Shoulder Cortisone Injections: Benefits & Risks

Shoulder Cortisone Injections: Benefits & Risks

By Alex Parker, Physiotherapist | Edited by the BVP Team

Shoulder cortisone injections are often recommended to relieve pain from conditions like rotator cuff injuries or subacromial impingement. But how effective are they really, and what are the risks of repeated use? In this article, we break down what the latest research says about the benefits, limitations, and potential side effects of corticosteroid injections for shoulder pain.

After a look at the research, here’s what you need to know.

Do Cortisone Injections Help Shoulder Pain?

Research shows that cortisone injections can provide short-term pain relief, particularly in cases of rotator cuff tendinosis.

  • A 2017 meta-analysis by Mohamadi et al. found moderate short-term relief (4–8 weeks) from cortisone injections. However, there was no benefit over placebo at the 3-month mark.

  • In other words, while they may reduce pain in the short run, the long-term effects are less convincing.

Shoulder cortisone injection being administered by a healthcare professional
Administration of a cortisone injection to the shoulder to reduce pain and inflammation

How Do Cortisone Injections Compare to Physiotherapy?

A 2022 study by Benjamin-Damons et al. compared corticosteroid injections with physiotherapy in patients with subacromial impingement syndrome. Their findings:

  • At 24 and 48 weeks, neither approach was superior for improving pain, range of motion, or shoulder function.

  • Both treatments were found to be beneficial, but cortisone injections carried potential adverse effects, including:

    • Immune system suppression

    • Possible cartilage toxicity

This highlights physiotherapy as a safe, effective alternative—especially for long-term management.

What Are the Risks of Cortisone Injections?

Cortisone is a powerful anti-inflammatory, but it may also interfere with the body's healing processes:

  • According to a 2020 review by Puzzitiello et al., corticosteroids:

    • Suppress inflammation

    • Induce tendon cell death (apoptosis)

    • Reduce tendon collagen production

    • Weaken the tendon’s mechanical strength, such as its ability to withstand load and anchor repairs

These effects were found to be dose- and frequency-dependent, meaning more frequent or stronger injections likely lead to greater tissue damage.

Why the "Three Injections per Year" Rule?

You may have heard the advice: “No more than three cortisone injections per year per joint.” But why?

Research from Harada et al. (cited in Puzzitiello et al., 2020) supports this caution. High concentrations of corticosteroids were shown to cause irreversible damage to tendon cells, while lower doses had only temporary effects. This likely forms the basis for the common clinical limit of three injections annually.

Can Cortisone Injections Cause Tendon Tears?

Yes, some evidence suggests a link.

A 2022 cohort study by Lin et al. found that patients receiving shoulder steroid injections had a 7.4 times higher risk of developing rotator cuff tears, compared to those who didn’t receive injections. However, the study couldn’t control for all factors (like injury severity or injection technique), so the results should be interpreted with caution.

Still, it adds weight to the argument for judicious use of corticosteroids especially in active individuals or those considering surgery.

Bottom Line: Are Shoulder Cortisone Injections Worth It?

Cortisone injections can provide temporary pain relief, which may help people engage in physiotherapy or manage short-term flare-ups. But they:

  • Don’t offer long-term benefit compared to physiotherapy

  • May weaken tendon tissue, especially with repeated use

  • Could increase the risk of tendon tears in some cases

What Should You Do?

Talk to your healthcare provider or physiotherapist about your individual condition. Physiotherapy remains the gold standard for many shoulder issues—and it comes without the long-term risks of corticosteroids.

If you and your provider are considering an injection, make sure it’s part of a broader rehab plan not a standalone fix.

Let us know if you’d like to speak to one of our physiotherapists about your shoulder condition, we’re here to help you move better, with less pain.

References:

Benjamin-Damons, N., Hussein El Kout, N. A. R., van Bever Donker, R., Edwards, T., & Ferguson, G. (2022). Corticosteroid therapy versus physiotherapy on pain, mobility and function in shoulder impingement: A short note. The South African journal of physiotherapy, 78(1), 1794. https://doi.org/10.4102/sajp.v78i1.1794

Mohamadi, A., Chan, J. J., Claessen, F. M., Ring, D., & Chen, N. C. (2017). Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis. Clinical orthopaedics and related research, 475(1), 232–243. https://doi.org/10.1007/s11999-016-5002-1

Puzzitiello, R. N., Patel, B. H., Forlenza, E. M., Nwachukwu, B. U., Allen, A. A., Forsythe, B., & Salzler, M. J. (2020). Adverse Impact of Corticosteroids on Rotator Cuff Tendon Health and Repair: A Systematic Review of Basic Science Studies. Arthroscopy, sports medicine, and rehabilitation, 2(2), e161–e169. https://doi.org/10.1016/j.asmr.2020.01.002

Lin, C. Y., Huang, S. C., Tzou, S. J., Yin, C. H., Chen, J. S., Chen, Y. S., & Chang, S. T. (2022). A Positive Correlation between Steroid Injections and Cuff Tendon Tears: A Cohort Study Using a Clinical Database. International journal of environmental research and public health, 19(8), 4520. https://doi.org/10.3390/ijerph19084520

Comments are closed.