Many are familiar with the use of steroid injections for management of shoulder pain. Some will argue that these injections are used too often as an initial go-to for shoulder pain management. As a result, there is much debate in the medical community regarding their use.

A good question would be: how many medical providers are using steroid injections to treat shoulder pain?

This is a pretty valid question considering the various opinions surrounding the use of steroid injections. The authors of this article had this same thought in mind.

Let’s break things down and see what they found out!

Purpose of the Research

The article makes it very clear that supporting research typically does not recommend the use of corticosteroid injections as the first line of treatment for shoulder pain. Rather, it may be a necessary form of treatment if initial treatment fails.

The reason for this is because steroid injections have been found to only give short-term pain relief and no long-term benefits. Additionally, there have been some safety concerns brought up by the medical community regarding the regular use of these injections.

Even with these general recommendations and thoughts regarding steroid injections, you might still wonder how many medical practitioners are using these injections, especially as a first measure for pain management.

If they are commonly being used by medical providers, is this because they’re a safer treatment option than what has usually been thought of in the past?

Methods for Gathering Data

So, what type of date did the authors of this article gather?

They used a specific medical database (Rijnmond Primary Care database) to analyze a multitude of patient records when they went to visit their general practitioner (GP) for shoulder pain.

All patient records involved adult patients only (no pediatric patients), and they’re shoulder pain had to have occurred within a specific 5-year time frame (January 1, 2012 – December 31, 2017). Specific patients were then selected and split into two sample groups.

Each group had detailed criteria the researchers were looking for. Both groups involved patients with isolated, new shoulder pain onset, but one group specifically selected those who had been given a corticosteroid injection within 1-year after their original shoulder pain diagnosis was made with their GP.

Various factors were included in the analysis and results, such as age, gender, and medical history. Documentation was recorded if there were any abnormal reactions to the steroid injections within 3 months of being given (e.g., skin reaction, hyperglycemia, abnormal menstruation, increased pain, headaches, etc.).

Results of the Study

Results time!

What did the researchers find out?…

The study showed that about ¼ of patients selected received a corticosteroid injection for onset of new shoulder pain within a year of receiving this diagnosis.

Half of the patients appeared to have received their injection as a first line of treatment versus consideration and application of alternative treatment methods, as is the typical recommendation among other research and literature.

Another interesting finding was that most of the patients who received injections as a first line of treatment were in an older population. These older patients also tended to receive multiple injections within the first year of their shoulder pain diagnosis. It’s a possibility GPs did this because they wanted to avoid the use of opioids or anti-inflammatory drugs with their older patients.

When comparing with other research, this study found that 26% of patients received a steroid injection by their GP. Other studies have normally shown a range of 20-24%, so the results among these studies seems pretty comparable.

In this particular study, almost half of the patients received their injection at the very first consult. This goes against the research-proven recommendations, which suggest initial shoulder pain management via patient education and other conservative measures for pain control, such as analgesics.

The study did not find anyone who experienced any serious side effects from the steroid injections. The most common mild side effects involved skin reactions, hyperglycemia, and abnormal menstruation.

An important finding to note with this research also includes the effects on the shoulder tendon/s with the use of steroid injections. This includes one or more of the following:

• Cell death within the treated tendon/s

• Slowing of cell growth

• Decreased ability to take on a higher load

Key Takeaways

That’s a lot of info!

Let’s try to sum things up with a few key findings from this article:

• More GPs than expected appeared to use corticosteroid injections as their first treatment measure for new shoulder pain.

• Older patients were given the injections as a first line of treatment and even given repeated injections during the first year of their shoulder pain.

• It would be beneficial to know more details surrounding the decision of the GPs in providing these injections so soon.

• Even with only mild side effects found in this study, the potential long-term effects on tendon health should not be neglected.

That’s our research in a nutshell!

Resource:

1. Pieter F van Doorn, Dieuwke Schiphof, Rianne M Rozendaal, Ramon P G Ottenheijm, Johan van der Lei, Patrick J E Bindels, Evelien I T de Schepper, The use and safety of corticosteroid injections for shoulder pain in general practice: a retrospective cohort study, Family Practice, Volume 39, Issue 3, June 2022, Pages 367–372, https://doi.org/10.1093/fampra/cmab116.