INJECTION FOR ROTATOR CUFF PAIN

Common Symptoms 

  • Dull ache deep in the shoulder
  • Disturbed sleep
  • Difficulty in combing your hair or reaching behind your back
  • Arm weakness
  • Some rotator cuff injuries don’t cause pain.

Treatments we offer 

  • Ultrasound guided steroid injection
rotator cuff pain injection therapy UK

Ultrasound guided steroid injection

A steroid injection into the subacromial bursa is the initial choice (similar to tendinopathy option). This creates a pain-free window for you to begin a physiotherapy programme. Following a rotator cuff tear, exercise-based treatment is critical to regaining complete shoulder strength and range of motion. However, because patients frequently struggle to complete physiotherapy exercises due to high pain levels, the combination of treatment (injection and physiotherapy rehabilitation) is particularly effective. This combination works well for a large number of our patients and often eliminates the need for surgery.

Your Care Pathway with us

  • To book an appointment, call us on 020 8870 8761 or email us at: info@joint-injections.co.uk.
  • Comprehensive MSK examination.
  • Detailed MSK ultrasound scan for just £120.
  • Treatments we offer. Cortisone Injection £250, Hyaluronic acid Ostenil Injection £350.

WHAT OUR PATIENTS SAY

What is frozen shoulder?

Frozen shoulder is a painful ailment in which the shoulder joint becomes tight and uncomfortable. It affects persons between the ages of 40 and 60 (women more than males) and often begins without warning. It can happen after shoulder surgery or a fall, for example. Using clinical testing and a diagnostic ultrasound scan, your doctor will be able to determine if you have frozen shoulder during your first session. Physiotherapy and conservative treatments such as rest and/or medications are generally ineffective in treating frozen shoulder. The most effective treatment for frozen shoulder has been found to be an ultrasound-guided steroid injection.

Frozen shoulder vs rotator cuff pain

Frozen shoulder creates a lot of discomfort and stiffness, so even if you weren’t in pain, you couldn’t move your arm through its full range of motion, whereas rotator cuff pain is unpleasant but has less stiffness.

Frozen shoulder is characterised by severe discomfort and stiffness of the shoulder joint that worsens with time. The capsule around the joint, in particular, becomes inflammatory and tight. There are three phases to frozen shoulder. Each of these stages can last anywhere from a few months to several years before finally resolving. The following are the stages of frozen shoulder:

  • The first stage, sometimes known as the “painful” stage. This stage might extend for several months, during which time the shoulder stiffens and becomes uncomfortable.
  • The second stage is referred to as the “stiff” stage. The shoulder stays quite rigid during this period, resulting in limited function.
  • The ‘unfreezing’ or ‘thawing’ step is the third stage. The shoulder begins to loosen and mobility becomes easier during the ‘thawing’ phase. This can take months, if not years, to fully resolve. According to recent studies, only 59 percent of patients regain full function after four years (Wang et al., 2016).

What is rotator cuff pain?

The rotator cuff is a typical source of shoulder pain in people of all ages. Tears, tendinopathy, and calcific tendinitis are some of the conditions that affect the rotator cuff tendons. These can happen as a result of a fall, a sporting injury, or for no apparent cause. Rotator cuff pain becomes more common as you get older.

The majority of rotator cuff pain will go away with some activity modification and rehabilitation. If your rotator cuff pain isn’t getting better and is keeping you up at night, an ultrasound-guided steroid injection can help. Depending on the sort of rotator cuff problem you have, there are a few injectable treatments available, including steroid, and barbotage.

What are the symptoms of rotator cuff pain?

The symptoms of rotator cuff pain are:

  • The outside of upper arm hurts. The front of the shoulder (even into the chest) and the back of the shoulder (into the shoulder blade) can both be affected.
  • Lifting the arm to the side and above head height, especially if a weight is in the hand, aggravates the pain.
  • Shoulder weakness, especially when lowering the arm from an above posture.

What conditions can be mistaken for Rotator Cuff Pain?

If this does not sound like your discomfort, there are a number of different conditions that can cause rotator cuff pain, including:

  1. calcific tendinitis
  2. frozen shoulder
  3. shoulder impingement
  4. sub-acromial bursitis
  5. shoulder joint osteoarthritis

Rotator cuff pain vs frozen shoulder

Both rotator cuff discomfort and frozen shoulder induce severe shoulder pain, but frozen shoulder is also linked with substantial stiffness in addition to the pain. Frozen shoulder is also a chronic ailment in which the pain worsens over time for no obvious reason. Frozen shoulder affects persons between the ages of 40 and 60, but rotator cuff pain affects people of all ages.

Anatomy

In the shoulder, the rotator cuff is made up of four muscles. Supraspinatus, infraspinatus, subscapularis, and teres minor are the muscles involved. The tendons of these muscles attach to the ‘ball’ of the shoulder joint, known as the humeral head. These tendons assist in lifting and rotating your arm, allowing for pain-free, fluid movement, by keeping the ‘ball’ in the centre of the shoulder joint. The supraspinatus tendon is the most often damaged rotator cuff tendon.

Rotator cuff pain can be excruciatingly painful and incapacitating. It can make it difficult for patients to perform basic daily tasks including reaching up, elevating their arm, and dressing and undressing. Overhead activities like tennis and gym weight training are also known to aggravate it.

Above the rotator cuff is the bursa (see illustration below), specifically the sub-acromial bursa. Bursitis occurs when the bursa becomes inflamed, which is common with rotator cuff problems. When the bursal tissue becomes inflamed, it is extremely sensitive and painful.

ultrasound-guided_injection_shoulder_rotator-cuff

What are the signs and symptoms of rotator cuff inflammation?

