Steroid (cortisol) injections can play and integral part in the diagnosis and management of many shoulder and elbow conditions. They can be undertaken in the clinic, however they are usually performed by the radiologist under ultrasound or X-ray control.
The shoulder joint is a complicated as there are a number of separate anatomical structures that can be implicated in your symptoms. To aid in the diagnosis of your condition, an ultrasound-guided injection can be used to isolate one particular structure, thereby helping to determine if it is the source of your symptoms. This can be undertaken purely with local anaesthetic, but if it is combined with a corticosteroid, then it can also give therapeutic benefits.
In the shoulder, injections are commonly used in the investigation and management of subacromial bursitis/impingement, small rotator cuff tears, ACJ osteoarthritis and for the management of a frozen shoulder. However, they can also be used in the management of end stage osteoarthritis or cuff tear arthropathy when surgery is not indicated or possible.
As with any injection there are theoretical risks. Although uncommon, risks associated with injections include infection, and when used in and around the elbow, de-pigmentation of the skin and some thinning of the fatty layer just deep to the skin can also occur. However, If used too frequently in the shoulder, thinning of the rotator cuff tendons can occur and therefore usually a maximum of only 2-3 injections are usually considered. If the symptoms have not improved after the 2nd or 3rd injection, then an alternative treatment will usually have to be considered.
Following your injection you may see an instantaneous improvement, but usually any changes occur over several days. In a small number of patients a “Flair” can occur such that there may be an increase in your symptoms for 1-2 days before hopefully improvements are then seen. After an injection, normal daily activities can be pursued however you should refrain from any activities that would normally aggravate your shoulder or elbow.
After your injection a ‘Pain Diary’ should be used to record the degree of any improvements noted, and their duration. This information is very useful in both confirming your diagnosis and planning any further treatment. The Radiologist usually gives the ‘Pain Diary’ to you at the time of your injection, but if you misplace it another can be obtained from the link below.