Exploring Steroid Injections for Frozen Shoulder

What You Need to Know (8 minute read).

24th February 2024

So you’ve been told by your GP or another healthcare provider that you’ve got a Frozen Shoulder or another shoulder concern* which was either caused by trauma or came on seemingly out of nowhere. 

Now this person is offering you a steroid injection as treatment. But before you agree to this treatment.....what should you know? 

I see many people in my clinics in Swindon who are living with shoulder pain (and other joint pain) and have in the past had a steroid injection or have recently been offered one. So here is my take on what you should know. 

*For simplicity of this blog I am only going to cover steroid injections for ‘Frozen shoulder’ as opposed to breaking it down into other shoulder complaints, but I would add many shoulder complaints can be mis-diagnosed as frozen shoulder (true frozen shoulder is not as common as you think), or can go on to ultimately cause frozen shoulder. But whatever the reason, if you’ve been given a recommendation of having a steroid injection, all of the below applies to you! 

So first off let’s start with this question = what even is Frozen Shoulder!? 

Frozen shoulder is medically known as adhesive capsulitis, and it is a painful condition which presents as stiffness with limited range of motion in the shoulder joint both when the person tries to move their arm themselves (active), or when someone else tries to move it for them (passive). 

The reason for true adhesive capsulitis is because of an excessive amount of new blood vessels growing in the tissues within the joint space (triggered by some inflammatory response). This then creates an increase of fibroblasts (cells in the bodies tissues which create collagen) which leads to more type 3 collagen fibres being produced, they are produced thicker and in a more random structure than the existing fibres, and it’s because of this that there is a reduction in space within the joint. 

If someone suffering with true Frozen Shoulder had their shoulder joint looked at from the inside you’d expect to see the capsule tissues being quite pink and red because of all the new blood vessels, whereas normally they would appear grey as the area should have a low blood supply. 

This condition typically progresses through three stages: freezing, frozen, and thawing.  

Freezing: 

You experience a gradual onset of pain and stiffness in the shoulder, but overall you are still able to complete everyday activities. 

Frozen: 

Likely the pain will have subsided a lot or completely but you are left with very limited movement in your shoulder which makes every day activities difficult to manage. 

Thawing: 

You start to get improved range of movement and any pain you were left with starts to reduce and normally disappear completely. 

There are various treatment options that someone can access which I won’t really cover here, however steroid injections have gained popularity because of their potential to alleviate symptoms and improve mobility.  

You should know that most cases of Frozen Shoulder heal spontaneously and do not require surgical intervention. However patience is required, because unfortunately it can be an average of 1.5 years for full recovery and sometimes longer than this (this doesn’t mean you won’t experience progress in your symptoms during this time, as you will....but to be completely symptom free can take this long) 

So why have a steroid injection? 

Steroid injections, also known as corticosteroid injections, are a common treatment approach for various inflammatory conditions, including frozen shoulder. These injections typically contain cortisone, an anti-inflammatory medication. They are designed to mimic the body's own hormone (cortisol) which has inflammatory reducing qualities. When injected directly into the affected shoulder joint, corticosteroids work by reducing inflammation and suppressing the immune response, thereby alleviating pain and improving mobility. 

Research suggests that steroid injections can provide significant relief for individuals with frozen shoulder, particularly during the early stages of the condition. Studies have demonstrated improvements in pain levels, range of motion, and functional outcome. However, it's important to note that the effectiveness of these injections may vary from person to person. 

How long does the benefits of a steroid injection last? 

Some people that I’ve seen in clinic find that they see benefit for up to 6 months from having a steroid injection, however other clients of mine have seen as little as 2 weeks of reduced symptoms. But then again some other people report that they never experience issues again after one treatment. 

How many steroid injections can you have? 

According to the NHS they normally recommend waiting 3 months between injections, and no more than 4 per year in the same joint. So baring in mind how long someone might see a benefit, and how long the condition can last, you might find that steroid injections alone are not enough to keep you symptoms free. 

Are there any side effects of a steroid injection into a joint? 

There are a number of side effects that you should be aware of when having a steroid injection and some (but not all) are covered below. Also to note some may be experienced soon after the treatment and others may come later down the line. 

You might experience swelling, redness, bruising and discomfort at the injection site, and there is a potential to get an infection which should be considered. They can also cause blood sugar levels to spike for a few days so if you’re diabetic you need to be aware of this. 

From a long term perspective there is some evidence to show that they can weaken tendon tissues (the more injections you have the higher the risk that is the case) and this could lead to tears or ruptures of the tendons in the shoulder later down the line. 

Top tip from me if choosing to have a steroid injection! 

Much like many treatments out there (including massage and manipulations etc) they are a plaster for the problem. They are unlikely on their own to be the thing that solves your problem. 

I always say to people that they should be thought of as providing you with a ‘window of opportunity’ to do the things that WILL help. If you’re in so much pain that you can’t do anything to make it better, but if a steroid injection takes some or all of that pain away, then there is your window to do the things that will help......... in this case for me it’s all about rehab exercises. 

While your pain is reduced and manageable this is the time to work on your rehab. But so many people don’t make this a priority, normally because they feel so much better they don’t see the need. 

So my ultimate conclusion about steroid injection treatment is that it can be a valuable treatment for many people to help reduce the painful and restrictive symptoms, but they do come with risks and there is no guarantee they will work, or for long. You should also consider this treatment as a part of the overall rehab and make sure to prioritise movement and strength exercises to provide long term improvement as well as reduction in the chances of experiencing a similar issue later down the line. The rehab is also especially important to counteract the risk of weakened tendons I mentioned earlier in the blog. 

For more information about the risks of steroid injections always consult with a healthcare provider who is qualified in administering such treatment (p.s this isn’t me!) 

L x