Issue: February 2018
Perspective from Joshua D. Harris, MD
Perspective from Ryan T. Bicknell, MD
February 14, 2018
4 min read

Steroid injection significantly relieved shoulder pain at 6 weeks

Early post-injection pain was transient and affected one-third of patients.

Issue: February 2018
Perspective from Joshua D. Harris, MD
Perspective from Ryan T. Bicknell, MD
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Treatment of shoulder pain with steroid injection and physiotherapy significantly improved pain in a sustained manner through 6 weeks, according to study results.

“Our results support that corticosteroid injection is an effective and safe tool in the management of shoulder pain,” Hassan M. T. Fawi, MBBS, MRCS Eng, of University Hospital of Wales, told Orthopedics Today.

Fawi and his colleagues Munier Hossain, MBBS, FRCS (Tr&Orth), and Timothy J.W. Matthews BSc(Hons), MBBS, MD, FRCS (Tr&Orth), studied 116 patients (64.7% were women) with shoulder pain treated with steroid injection and physiotherapy and had them complete a VAS questionnaire for pain prior to the injection. The patients also completed the questionnaire 30 minutes after they receive the injection, daily through day 7 and at 6 weeks following the steroid injection.

The investigators used successful discharge or progression onto surgery at 6 months as a secondary outcome.

Although the results showed there were no significant differences in pain scores 30 minutes after injection, researchers observed a statistically significant reduction in pain scores by day 1, which was maintained at weeks 1 and 6.

Post-injection pain

Overall, Fawi and colleagues found 35.3% of patients experienced post-injection pain or flare, which was defined as a two-point increase in the pre-injection VAS score at any time on days 0 to 7. They also found 7.7% of patients experienced severe post-injection flare defined as an increase in pain score by four points or more. Among patients with post-injection pain or flare, the results showed 24 patients experienced pain within the first 30 minutes of injection. Researchers found 45.83% of those 24 patients remained symptomatic for 3.8 days mean compared to 54.16% of patients who had symptoms solely on the day of the injection.

“Early post-injection pain is a transient phenomenon lasting up to 4 days and affecting one-third of patients,” Fawi said.

The results showed 69.8% of patients were discharged successfully, were satisfied with their current level of symptoms and did not need any further intervention at 6 months post-injection. The mean pre-injection pain VAS score improved from 6.1 points to 3.5 points among the successfully discharged patients.

In addition, 25% of patients either had surgery or were listed for surgery.

Future management

“The response to the injection at 6 weeks should help guide the patient’s future management without the need for further delay,” Fawi said.

Various rates of steroid flare have been discussed anecdotally, Fawi said. However, he said, this was the first study to quantify the ‘steroid flare’ effect methodically and it allows surgeons to provide more accurate answers to their patients.


“We are happy, as well, that we demystified the myth about ‘no pain, no gain’ in relation to steroid flare post-shoulder injections, where developing a flare or not was not related to the final outcome, good or bad.” Fawi said. – by Casey Tingle

Disclosure: Fawi reports no relevant financial disclosures.