Ultrasound guided injections can be an extremely effective tool for controlling shoulder pain. This blog discusses when, how and why an injection should be used. The most commonly injected shoulder conditions will also be discussed in detail, allowing you to make an informed decision about whether an injection is right for you. Below is a list of shoulder conditions commonly injected at Complete injections. Please click on a condition to understand more:

Shoulder injection FAQ’s

Should all shoulder injections be carried out under ultrasound guidance?

Yes, at Complete we believe all shoulder injections should be carried out using ultrasound guidance. The use of ultrasound guidance to perform a shoulder injection allows the needle to be monitored, in real time, to ensure it reaches the intended target. The high level of accuracy associated with ultrasound guided injections has been shown to improve the effectiveness of the injection and reduce the chance of accidentally traumatising local sensitive structures such as the nerves, blood, vessels, bones, and tendons. Ultrasound guided injections are significantly less painful and cause less post injection complications than injections carried out without guidance. If you have had a previous injection carried out without ultrasound guidance which has not been successful it may have missed the intended target. If you are still in pain it is worth repeating the procedure with ultrasound guidance.

All injections at complete are carried out under ultrasound guidance. To know more about ultrasound guided injections, read this link.

When should a shoulder injection be considered?

There could be a variety of reasons why you might be suffering from shoulder pain. When a course of physiotherapy and rehabilitation exercises have not had the desired effect then an ultrasound guided injection should be considered. An ultrasound guided injection is designed to control your pain, increase your movement, undertake a directed rehabilitation program and ultimately, return to the activities you love.

Injections should never be used as a stand-alone treatment. Maximum benefits are achieved when the injection is combined with a period of physiotherapy rehabilitation. Ultrasound guided injections provide a ‘window of opportunity’ which enables you to address the underlying causes of your pain. At Complete we will always recommend that after your injections that you seek the help of a physiotherapist.

If you can relate to the below list of symptoms then an ultrasound guided injection may be considered:

  • Significant pain with has been present for over six weeks or pain that is getting worse.
  • Pain that is stopping you from getting to sleep or wakes you at night.
  • Pain that is affecting your ability to walk.
  • Pain that is interfering with activities of daily living including walking and working.Pain that is stopping you from exercising or undertaking hobbies.

If you are suffering from one or more of the above symptoms then an injection might be indicated. If you would like to talk to one of our clinical experts or would like to book an appointment then please contact Complete 020 7482 3875 or email injections@complete-physio.co.uk.

What injection options are there for shoulder pain?

To understand each injection in more detail click on one of the below links:

Are ultrasound guided steroid injections painful?

The vast majority of patients tolerate ultrasound guided steroid injections in the shoulder very well. Using ultrasound to guide a needle directly to the point of pain means that thinner and shorter needles can often be used.. Using thinner needles causes less soft tissue trauma in the surrounding area. Guided injections are generally less painful than non-guided injections. All injections carried out at Complete are accompanied with the use of local anaesthetic. Local anaesthetic gives between 1 and 2 hours of local numbness. This is long enough to give pain relief during and after the injection and will get you home comfortably.

Pain is a very individual experience. Everyone has different pain thresholds and therefore one person may find an injection more uncomfortable than another. At Complete we always use the most comfortable position for the patient to relax the muscles and support the joint.

All our clinicians are highly experienced and carry out over 500 injections a year each. We pride ourselves on providing a comfortable and professional experience during and after every injection.

Read more.

How long the effects of an injection last?

A vast majority of the injections at Complete provide rapid, pain relief for our patients. This pain relief can last months to years and for some conditions it can cure the condition. The purpose of an injection is to provide a window of opportunity, allowing you to rehabilitate the underlying cause of your symptoms with significantly less or no pain. To maximise the benefits of an injection it is essential that a physiotherapy program start within 1-2 weeks after an injection.

A majority of the injections carried out at Complete are one off procedures because they provide the necessary pain relief. However, the effectiveness of an injection does vary from person to person. It can depend on many factors including your exact diagnosis, how long you have had the condition, the severity of your condition and other lifestyle factors.

To know more please follow this link.

How many shoulder injections can I have?

