A frozen shoulder is a frustrating condition that can last up to 18 months before full range of motion is restored.
Corticosteroid injections for frozen shoulder can be helpful when done early on with the condition. A study was done in 2017 and found that pain levels and range of motion were improved in weeks 0-8 after injection. In weeks 9-24, pain levels were the same as the control group, however, range of motion benefits were still present in the injection group while they were not present in the control group.
You can read that abstract (article), here.
In this article, we will look into the research and discuss if shoulder injections are safe and whether or not they are effective for frozen shoulder.
Are Injections Effective For Frozen Shoulder
If you truly have frozen shoulder and it’s not just a stiff shoulder, then a corticosteroid injection can be helpful in reducing pain in the short term, and improving range of motion over the long term.
Are Injections Safe for Frozen Shoulders
Here’s what this study, done in 2017, says about the safety of corticosteroid injections, in general.
“The beneficial effects of corticosteroids occurred at low doses and short culture durations (usually <2-3 mg/dose or 8-12 mg/cumulative total dose in vivo) (Tables 2 and and3), 3), at which increased cell growth and recovery from damage was observed.
However, at higher doses and longer culture durations (>3 mg/dose or 18-24 mg/cumulative total dose in vivo), corticosteroids were associated with gross cartilage damage and chondrotoxicity.
The literature demonstrates the complex effect methylpredisolone, dexamethasone, betamethasone, and hydrocortisone have on cartilage proteins (especially proteoglycan, type II collagen, aggrecan) through simultaneous mediation of the processes of protein production and breakdown.
Methylprednisolone, dexamethasone, and hydrocortisone have demonstrated simultaneous mediation of both beneficial and detrimental upstream regulators of cartilage protein synthesis and breakdown, most notably the MMPs and tissue inhibitors of MMPs depending on dose and duration.”
In layman’s terms, dosages of <3 mg/dose don’t seem to have a negative effect on intraarticular cartilage (cartilage inside the joint).
It’s recommended by the American Academy of Family Physicians that intraarticular steroid injections should be only be done at the maximum 4 times per year, or every 3 months. This is to decrease the risk of any cartilage damage.
What about if you have diabetes?
It’s important to note that periarticular (steroid injections around the joint) or into the soft tissue can cause a large spike in blood sugar. It is recommended to closely monitor your blood glucose during the first two weeks after receiving an injection.
This of course should be fully covered by your physician prior to receiving the injection.
Are there different types of injections?
There are corticosteroid injections, used to reduce inflammation.
Lidocaine injections are used to numb an area.
Lubricant injections are used to add additional lubrication to joints. A common one is “synvisc,” which is a cocktail of different types of substances that adds more ‘synovial type,’ fluid to a joint to help reduce pain.
Platelet rich plasma (PRP) injections are used to encourage healing and regenerate damaged tissue. This is also a newer technology who’s efficacy has not yet been proven to be more effective than ~ 50%.
Stem Cell injections are used to help regenerate tissue that has been damaged. This is a newer technology and its efficacy is still being studied.
Out of all of these, corticosteroid injections are the most common and have the most research behind them.
In future articles, I will be writing about different types of treatment methods for frozen shoulder and I will link to those as appropriate.
For the time being, here is an article that one of my professors wrote about the best treatment methods for frozen shoulder.
- Early steroid injections to the shoulder can be helpful in reducing pain and increasing range of motion.
- Steroid injections should not be given more than 4x/year and are suggested to be spread out every 3 months.
- Corticosteroid injections are the most common type of injection given for frozen shoulder and has the most research behind it.
- Be careful and cautious if you have diabetes and are receiving a corticosteroid injection.