pain. This process is called inflammation; the body’s natural response to injury and infection. Usually, the body does its things and the inflammation goes away leaving behind tissues that have hopefully been repaired and healed. This inflammation can be quite painful and can sometimes go haywire. This is where the shot comes in. The corticosteroid is delivered to local tissues to stop current and prevent more inflammation thus decreasing the associated pain, swelling, and warmth.
But do you see the kicker? The inflammation is was heals the underlying injured tissues. So when you put an abrupt stop to inflammation, you’re leaving injured tissues in a vulnerable state by prolonging the healing time and making re-injury more likely.
Do corticosteroid Shots Work?
Success with corticosteroid shots is across the board. With things like bursitis and arthritis, I’ve had patients that swear by them. But I’ve been seeing a lot of patients get them for rotator cuff injuries with little to no benefit. Now to be fair, that’s a biased view. Because if the shot did work, I wouldn’t be seeing them for the same shoulder pain. So of course I only see people that didn’t get much help. That’s why the title of this study caught my eye: Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendonosis by Mohamadi written this year.
Results of the Study
The analysis looked at a total of 726 patients with rotator cuff tendonitis spread across 11 random controlled trials. Some of the patients were given a single shot, some were given multiple injections, and some were given a fake injection. Then they checked in on their pain levels at 4, 8, and 12 weeks. What they found is that for the people who got the shot, their pain levels were only a little better than people who got the sham (fake) shot at 4 and 8 weeks. Only 1 in 5 had significantly less pain. At three months, the pain levels of people who did and didn’t get the shot were the same. They also found that multiple injections made no difference.
In other words, the injection made their shoulders feel slightly better for 2 months, but the effect was gone by month 3.
Why Don’t Cortisone Shots work for Shoulder Tendonosis?
The cortisone shot prevents/decreases inflammation, but in tendonitis, the underlying cause isn’t the presence of inflammation, it’s the damaged and injured tissues. So treating the inflammation is like fixing a leaky tire by stopping anyone from patching and airing it up – it makes no sense. Preventing the natural healing process with a cortisone shot can lead to the tendons being chronically degenerative and sore, making it prone to more injury and possibly making it impossible to get back to its pre-injury state.
What are the alternatives?
Chiropractic care works with the body’s natural healing process rather than in spite of it. Our natural approach using tools like electrical stimulation, adjustments, and functional rehab can speed up the body’s inflammatory process which heals tissues quicker – all the while decreasing pain levels.
If you are considering steroid injections for your shoulder, or did not get much relief from them, make an appointment with our online scheduler and start getting better.
For regular health tips and health news that matters to you and the ones you love, sign up for my newsletter. A special gift will be sent to your inbox when you do.
References and Interesting Reading