Author | John G. Skedros, MD


Corticosteroids for painful shoulder conditions: Injection techniques

July 26, 2008

ABSTRACT: Corticosteroid/anesthetic injections may be useful diagnosticand therapeutic tools for painful shoulder conditions. The currentdogma is to avoid performing more than 3 injections over a9- to 12-month period, but this rule may be broken. The volume of localanesthetic typically injected might be insufficient for assessing accuracy.Data demonstrating significant advantages of one corticosteroidover another are scarce. For patients with diabetes mellitus, considera somewhat insoluble phosphoric corticosteroid. There is no consensusabout appropriate dosages and techniques.We recommend using1.5-inch 25-gauge needles for most injections. Re-evaluating provocativemaneuvers after each injection is important. The patient's estimatedpain relief always should be documented.Two approaches toinjection may be used, an advanced/detailed method and abasic/quick method. (J Musculoskel Med. 2008;25:375-386)

Injectable corticosteroids for the painful shoulder: Patient evaluation

April 29, 2008

ABSTRACT: Management with corticosteroid injections should beconsidered for a variety of painful shoulder conditions, such ascervical, acromioclavicular, subacromial, glenohumeral, and bicepstendon pathology. Several aspects of the physical examination areused to isolate the anatomical source of a patient's shoulder pain.Knowing how to perform provocative maneuvers and evaluate theresults is critical for making the diagnosis and identifying potentialcorticosteroid/anesthetic injection sites. In our comprehensive16-step shoulder examination, radiographs are not viewed initiallyto avoid bias that can lead to inaccurate diagnosis. When commonprovocative maneuvers for shoulder conditions are used in isolation,their sensitivity and specificity typically are lower than whenthey are used in combination. Obtaining high-quality radiographs isessential. (J Musculoskel Med. 2008;25:236-245)

The use and misuse of injectable corticosteroids for the painful shoulder

January 28, 2008

Injectable corticosteroids may be used for managing painful shoulder conditions, but there are no universally accepted guidelines for dosage and administration. Understanding the mechanisms of action is critical for knowing when they can be used effectively. The biggest absolute contraindication to intra-articular or extra-articular corticosteroid injections is evidence or probability of infection. Relative contraindications include anticoagulation therapy, hemarthrosis, and poorly controlled diabetes mellitus. Most complications result from frequent use and can be avoided with appropriate doses and dosing intervals. Intra-articular and periarticular corticosteroid injections may cause significant systemic effects. The misuse of corticosteroid injections often is overuse. Creation of uniform guidelines for injections would help reduce their deleterious effects and maximize pain relief. (J Musculoskel Med. 2008;25:78-98)