Symptoms vary from patient to patient and are not limited to rotator cuff pain. It’s critical to distinguish rotator cuff pain from other shoulder issues like frozen shoulder or osteoarthritis.

Typical rotator cuff pain signs and symptoms

  • On the outside of the upper arm, there is pain. The front of the shoulder (even into the chest) and the back of the shoulder into the shoulder blade can both be painful.
  • Lifting the arm to the side and above head height exacerbates the pain. Reaching behind and moving your hand behind your back might be unpleasant.
  • Shoulder weakness, especially while lowering an arm from an above posture.
  • Nighttime pain, especially if you sleep on your affected side.

What causes rotator cuff pain?

The type of rotator cuff injury determines the type of rotator cuff pain. A diagnostic ultrasonography is used to obtain this information.

Prior to receiving an injection, every patient at Joint Injections, patient receives a diagnostic ultrasound scan (at no additional cost) to ensure the accurate diagnosis.

  • Rotator cuff tendinitis/tendinopathy occurs when the tendons in the rotator cuff become inflamed and painful as a result of overuse or age. It is usually accompanied by a sub-acromial impingement and accompanying bursitis. The bursa is a small sac that rests on top of the tendons of the rotator cuff (see image above).
  • A rotator cuff tear occurs when the tendon in the shoulder is torn. This might happen gradually over time or as a result of a single event, such as a fall. The tendon can be torn in two ways: completely or partially.
  • Calcific tendinopathy (also known as calcific tendinitis) occurs when the rotator cuff tendon develops bone deposits (calcification). It can result in excruciating pain and a significant loss in mobility. The specific origin is unknown, but it may be linked to metabolic illnesses such as an overactive thyroid or diabetes.

How is rotator cuff pain diagnosed?

Rotator cuff discomfort is a “clinical diagnostic,” which means your physiotherapist can diagnose it during your initial evaluation. A diagnostic ultrasound is required to determine if you have a tendinopathy, bursitis, tear, or calcification within the tendon. Without an ultrasound scan, this information cannot be determined. All of our specialists at Joint Injections are dual-trained sonographers, and your initial session will include a diagnostic ultrasound scan.

Injections for rotator cuff pain

What is the most effective injection for rotator cuff pain?

Your unique diagnosis will determine which injection is most efficient for your shoulder pain.

Rotator cuff tendinopathy/tendinitis injection possibilities

A steroid injection is the most common ultrasound-guided injection for rotator cuff tendinopathy. When rotator cuff discomfort does not improve, steroid (also known as corticosteroid) injections are very beneficial, especially if the pain is keeping the patient awake at night. A potent anti-inflammatory, steroid can provide quick and efficient pain relief.

Injections are especially helpful if patients are having difficulty sticking to a physiotherapy regimen owing to severe discomfort. The injection creates a “window of opportunity” for you to undertake physiotherapy with a lot less pain.

It’s vital to remember that the steroid does not penetrate the rotator cuff tendon, which could be harmful to the tendon. The injection targets the overlying bursa, which is inflamed (known as a sub-acromial bursitis). When you experience rotator cuff pain, the subacromial bursa is often irritated as well. Because the bursa is such a pain-sensitive tissue, injecting into it usually provides good pain relief.

All of our injections at Joint Injections are done under ultrasound supervision to ensure that we only inject the bursa and not the tendon. Because the bursa is only 2-4mm in diameter, it is impossible to target it without ultrasound guidance. When compared to unguided injections, research has demonstrated that ultrasound guided injections enhance shoulder pain outcomes (Aly et al, 2015, Eustace et al, 1997,Finnoff et al, 2015).

Rotator cuff tear injection possibilities

Several factors influence the best treatment for rotator cuff injuries, including:

  • Age.
  • The tear’s size and location (determined on the ultrasound scan)
  • Your shoulder’s required demands, i.e. what activities you want to resume.

For rotator cuff injuries, there are two major injection options:

Ultrasound guided steroid injection

A steroid injection into the subacromial bursa is the initial choice (similar to tendinopathy option). This creates a pain-free window for you to begin a physiotherapy programme. Following a rotator cuff tear, exercise-based treatment is critical to regaining complete shoulder strength and range of motion. However, because patients frequently struggle to complete physiotherapy exercises due to high pain levels, the combination of treatment (injection and physiotherapy rehabilitation) is particularly effective.

This combination works well for a large number of our patients and often eliminates the need for surgery.

What are the options for calcific tendinopathy/tendinitis?

If the rotator cuff pain is caused by calcium/bony deposits in the tendon, there are three possible treatments:

  1. Shockwave Therapy (not injection): Shockwave therapy is an excellent treatment for calcific tendinopathy (Cacchio et al, 2016). The acoustic energy is delivered into the calcific regions to induce breakdown and reabsorption. A minimum of three sessions, once a week for three weeks, are required.
  2. Steroid Injection: A steroid injection into the subacromial bursa guided by ultrasonography can be highly successful in relieving the discomfort associated with calcific tendinopathy/tendinitis.
  3. Barbotage/Lavage: This procedure involves utilising a needle to extract calcium/bony deposits from the tendon under ultrasound supervision. Traditionally, calcium removal required a surgical treatment. This treatment is quite effective and frequently eliminates the need for surgery.

For rotator cuff pain, how many steroid injections are allowed?

For the most part, our patients just need one injection. The injection’s purpose is to give you a window of opportunity to begin a physiotherapy programme to regain complete range of motion and strength in your shoulder.

We always attempt to keep the number of injections we give our patients to a minimum, but in some cases, more than one injection is required to get effective pain relief.