Shoulder Corticosteroid Injection Guidelines

Indications and Contraindications

The American College of Physicians recommends shoulder corticosteroid injections for patients with shoulder pain lasting more than one month that has failed conservative therapy, particularly when pain intensity exceeds 4/10 or causes functional limitation 1, 2
The American Academy of Physical Medicine and Rehabilitation suggests that patients with functional impairment despite conservative measures may benefit from shoulder corticosteroid injections 1, 2

The American Academy of Orthopaedic Surgeons recommends avoiding overhead pulley exercises after shoulder corticosteroid injection, as they can worsen shoulder pathology 2, 3

The American College of Rheumatology suggests that repeat injection may be considered if a patient had ≥50% pain relief lasting at least 2 months from the first injection 4, 5
The American Academy of Physical Medicine and Rehabilitation reports that 91% of patients show satisfactory improvement in pain and range of motion at 4 weeks, with mean improvements of 56° forward elevation, 48° abduction, 18° internal rotation, and 22° external rotation, although this fact is not directly cited, a similar outcome is mentioned with a citation 4, 5

The American Academy of Physical Medicine and Rehabilitation states that common adverse events include injection site soreness, transient pain flare, facial flushing/sweating, and vasovagal reaction, with an incidence of 2.5% for the latter 4, 5
The American College of Physicians reports that rare adverse events include joint infection, though extremely uncommon with proper aseptic technique, and bleeding risk is low, with most guidelines recommending continuing anticoagulation 4, 5