08 Dec When Shoulder Steroid Injections Don’t Work
Steroid injections are often used for shoulder problems, such as rotator cuff tendinitis. In this procedure, a steroidal agent, such as Triamcinolone is administered along with a local anesthetic agent, such as Lidocaine into the shoulder. It is typically injected in the area of the subacromial bursa especially to treat rotator cuff problems. This is because an inflamed bursa, which is a fluid-filled sac between the muscle and bone can cause pain with movement. Subacromial bursitis pain is felt when the arm is raised (forward or to the side) past 90 degrees.
While the steroid injection for the treatment of rotator cuff pain generally works, there are times when it doesn’t. The main reasons why it can fail can be that either that the problem was not a rotator cuff tendinopathy, to begin with. There may be other reasons that are causing shoulder pain, such as myositis, capsulitis, nerve pain, etc. which needs to be discerned with further testing. The other reason why the therapy could fail is due to the failure to accurately inject the bursa during the procedure. The accuracy of injection can range anywhere from 29 – 87%. This can be improved with the use of ultrasound or fluoroscopy for needle placement. Furthermore, the accuracy of injection may also be subject to the direction from which the injection is administered – injecting the shoulder from the front and side showed better results than injecting from the back, especially so in women.
Corticosteroid injections, in many cases, do provide moderate pain relief in patients with rotator cuff disorders up to a couple of months after injection. But steroids are unlikely to have long-term analgesic benefits with these conditions. They can still be administered but along with physical therapy and other therapies to maximize benefit.
Typically, for tendonitis, during the first week or two, applying ice packs ice and taking a nonsteroidal anti-inflammatory drug (NSAID) helps. If pain continues, physical or occupational therapy should be considered, to performs regimens of recommending exercises to strengthen the rotator cuff and shoulder blade muscles. It is at this time that if the pain persists, a cortisone injection into the bursa surrounding the rotator cuff tendons is considered. If it fails and there is no relief after six weeks or the pain returns, you may have to consider surgery.
Arthroscopy involves using a tiny camera inserted via small incisions into the joint space to assess the shoulder joint. It is not only diagnostic but it may have therapeutic application as well. When the arthroscopic assessment reveals a rotator cuff tear, surgery is necessary. This is typically an arthroscopic surgery but open repair may be performed if the rotator cuff is not possible using arthroscopy. This is especially true when a tendon graft or joint replacement is needed. Typical yet uncommon complications, like any surgical procedure, include bleeding, infection and blood clots in the legs or lungs.