Intra-articular Steroid Injections for the Shoulder
Introduction
The intra-articular steroid injections are a treatment method for relief from joint pain. These steroids are used to decrease the inflammatory reaction associated with osteoarthritis and rheumatoid arthritis. The most prominent indication of the use of such steroid injection is conservative management of an impingement. An intra-articular steroid injection for the shoulder is also known as a subacromial injection as it is injected into the subacromial space in the shoulder. This form of treatment is a common remedy for painful conditions of the shoulder such as the rotator cuff disease. Basically, the intra-articular steroid injections aim to provide a 2 to 6 week relief from shoulder pain. Meanwhile, the higher-dose steroids with or without joint lavage can provide pain relief up to 24 weeks.
Research and Analysis
Recent research indicates that the intra-articular steroid injections for the shoulder are effective for improvement of rotator cuff tendonitis upto a 9-month period. This form of medication has also often been found to be more effective than NSAIDs. In addition, higher doses are often said to be better than lower doses for such injections. Research also suggests that the intra-articular steroid injections have a useful role in the outpatients management of capsulitis in its early stage.
The Procedure
These intra-articular steroid injections are injected by a needle into and around joints to relieve pain and swelling. Many different types of steroids can be injected. Besides, steroids can be injected into different parts of the joint or around the joint depending on the point that is diagnosed with the problem. Prior to the procedure, the surgeon has to be sure that there is no tear of the rotator cuff, which can be confirmed by investigations such as an MRI scan. However, the injections should not be too frequent as this can increase the risk of a vascular necrosis. The injections are given into the anterior part of the subacromial bursa, while the intra-articular local anesthetic injections are used as a diagnostic test for impingement.
Application and Benefits
The intra-articular steroid injections are commonly used as a part of the treatment modality for relief from shoulder pain. These steroid injections are successfully used with:
- Physical therapy
- NSAIDs
- Weight reduction programmes
- Topical and opioid analgesics
- Education
The most important benefits of the intra-articular steroid injections for shoulder pain include:
- Pain and movement in the shoulder might improve considerably
- Ability to resume daily activities gets restored quickly
- Quicker relief as compared to conventional medicines
- Helps to avoid risk of stomach side-effects associated with NSAIDs
Another key benefit of using the intra-articular steroid injections for shoulder pain is that it is an effective remedy for decreasing pain and swelling quickly. Patients also prefer to opt for these intra-articular steroid injections in order to delay using steroid pills or arthritis drugs.
Types and Forms
There are various types of preparation of steroids that have a different duration of effect and action. The guiding principle which determines the effectiveness of each of these preparations is their solubility. The insoluble preparations are known to have a longer duration of effect and are the most preferred. For the benefit of analysis, here we briefly list each one of the preparations of the intra-articular steroid injections.
Aristospan (Triamcinolone HEXACETANIDE) – These are the most soluble and preferred preparation for intra-articular injections. The duration of effect is usually 6 months. Aristocort (Triamcinolone ACETONIDE) – Highly insoluble, this is the preparation normally preferred after the above. This particular preparation normally has a duration of 3 months. Depo-medrol (Methylprednisolone acetate) – This is highly soluble and should only be used as a last resort. The duration of effect in this preparation is only 5 weeks.
Conclusion
The subacromial corticosteroid injections for the rotator cuff disease and intra-articular steroid injection for adhesive capsulitis are quite beneficial. However the impact of these injections can be short-lived. Experts suggest that a more extensive research is required to study the efficacy of the corticosteroid injections for shoulder pain. There are other issues that also need to be clarified. The most important amongst these is whether the factors like accuracy of needle placement, anatomical site, frequency, dose and type of corticosteroid influences the efficacy of the injection.
