Is a Cortisone Shot in the Shoulder Worth It?

Short answer: Often, yes, when the shot is matched to the right problem. A cortisone shot can quiet inflammation from bursitis, impingement, frozen shoulder, or arthritis, and the relief often lasts long enough for physical therapy to make real progress. It will not repair a torn tendon or worn cartilage, and repeated shots carry tradeoffs, especially if surgery could be in your future.

What does a cortisone shot actually do?

Cortisone is a corticosteroid, a strong anti-inflammatory medicine. When it is injected into or next to the shoulder, usually mixed with a numbing agent, it calms the irritated tissue that is producing pain. It acts mostly where it is placed, so far less reaches the rest of your body than with steroid pills.

What it cannot do is change structure. If a tendon is torn or the joint cartilage has worn thin, the shot can make those problems hurt less for a while, but they are still there when it wears off. Keep that in mind as you weigh whether a shot is worth it for you.

Which shoulder problems respond best?

• Bursitis and impingement. Pain on the outside of the shoulder when you reach overhead or lie on that side often responds well, particularly when the shot is paired with exercises that strengthen the rotator cuff.
• Frozen shoulder. A large 2020 review in JAMA Network Open compared the available treatments and found that an injection into the joint was the only one with clear short-term benefits for pain and function. Adding a home exercise program helped further. Our article on whether a frozen shoulder will heal itself walks through the stages.
• Arthritis. For some people a shot buys months of comfort, though the benefit usually shrinks as arthritis progresses. See our overview of treatment options for shoulder arthritis.
• Rotator cuff tears. A shot can settle inflammation around a tear, but it will not shrink the tear. With a large or growing tear, feeling better after a shot can hide a problem that is becoming harder to repair. We explain that in Do Rotator Cuff Tears Heal Themselves?

How long does a cortisone shot in the shoulder last?

Most people feel the numbing medicine for a few hours, then notice the steroid start working over the next several days. How long the relief lasts varies a lot. Some people get a few weeks, others several months, and sometimes the problem settles for good because therapy had a chance to work during the calm stretch.

A shot that helps for only a week or two, or not at all, tells us something too. The pain may be coming from somewhere other than the spot that was injected, or there may be a mechanical problem that no injection can fix.

How many cortisone shots can you get in your shoulder?

There is no universal number, but most shoulder surgeons space injections at least three months apart and keep the yearly total low. The concern is that steroids can weaken tendon tissue with repeated exposure.

Research on rotator cuff repair backs up that caution. In a study of more than 110,000 Medicare patients and nearly 13,000 privately insured patients, one injection in the year before a rotator cuff repair was not linked to a higher chance of revision surgery. Two or more injections in that year were linked to roughly two and a half to three times the odds of needing a revision.

If you need a shot every few months just to get through the day, treat that pattern as a signal to look more closely at what is going on.

Can a cortisone shot affect future shoulder surgery?

Yes, and timing matters. A study of Medicare patients in the Journal of Shoulder and Elbow Surgery found that an injection within the three months before a shoulder replacement roughly doubled the odds of infection after surgery. Arthroscopic surgery showed the same pattern. Injections given more than three months before surgery did not carry that increase.

So if surgery is on the table, tell your surgeon about every shoulder injection you have had and roughly when. We plan any injection around a possible operation, not the other way around.

What should you do after a shoulder cortisone shot?

Take it easy for a day or two. The shoulder can be sore once the numbing medicine wears off, and ice usually helps more than anything else in that first stretch. Skip heavy lifting and hard overhead work for a few days, even if the arm feels great, because the numbing effect can make you overdo it.

Then use the relief. The weeks after an injection are the best time to work on strength and motion, since the exercises hurt less and you can do more of them. People who treat the shot as a head start on therapy tend to get more from it than people who treat it as the whole treatment. Keep a simple note of when the shot was given and how long it helped. That record is useful for any doctor you see next, and it helps decide whether another shot makes sense.

What are the side effects?

Most people tolerate a shoulder injection well. The common issues are a day or two of extra soreness, temporary facial flushing, and higher blood sugar for a few days, which matters if you have diabetes. Less often, the skin at the injection site thins or lightens. Infection is rare but serious. Call the office the same day if you notice spreading redness, warmth, or fever after an injection.

When to see a shoulder specialist

• Your shot wore off within a few weeks, or never helped at all.
• You have needed two or more injections in the same shoulder in the past year.
• You have weakness lifting your arm, not just pain.
• The pain started after a fall or another injury.
• Someone has mentioned surgery and you want to know whether a shot is a smarter next step, or the other way around.

Find out what your shoulder actually needs

Most people we see at Oregon Shoulder Institute are treated without surgery, and injections are one of the tools we use. We give a shot when the diagnosis supports it, pair it with a therapy plan, and tell you plainly when a shot is only postponing a decision. Learn more about shoulder injections at our practice.

Our surgeons have performed more than 10,000 surgeries, and Dr. Patrick Denard has been voted one of the top 20 shoulder surgeons in North America and is the most widely published shoulder specialist in Oregon. If your shots have stopped working and you already have an MRI, our remote MRI review is a fast way to find out why. Dr. Denard reviews your images himself and records a narrated video with treatment guidance, typically within 48 hours, for $250. To be seen in person, request an appointment at our Medford office, 2780 E. Barnett Rd, Suite 200, or call 541-608-2595.

Frequently asked questions

How long does a cortisone shot in the shoulder take to work?

The numbing medicine works within minutes and fades after a few hours. The steroid itself usually starts to help within a few days, and some people notice the full effect closer to a week after the injection.

How many cortisone shots can you get in your shoulder in a year?

There is no fixed rule, but most shoulder surgeons space injections at least three months apart and keep the yearly number low. Research links two or more injections in the year before rotator cuff repair with higher odds of needing a revision surgery.

Should I get a cortisone shot before shoulder surgery?

Timing matters. A large Medicare study found that an injection within three months before shoulder surgery was associated with a higher infection risk afterward, so tell your surgeon about any recent injections and plan them together.

Does a cortisone shot help a rotator cuff tear?

It can ease pain from inflammation around a tear, but it does not heal or shrink the tear. If you have weakness or a larger tear, get an evaluation so relief from a shot does not hide a problem that is getting harder to fix.

What does it mean if my cortisone shot did not work?

It may mean the pain is coming from a different structure than the one injected, or that there is a mechanical problem such as a tear. That is a good time to have a shoulder specialist review your exam and MRI.

References

1. Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. PMID 33326025.
2. Desai VS, Camp CL, Boddapati V, et al. Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery. Arthroscopy. 2019;35(1):45-50. PMID 30473453.
3. Werner BC, Cancienne JM, Burrus MT, et al. The timing of elective shoulder surgery after shoulder injection affects postoperative infection risk in Medicare patients. J Shoulder Elbow Surg. 2016;25(3):390-397. PMID 26651428.
4. American Academy of Orthopaedic Surgeons. Frozen Shoulder. OrthoInfo. orthoinfo.aaos.org/en/diseases--conditions/frozen-shoulder
5. American Academy of Orthopaedic Surgeons. Shoulder Impingement/Rotator Cuff Tendinitis. OrthoInfo. orthoinfo.aaos.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis

This article is for education and is not a substitute for an exam.