Q: Should I get an Injection?

A: Winters et al (1) compared exercise, manual therapy, and corticosteroid injection for shoulder pain patients.  Patients with pain and limited range of motion in one or more directions that was due to dysfunction in specific joint structures and patients with pain and slightly limited range of motion not stemming from specific joint structures were placed in groups.  Those with dysfunction related to the glenohumeral joint itself benefitted most from injection while those with dysfunction stemming from movement dysfunction of the whole shoulder girdle (shoulder blade, thoracic spine, cervical spine), benefitted most from manual physical therapy.

Crawshaw et al (2) compared the effectiveness of subacromial injection with exercise and manual therapy to exercise and manual therapy alone for pain and disability of the shoulder for 12 weeks.  After 1 week the patients receiving injection and therapy felt significant better than the group receiving only therapy.  After 12 weeks, however, there was no significant difference between these two groups of patients in change in total pain and disability.


Bottom line: Subacromial corticosteroid injection for rotator cuff disease/impingement may be beneficial although the effect may be small and not well-maintained over time, when it seems to be no more beneficial than a comprehensive exercise and manual physical therapy program.

1.J. C. Winters, J. S. Sobel, K. H. Groenier, H. J. Arendzen, and B. Meyboom-de Jong. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study. Brit Med Jour. 1997 May 3; 314(7090): 1320–1325.

2. Crawshaw DP, Helliwell PS, Hensor EM, Hay EM, Aldous SJ, Conaghan Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial.  BMJ. 2010 Jun 28;340:c3037