Do Corticosteroid Shots work for Shoulder Tendonitis?

Hey guys! Dr. Lell here, your family Chiropractor helping patients from Sellwood to Oregon City and I’m back to talk about corticosteroid shots for shoulder / rotator cuff tendonitis.

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?

Corticosteroid shots have been used since the 1950’s for many acute and chronic conditions. It’s a very common procedure and often a first choice in the management of musculoskeletal conditions 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 too 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 repaired and healthy tissues. Sometimes the inflammation can go haywire. This is where the shot comes in. The corticosteroid is delivered to local tissues to stop current and prevent more inflammation thereby decreasing the associated pain, swelling, and warmth.

But do you see the kicker? The inflammation was healing the injury. So when you put an abrupt stop to inflammation, you’re leaving injured tissues in a vulnerable state by prolonging the healing time. This can make re-injury more likely.

Do corticosteroid Shots Work?

Success with corticosteroid shots is across the board. For bursitis and arthritis, I have patients that swear by them. But I’m 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. Some patients got a single shot, some got multiple, and some got a fake shot. Then they checked in on their pain levels at 4, 8, and 12 weeks. They found that the people who got the shot had pain levels only a little better than people who got the fake shot at 4 and 8 weeks. Only 1 in 5 had much less pain. At three months, the pain levels of everyone was the same. They 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. After three months, there was no difference in people who did and didn’t get the shot.

Why Don’t Cortisone Shots work for Shoulder Tendonosis?

The cortisone shot prevents and decreases inflammation. But in tendonitis, the underlying issue isn’t the presence of inflammation, it’s the damaged tissues. Preventing the natural healing process with a cortisone shot can make the tendons chronically degenerative and sore. This makes them prone to more injury.

What are the alternatives?

Chiropractic works with the body’s natural healing process. Not in spite of it. This approach uses treatments like electrical stimulation, adjustments, and functional rehab which can speed up the body’s inflammatory process healing tissues quicker. It helps with pain levels too.

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.

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References and Interesting Reading