Shoulder pain affects thousands of U.S. adults. According to clinical studies, shoulder pain affects 4% of the general population, and 1% of people age 45 years and older consult their family doctor each year with a new presentation of shoulder pain. Many individuals suffer from mild-to-moderate osteoarthritis of the shoulder. While pain medicine and physical therapy may work for some, others suffer with long-term, recurring shoulder discomfort. A shoulder injection may be necessary to relieve the pain associated with many types of shoulder arthritis.
If pain medication does not provide relief, the pain management specialist may recommend an injection of medicine directly into the shoulder joint. Orthopedic and rheumatologic specialists often use ultrasound guidance to assure the medication goes directly into the joint. Injections for shoulder pain are safe and effective and offer longer pain relief than conservative measures.
Corticosteroid Injection for Shoulder Pain
Many shoulder conditions produce an inflammatory effect that leads to pain. Corticosteroids are anti-inflammatory medications that are injected into the shoulder joint. A corticosteroid will reduce inflammation, which is the body’s immune response. Inflammation leads to swelling, redness, warmth, and pain. Before the injection, the doctor will administer an anesthetic, either locally or into the skin. After numbing the area, the corticosteroid agent is injected directly into the joint.
The corticosteroid solution starts to work after 2-3 days. An anesthetic, such as bupivacaine or lidocaine, is added into the solution to offer immediate pain relief. For some people, a corticosteroid shoulder injection for pain can offer several months of pain relief. Doctors recommend no more than 3 corticosteroid injections into the shoulder joint during a time-span of 3-5 years.
Hyaluronic Acid Shoulder Injection
The shoulder joint contains a gel-like lubricating substance known as synovial fluid. Over time, and with age, the joint becomes depleted of this fluid. Synovial fluid cushions and lubricates the joint. Hyaluronic acid is a component of this fluid. A medication produced in the laboratory, hyaluronic acid, is now used to replace this lost fluid. Hyaluronic acid injections can increase the joint fluid’s viscosity, improving the gliding motion, and relieving symptoms of arthritis.
With chronic shoulder pain, the pain management specialist may recommend an injection of hyaluronic acid. The injection involves placing the medication into the joint under ultrasound guidance. After the injection, the joint may be tender for 24-76 hours, and maximum effects are noticed in 2-3 weeks. One hyaluronic acid shoulder joint injection can provide beneficial for up to 12 months.
Platelet-Rich Plasma for Chronic Shoulder Pain
Platelet-rich plasma (PRP) is a solution of the patient’s own blood components that is injected into a joint. The patient first has his/her blood drawn. The nurse processes the blood in the laboratory, where the platelets are separated from other blood components. The platelet solution is then injected into the painful shoulder joint using x-ray (real-time) guidance. For shoulder pain, the results are usually felt within 2 weeks, and benefits may last for up to a year.
In a recent study involving joint degeneration from osteoarthritis, researchers evaluated the safety and effectiveness of PRP joint injections. They found that PRP injections were beneficial for people with mild osteoarthritis, but only were somewhat effective for moderate arthritis. Because the patient goes through a mild exacerbation period after the injection, the shoulder joint may be tender for up to a week.
Jang SJ, Kim JD, and Cha SS (2013). Platelet-rich plasma injections as an effective treatment for early osteoarthritis. Eur J of Orth Surg & Traum, 23(5), 573-580.