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Acute Pain | Chronic Pain | General

Steroid injection for shoulder disorders

Clinical bottom line:

There is currently insufficient evidence to provide a definitive answer on the efficacy of steroid injections. Existing data suggest no compelling evidence. Steroid injections should not be used to alleviate pain associated with shoulder disorders until the effectiveness of this treatment can be demonstrated.

Shoulder disorders are often caused by periarticular soft tissue impairment, with a minority originating from neurological or generalised musculoskeletal conditions, neoplasms or referred pain from the neck or from internal organs. Based on Dutch data, of all newly presented episodes, 23% resolve within one month, 51% within six months and 59% within one year. Steroid injections are used in about 12% of consultations, usually in combination with analgesics, rest or exercise. However, steroid injections are associated with a range of adverse effects including minor and serious ones.

Systematic review

van der Heijden CJMG, van der Windt DAWM, Kleijnen J, Koes BW, Bouter LM. Steroid injections for shoulder disorders: a systematic review of randomized clinical trials. British Journal of General Practice. 1996; 46: 309-16.

Inclusion criteria were randomised controlled trials of shoulder pain; pain present at moment of inclusion; treatment by steroid injection; clinically relevant outcome measures.

Reviewers calculated 'success rate' of treatments by dividing the number of documented successes at the end of the intervention period by the number of patients randomly allocated to the intervention, with 95% confidence intervals.


Reviewers noted that methodological quality of most trials was poor. Each trial looked at a variety of time points ranging from 2 to 24 weeks.

Seven trials compared steroid injection with a placebo treatment (usually steroid plus lignocaine versus lignocaine alone or lignocaine with saline). Two of seven trials reported a significant benefit of steroid injection on at least one key measure, these two trials ranked highest in terms of quality.

We calculated a number-needed-to-treat for success at four weeks or later using the three trials comparing steroid injection with saline injection. The number-needed-to-treat was 17 with a confidence interval which included no benefit to any patient. The number-needed-to-treat rose to 33 when the remaining placebo trials were examined.

Reviewers also considered trials with active comparisons. Given the difficulties with methodological quality, these are not considered here.

Adverse effects

Reviewers do not state whether trials examined adverse effects.

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