As previously mentioned the vast majority of injections carried out at Complete are one off treatments. An injection coupled with the period of post injection rehabilitation is often enough to resolve your symptoms however, there are some conditions that require more than one injection. These include:

  • Degenerative conditions such as knee osteoarthritis
  • Multiple conditions running concurrently such as osteoarthritis of the shoulder and a shoulder bursitis
  • Frozen shoulder. Frozen shoulder is incredibly painful condition characterised by pain and stiffness in the shoulder. This condition may require a second injection.
  • Some conditions such as rotator cuff tears or bursitis. If you respond positively to your first injection but symptoms still remain a second injection may be required to allow maximum pain free rehabilitation to occur.

The Arthritis Research Council (ARC) recommend no more than three injections in one area over a one year period however, to read more please follow this link.

Do injections just numb the pain?

In short the answer is no. A cortiosteroid is a powerful anti-inflammatory medication which has the power to reduce inflammation. By reducing inflammation your symptoms can be effectively and safely controlled. This allows you to comfortably undertake a rehabilitation program under the guidance of a physiotherapist. To read more please follow this link.

How long do I need to rest after having a shoulder injection?

A period of rest immediately after a shoulder injection is highly recommended however, not all injections require the same amount of rest. There are many factors which can influence the recommended period of rest. These include:

  • The severity of your condition
  • The underlying pathology responsible for your symptoms
  • Your specific goals.

Do you want to just be able to complete pain free activities of daily living or do you want to return to the gym and push heavy weights?

Steroid injections can provide fast effective pain relief but it is important to understand the reasons behind your pain. Your clinician will explain your condition to you and talk you through what you can and cannot do after your injection.
To know more please follow this link.

How much does a shoulder injection cost?

Single ultrasound guided injection prices range between £250 and £450. For a full list of prices and for more information please follow this link.

Shoulder conditions that can be treated with an injection?

Below is a list, and description, of the most common shoulder conditions that can be successfully treated with an injection.

Osteoarthritis of the glenohumeral joint (ball and socket joint of the shoulder)

The shoulder is made up of two joints, The glenohumeral joint (the shoulder joint proper) and the acromioclavicular joint (sitting at the tip of your shoulder). Both joints can be affected by osteoarthritis. Osteoarthritis is known as a progressive degenerative condition which affects joints. This condition mostly affects people from their 50s onwards. Osteoarthritis develops when a joint is subjected under excessive pressure over a prolonged period of time. This increased joint pressure can result in the joint surfaces rubbing together which, in turn, causes the articular cartilage (shock absorbing inner layer of the joint) to wear. If the joint is continually stressed the articular cartilage wears away leaving the underlaying bone surfaces to become exposed. Joint irritation can result in the inner lining of the joint capsule (called the synovial membrane) to become irritated and inflamed. This is called (known as synovitis) and is often the cause of the pain associated with osteoarthritis.
General signs and symptoms associated with osteoarthritis of the shoulder include:
  • Pain surrounding the shoulder joint. This can be hard to locate.
  • Shoulder joint stiffness (especially first thing in the morning).
  • Reduced range of motion. Some people find difficulty with raising the hands above their head.
  • Change in shape. An osteoarthritic joint can appear larger and thickened as the disease process progresses.

To know more about shoulder osteoarthritis please click on this link.

Frozen shoulder

A frozen shoulder is an incredibly common condition which causes the shoulder joint to become stiff and extremely painful. Symptoms often start without any warning, frequently without incident or accident. Frozen shoulders typically affect people in their 40’s to 60’s and most commonly affects women and Diabetics. The pain and stiffness associated with a frozen shoulder can last for a few years and so it is paramount that a frozen shoulder is treated correctly as soon as possible.

General signs and symptoms associated with frozen shoulder are:

Research states that the most effective treatment available for frozen shoulder is injection therapy. After an injection pain levels can be significantly reduced allowing you to partake in a period of intensive physiotherapy, aimed at increasing the flexibility and function in the arm. Follow this link to find out more about frozen shoulder.

Rotator cuff pain

The rotator cuff is a series of important muscles who’s tendons attach around the shoulder joint. The muscles (and most importantly, their tendons, are supraspinatus, infraspinatus, subscapularis and teres minor). The rotator cuff contracts together to hold the shoulder joint in position during movement and so are pivotal in producing pain free movement. The rotator cuff is susceptible to injury. Injury can occur due to repetitive movements undertaken during sports and hobbies, after an accident or fall or can slowly develop over time, seemly without any reason.

Rotator cuff related pain encompasses a series of pathologies which can affect the rotator cuff tendons of the shoulder. These include tendinitis (an inflamed and irritated tendon), tendinopathy (wear and tear of a tendon) or tear (tears can be partial, leaving a portion of the tendon unaffected or complete, involving the whole of the tendon).

