Shoulder Joint Injection
Corticosteroid injection for shoulder pain and inflammation
About this injection
The shoulder is the most mobile joint in the body and one of the most commonly injected. Corticosteroid injection into the shoulder delivers powerful anti-inflammatory medication directly to the source of pain, providing rapid and often prolonged relief.
Dr Hasham performs shoulder injections using anatomical landmark technique. Depending on the diagnosis, the injection is placed into the subacromial bursa, the glenohumeral joint, or the acromioclavicular (AC) joint. The correct target is selected based on clinical assessment and the pattern of symptoms.
The procedure is performed without ultrasound guidance. For most patients with a clear clinical diagnosis and appropriate anatomy, landmark-guided injection achieves excellent results with a well-established safety profile.
Conditions treated
- ✓Subacromial bursitis — inflammation of the bursa beneath the acromion
- ✓Rotator cuff tendinopathy — degeneration and inflammation of rotator cuff tendons
- ✓Subacromial impingement syndrome — painful arc on shoulder elevation
- ✓Glenohumeral osteoarthritis — wear-and-tear arthritis of the ball-and-socket joint
- ✓Adhesive capsulitis (frozen shoulder) — stiffness and pain from capsular thickening
- ✓Acromioclavicular (AC) joint arthritis or sprain
- ✓Calcific tendinitis — calcium deposits within the rotator cuff
- ✓Post-operative or post-injury shoulder inflammation
Symptoms
- —Pain on raising the arm above shoulder height
- —Painful arc between 60° and 120° of elevation
- —Night pain and difficulty sleeping on the affected side
- —Weakness and restricted range of movement
- —Localised tenderness over the shoulder
- —Pain radiating into the upper arm (not below the elbow)
- !Pain radiating below the elbow with neurological symptoms — consider cervical spine pathology
- !Fever, night sweats, unexplained weight loss — exclude infection or malignancy
- !Acute traumatic injury with significant swelling — may require imaging before injection
- !Previous septic arthritis of the shoulder
Assessment & diagnosis
Dr Hasham performs a thorough clinical assessment including active and passive range of movement, impingement tests (Neer, Hawkins-Kennedy), AC joint stress tests, and rotator cuff power testing. This determines which structure is the primary pain generator and guides injection site selection.
Treatment options
What happens on the day
- Full clinical assessment and confirmation of diagnosis
- Patient positioned seated or lying with the shoulder exposed
- Landmark identification — acromion, coracoid, and glenohumeral joint line
- Skin cleaned with antiseptic solution
- Corticosteroid and local anaesthetic drawn up and confirmed
- Needle inserted to the target site using anatomical landmark technique
- Aspiration check before injection
- Medication injected smoothly — resistance indicates incorrect placement
- Needle withdrawn, pressure applied, dressing applied
- Post-procedure advice and aftercare instructions given
Injection technique
The subacromial space is most commonly accessed via the posterior approach, with the needle directed anteriorly beneath the posterior acromion. The glenohumeral joint is accessed posteriorly, aiming toward the coracoid. The AC joint is approached superiorly with a small-gauge needle. A mixture of corticosteroid (e.g. methylprednisolone 40mg or triamcinolone 40mg) and local anaesthetic (1% lidocaine) is used. Injection should flow freely — resistance suggests extracapsular placement.
Risks & side effects
- —Post-injection flare — temporary increase in pain 12–24 hours after injection, settling within 2–3 days
- —Skin and subcutaneous fat atrophy at injection site (rare with deep injections)
- —Temporary elevation in blood glucose in diabetic patients
- —Infection — rare (<1 in 10,000) but serious; sterile technique minimised this risk
- —Tendon weakening with repeated injections — limit to 3 per year per joint
- —Facial flushing — transient, harmless
Aftercare
- ✓Rest the shoulder for 24–48 hours following injection
- ✓Avoid strenuous shoulder activity for 2 weeks
- ✓Expect temporary numbness from local anaesthetic — lasting 2–4 hours
- ✓Post-injection flare is normal — ice and simple analgesia help
- ✓Begin physiotherapy 2 weeks after injection for best long-term results
- ✓Effect typically develops over 48–72 hours and peaks at 2 weeks
- ✓Return if no improvement after 4 weeks — reassessment and further management
Frequently asked questions
£50 consultation fee redeemable against treatment
30 years NHS · GMC registered. Every injection performed personally — full clinical assessment included.
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