Cortisone is a powerful synthetic anti-inflammatory agent often injected into the joint or surrounding tissue to suppress localized swelling and provide relief for persistent shoulder pain. When this standard medical intervention fails, it suggests the underlying cause of the discomfort is more complex than simple inflammation. Understanding the reasons for this non-response is the first step toward finding an effective and lasting solution for shoulder health.
Why the Initial Treatment Did Not Provide Relief
The lack of pain reduction after a corticosteroid injection often points to a diagnostic or mechanical issue rather than a failure of the medication itself. Cortisone reduces inflammation, but if the main source of the pain is not inflammation, the shot will not provide relief. For instance, pain caused by a severe tendon tear or a nerve issue cannot be fixed by anti-inflammatory medicine.
A common reason for failure is an incorrect diagnosis, where the pain originates from a structure other than the one treated. A rotator cuff issue, for example, may be misdiagnosed as bursitis, limiting the success of the injection. Technical failure is also a factor, as the injection may have missed the precise target area. This risk is significantly reduced when imaging guidance, such as ultrasound, is used during the procedure.
If the injection was unsuccessful, communicate with your physician about further diagnostic testing. Advanced imaging like an MRI or detailed ultrasound may be necessary to confirm the structural integrity of the joint, tendons, and surrounding tissues. This re-evaluation helps pinpoint the actual source of the shoulder pain, which is the foundation for developing a targeted treatment strategy.
Next Steps in Physical Rehabilitation
Following a failed injection, the most effective next step is often a dedicated course of physical rehabilitation (PT). PT shifts the focus from symptom suppression to addressing the biomechanical issues that contribute to shoulder pain. This approach restores joint function, improves stability, and corrects underlying muscle imbalances that lead to chronic irritation.
A targeted PT program involves specific exercises aimed at strengthening the rotator cuff muscles, which stabilize the shoulder joint. Building this strength helps to center the head of the humerus within the socket, reducing friction and impingement. Improving the control and endurance of the scapular (shoulder blade) muscles is also a major focus, as this provides a stable platform for the arm to move.
Range-of-motion exercises are incorporated to restore mobility, which is important if conditions like adhesive capsulitis (frozen shoulder) are present. Modalities like heat and ice application are used in conjunction with exercises to manage localized discomfort. Heat helps relax stiff muscles before exercise, while ice is effective for cooling down inflamed tissue afterward.
Alternative Injection Therapies
If physical rehabilitation does not resolve the pain, alternative non-surgical procedural options may be considered. These next-level injection therapies focus on promoting tissue repair and regeneration rather than just suppressing inflammation. Platelet-Rich Plasma (PRP) therapy is one such option, utilizing the patient’s own blood components to stimulate healing.
PRP involves drawing blood, processing it to concentrate the platelets, and then injecting this plasma into the injured area. Platelets contain growth factors and signaling proteins that accelerate the body’s natural repair process in damaged tendons or ligaments. This method is a regenerative approach because it aims to repair the underlying structural damage.
Another option is hyaluronic acid injection, also known as viscosupplementation, used when pain involves joint friction due to osteoarthritis. Hyaluronic acid is a natural lubricant and shock absorber found in joint fluid. Injecting a synthetic version improves the joint’s mechanical properties. For neuropathic pain, a nerve block may be used to interrupt pain signals, providing diagnostic information and temporary relief.
Evaluating the Need for Surgery
When all conservative measures, including physical therapy and advanced injections, have failed to provide functional relief, surgery becomes the final step. Surgery offers a definitive solution for structural issues that non-surgical treatments cannot correct. A consultation with an orthopedic surgeon is essential to determine if the shoulder’s anatomy requires mechanical repair.
Specific shoulder conditions require surgical intervention for a successful outcome. These include full-thickness rotator cuff tears, which need surgical repair to reattach the tendon to the bone. Severe shoulder instability, often caused by a significant labral tear, is another common indication. Chronic shoulder impingement that has led to substantial damage also warrants a surgical procedure.
The surgical evaluation involves a review of the latest imaging, such as an MRI, and a discussion of the patient’s functional limitations. The procedure is often performed using arthroscopy, a minimally invasive technique where a small camera guides the repair. This approach allows the surgeon to visualize and repair damaged structures, restoring full shoulder function.