When Are Injections Used To Treat Shoulder Pain?

The answer to this question depends on the cause of your shoulder pain as well as the type of injection being considered.

There are two main types of injections used in and around the shoulder, these include steroid medications, which are the most common and PRP or “platelet rich plasma”.

Steroid is a type of medication that is used very frequently in medicine. Some forms of steroid are taken by mouth, some are used through an IV, and others are made to be injected into different locations, including into and around the shoulder joint. Steroids are actually naturally occurring, meaning that we normally have steroid in our body, but the type that is used for injections are slightly different and are made in a laboratory. Steroids work through the inflammation pathway, blocking several molecules that lead to inflammation, redness and pain. Therefore, they are very helpful for treating painful orthopedic conditions.

Dr. Johnny T. Nelson uses steroids for two main reasons in and around the shoulder.

The first reason is if the patient is in severe pain, sometimes this pain is so severe that the patient is not able to start or participate in physical therapy which may be the best treatment for that pain. Also, patients can have pain that is so severe that they cannot sleep, and they cannot work and provide for themselves. If that is the case, the decision is sometimes made to perform a steroid injection.

However in some patients, such as patients with large rotator cuff tears that may require surgery, Dr. Nelson sometimes avoids steroids because there is evidence that steroids impedes and prevents the healing that is necessary after shoulder surgery and rotator cuff repair surgery(1).

The second reason Dr. Nelson uses steroids is to identify the actual cause of your pain. Because there are so many structures in and around the shoulder that can cause pain, sometimes even with imaging, physical examination performed by your orthopedic surgeon, the actual cause of your pain may be unclear. A steroid injection around a structure may help to define or eliminate whether that structure is the cause of the pain. For example, Dr. Nelson often performs injections around the biceps tendon sheath under ultrasound, if the patient’s pain improves, it is very likely the biceps tendon is a cause of the pain.

Okay, what about platelet rich plasma?

Platelet rich plasma is a new technology that shows a lot of promise. Certain patients with certain problems around the shoulder can be candidates for platelet rich plasma therapy. These include patients with bad bursitis, inflammation, partial tearing of the rotator cuff, and even arthritis. Although the evidence for effectiveness of platelet rich plasma is limited because the technology is so new, it is a good nonsurgical treatment method to try in some situations.

Although platelet rich plasma is not usually covered by insurance, it is a simple process. It requires taking some of your own blood, spinning it down in a machine, and taking the portion of the blood that contains many special growth factors and other molecules and injecting it around the area that is painful and inflamed. This platelet rich plasma injection triggers an inflammatory response that after several weeks will quiet down, leaving the inflamed and painful area more quiet, healed, and less painful.

If you are having shoulder pain, call 919-872-5296 to schedule a visit with shoulder specialist Dr. Johnny Nelson. Before you see your primary care doctor, physical therapist, chiropractor, or other provider, it is important that you have a thorough history and physical examination by an orthopedic surgeon to establish the correct diagnosis!

References:
Puzzitiello RN, Patel BH, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Arthroscopy. 2020 May; 36(5):1468-1475. Epub 2019 Dec 17.