Shoulder Pain Treatment: Shoulder Injection

Shoulder pain?

The syndrome shoulder pain is a very frequent reason for medical consultations. The shoulder is a very fragile joint, and is put under a great deal of strain by your daily movements. What's more, the shoulder is a very complex joint, made up of several structures (as you've already seen). Damage to any one of these structures can lead to a range of symptoms, including pain.

What is a shoulder pain treatment?

Shoulder Pain Treatment involves injecting a drug into the painful joint.

Shoulder Injection can be used for :

• A diagnostic goal: When there are several possible origins of the shoulder pain.
• A therapeutic goal: In general, we start by treating the painful shoulder with non-medication (good posture, rest) and more or less medication (analgesics and anti-inflammatories). If, despite first-line treatment, the pain persists, injection of the shoulder is indicated.

On which sites shoulder pain treatment should be done?

A shoulder pain treatment can be performed in several regions of the shoulder, depending on the etiology. These regions include :

• The glenohumeral joint: This is the joint between the arm and the shoulder blade.
• Acromioclavicular joint: Injection is performed at the joint between the acromion and the clavicle.
• Subacromial bursa.

As with other joints, Injection can be either intra-articular or periarticular.

How does shoulder pain treatment work?

Infiltration of the shoulder is performed by radiologists who specialize in this procedure. The procedure, which takes around 10 minutes, is quick and generally well tolerated.

You will be comfortably installed in a supine position. In some cases, a local anesthetic may be required to minimize discomfort during the procedure.

The procedure is performed under radiological guidance, using ultrasound or X-ray. This guidance enables continuous control of the needle's position and trajectory, guaranteeing optimum precision. This targeted technique ensures greater treatment efficacy and improved patient safety.

What methods of shoulder infiltration are available?

Shoulder infiltration can be performed in two main ways: without imaging guidance, commonly known as the "blind" method, or under ultrasound guidance.

In the blind method, the practitioner generally uses the posterior approach, although lateral or anterior approaches are also possible depending on the practitioner's experience. The posterior approach involves inserting an 18-gauge needle approximately 1 cm beneath the posterolateral acromion to reach the subacromial bursa. The injection should be performed without resistance, with a volume of 10 to 15 ml of liquid. Antero-lateral expansion of the bursa may be observed, indicating good diffusion of the product. However, this method has limited precision, with an accuracy of 76 % for the posterior approach and 69 % for the anteromedial approach. What's more, the correlation between practitioner perception and MRI-confirmed localization is around 66 %. A successful injection significantly improves pain and function scores (VAS and Constant score) after six weeks.

In some cases, the blind method may also unintentionally touch the rotator cuff, which is observed in around 51 % of infiltrations, but this is not always desired.

Ultrasound-guided infiltration is a more precise method. It mainly targets the subdeltoid zone, which differs from the subacromial approach of the blind method. With this technique, the bursa is compressed between the rotator cuff and deltoid, making access more technical. Clear visualization is essential to correctly position the needle and inject the fluid into the bursa without unwanted dispersion. Homogeneous propagation of the product within the bursa is a sign of success.

Studies show that ultrasound-guided infiltrations are generally more accurate than blind methods. However, clinical results vary depending on the patient and specific pathologies. The choice between these techniques will depend on the patient's needs, the practitioner's skills and the equipment available, in order to optimize pain reduction and improved shoulder function.

Does it work? What are the possible results?

Efficacy is not immediate. It takes 1 to 2 days for the pain to diminish. Rest is therefore indicated to increase the likelihood of treatment efficacy. In the event of failure, re-injection is indicated. A maximum of 3 injections is recommended. If, despite all this, the pain persists, other therapeutic strategies will be adopted by your attending physician.

Can I work after a shoulder infiltration?

After shoulder infiltration, it is generally recommended to take a few days off work to optimize the effectiveness of the treatment and reduce the risk of complications. Resuming work will depend on a number of factors, including the nature of your job and the level of stress on your shoulder.

For sedentary jobs or those requiring little physical effort, a quick return to work, sometimes as early as the next day, is possible. On the other hand, for jobs involving repetitive movements, the carrying of heavy loads or movements that place intense demands on the joint, a longer rest period is often advisable. Your doctor or radiologist will be able to give you recommendations tailored to your specific situation.

It is also essential to avoid sudden or excessive exertion on the shoulder in the days following infiltration, even if the pain rapidly subsides. Respecting this recovery period helps to ensure that the treatment is more effective.

Shoulder bursitis infiltration

Infiltration for shoulder bursitis is a technique used to treat inflammation of the bursa beneath the acromion, a small fluid-filled pocket that reduces friction between joint structures. When inflamed, this bursa can cause intense pain and limit shoulder movement. Infiltration involves injecting an anti-inflammatory drug, often under ultrasound guidance, directly into the affected bursa. This procedure rapidly reduces inflammation and pain, while improving joint mobility. The procedure is generally well tolerated, and requires only a short recovery period.