General signs and symptoms associated with rotator cuff pain are:

  • Pain radiating from the shoulder down the outside of the arm towards the elbow and around the back of the shoulder and shoulder blade.
  • Pain which is made worse when lifting the arm above the head or out to the side.
  • A sensation of weakness. This is mostly evident when trying to bring your arm back down from an overhead activity.
  • Pain that wakes you at night

When conservative management including physiotherapy and rehabilitation exercises have not been effective then an injection can be very useful to reduce pain and allow you to rehabilitate the rotator cuff tendons.

Follow this link to know more about rotator cuff related pain.

Subacromial bursitis

A bursa is a fluid filled sack which provides a friction free surface for different structures to slide past each other allowing pain free during movement to occur. There are around 150 bursae found throughout the body. The shoulder is a highly mobile joint, capable of a wide variety of movements and so has many bursae surrounding it. The largest, and by far the most pain sensitive, is the subacromial bursa. The subacromial bursa sits above the rotator cuff tendons and provides a friction free surface for shoulder motion to occur. A bursitis occurs when a bursa becomes irritated and inflamed. This can occur due to a single incident or accident but most commonly happens gradually due to low level, repetitive movements.
General signs and symptoms associated with rotator cuff pain are very similar to rotator cuff related pain and include:
  • Pain radiating from the shoulder down the outside of the arm towards the elbow and around the back of the shoulder and shoulder blade.
  • Pain which is made worse when lifting the arm above the head or out to the side.
  • A sensation of weakness. This is mostly evident when trying to bring your arm back down from an overhead activity.
  • Pain that wakes you at night

This is a highly painful condition and is an incredibly common condition treated with both physiotherapy and injection therapy. When physiotherapy and rehabilitation exercises have not worked then an injection can be considered.

For more information regarding subacromial bursitis follow this link.

Calcific tendinopathy

Calcific tendinitis of the shoulder is an incredibly painful condition which has a rapid onset of significant pain which often radiates from the shoulder down the arm. Many patients even report attending A&E due to the severity and rapidity of their symptoms. All activities of daily living are affected and sleep can be challenging. A calcific tendinitis can occur throughout the rotator cuff of the shoulder but is most common in the supraspinatus tendon. It is still not fully understood why some people develop a build-up of calcium within a tendon however it is believed to be associated with repetitive tasks. Being female and in the 4th and 5th decade of life are also common sufferers.
General signs and symptoms associated with calcific tendinitis are:
  • A sudden and significant onset of severe pain in the shoulder and upper arm.
  • A significant reduction in the ability to use the arm (due to pain).
  • Pain that is worse first thing in the morning.
  • Pain that wakes you at night.

For more information regarding calcific tendinitis follow this link.

Biceps tendinitis

Biceps tendinitis typically causes pain located at the front and side of the shoulder. Although it can affect anyone at any age it is most commonly seen in younger sporty patients. Biceps tendinopathy occurs due to repetitive movements and is often associated with manual jobs such as building or sports such as tennis. When the biceps tendon is subjected to prolonged periods of stress it can become irritated and inflamed, this is known as tendinitis. If the tendon continues to be subjected to repeated episodes of tendinitis the tendon structure can become compromised resulting in a weakened tendon. This is called tendinopathy. Furthermore, the biceps tendon can rupture however, the bicep tendon can easily be assessed using diagnostic ultrasound and the most effective treatment selected. If physiotherapy and a specific rehabilitation program does not resolve your symptoms then a corticosteroid injection may be required.

General signs and symptoms associated with a biceps tendinitis are:

  • Pain both at the front and side of the shoulder.
  • Pain when lifting the arm above the head, especially out in front of you.
  • Tenderness located at the front of the shoulder.

For more information regarding Biceps tendinitis follow this link.

Acromioclavicular joint sprain

The acromioclavicular joint is located at the tip of the shoulder (the junction between the acromion of the scapular and the clavicle or collarbone). This joint is highly susceptible to injury during contact sports such as a tackle during a rugby match or after falling from a bicycle. Furthermore; the acromioclavicular joint is commonly affected by osteoarthritis.

General signs and symptoms associated with a acromioclavicular joint sprain are:

  • Focal pain located at the top of the shoulder.
  • Pain on palpation of the joint itself.
  • Pain lying on your affected side.
  • Pain when moving your arm across your body.

For more information regarding acromioclavicular joint sprain follow this link.

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