Frozen Shoulder: Cortisone Shots, Benefits, Risks, and Comprehensive Treatment

Should you get a cortisone shot for frozen shoulder?

For individuals experiencing frozen shoulder (adhesive capsulitis), a cortisone shot can offer significant, albeit temporary, pain relief and may improve range of motion, particularly in the early, more inflammatory stages, but it is rarely a standalone solution and must be considered within a comprehensive treatment plan including consistent physical therapy.

Understanding Frozen Shoulder: A Kinesiology Perspective

Frozen shoulder, medically known as adhesive capsulitis, is a debilitating condition characterized by progressive pain and stiffness in the shoulder joint. From a kinesiology standpoint, it involves the thickening and tightening of the connective tissue capsule surrounding the glenohumeral joint, leading to a significant restriction in both active and passive range of motion. This process typically unfolds in three distinct stages:

• Freezing Stage: Marked by gradually increasing pain and a slow, progressive loss of shoulder motion. Pain is often worse at night.
• Frozen Stage: Pain may begin to diminish, but the stiffness becomes more pronounced, severely limiting daily activities.
• Thawing Stage: Gradual improvement in range of motion occurs, though full recovery can take months to years.

The exact cause is often unknown (idiopathic), but it can be associated with diabetes, thyroid disorders, and periods of immobility.

The Role of Cortisone Shots in Musculoskeletal Conditions

Cortisone, a synthetic corticosteroid, is a powerful anti-inflammatory medication. When injected directly into or around the affected joint, it aims to reduce local inflammation and pain. For frozen shoulder, the injection is typically administered into the glenohumeral joint capsule, or sometimes into the subacromial bursa if bursitis is also present.

Mechanism of Action: Corticosteroids work by mimicking the effects of hormones naturally produced by the adrenal glands. They suppress the immune response and reduce the production of inflammatory chemicals, thereby decreasing swelling, pain, and stiffness. This targeted delivery allows for a high concentration of the drug at the site of inflammation with fewer systemic side effects compared to oral corticosteroids.

Benefits of Cortisone for Frozen Shoulder

When used appropriately, cortisone injections can provide several notable benefits for individuals with frozen shoulder:

• Rapid Pain Relief: One of the most immediate and significant benefits is the reduction in pain, which can be severe and debilitating, especially during the freezing stage. This relief can occur within days of the injection.
• Improved Range of Motion (Temporary): By reducing inflammation and pain, the injection can temporarily ease the stiffness, allowing for a greater, albeit often modest, increase in shoulder mobility. This window of reduced pain and increased mobility is critical for maximizing the effectiveness of concurrent physical therapy.
• Facilitation of Physical Therapy: For many, the intense pain of frozen shoulder makes effective physical therapy extremely difficult or impossible. A cortisone shot can provide enough pain relief to enable more productive participation in stretching and strengthening exercises.

Potential Risks and Limitations of Cortisone Shots

While beneficial, cortisone injections are not without risks and limitations that must be carefully weighed:

• Temporary Nature: The pain relief and improved mobility are typically temporary, lasting weeks to a few months. It does not "cure" the underlying capsular restriction.
• Limited Efficacy in Later Stages: Cortisone is most effective in the early, more inflammatory "freezing" stage. Its benefits are often diminished once the shoulder is fully "frozen" and the primary issue is scar tissue and contracture rather than active inflammation.
• Post-Injection Flare: Some individuals may experience a temporary increase in pain and swelling (a "flare") for 24-48 hours after the injection.
• Risk of Infection: As with any injection, there is a small risk of introducing bacteria into the joint.
• Tissue Damage: Repeated or excessive injections in the same area can potentially lead to weakening of tendons, ligaments, or cartilage, though this is less of a concern for the joint capsule itself in frozen shoulder compared to direct tendon injections.
• Facial Flushing/Insomnia: Some individuals may experience temporary side effects such as facial flushing or difficulty sleeping.
• Blood Sugar Spikes: For individuals with diabetes, cortisone injections can cause a temporary elevation in blood glucose levels, requiring careful monitoring.
• Masking Pain: While beneficial for pain relief, relying solely on injections without addressing the underlying mechanics through exercise can mask the problem and delay true recovery.

A Holistic Approach: The Importance of Physical Therapy and Exercise

For frozen shoulder, physical therapy and a structured exercise program are the cornerstone of long-term recovery. Cortisone injections are best viewed as an adjunct to facilitate this process, not a standalone solution.

Key Components of Exercise Therapy:

• Pain Management: Initial focus on gentle movements and modalities to reduce pain and inflammation.
• Mobility Restoration: Gradually increasing range of motion through passive, active-assistive, and active stretching exercises. This includes pendulum swings, wall slides, pulley exercises, and external rotation stretches.
• Strength Training: Once mobility improves, strengthening exercises for the rotator cuff, scapular stabilizers, and deltoid muscles are crucial to restore function and prevent recurrence.
• Neuromuscular Re-education: Re-establishing proper movement patterns and coordination of the shoulder complex.

A skilled physical therapist will guide you through progressive exercises tailored to your specific stage of recovery, ensuring proper technique and preventing further injury. Consistency with your home exercise program is paramount for regaining full function.

When is a Cortisone Shot Considered?

A cortisone shot for frozen shoulder is typically considered in specific scenarios:

• Severe Pain: When pain is so intense that it significantly interferes with sleep, daily activities, or the ability to perform physical therapy exercises.
• Early Inflammatory Stage: Injections are generally more effective during the "freezing" stage when inflammation is a primary driver of pain and stiffness.
• As an Adjunct to Physical Therapy: Never as a sole treatment. The goal is to create a window of opportunity for more effective rehabilitation.
• After Initial Conservative Measures Fail: If pain and stiffness persist despite consistent adherence to a gentle physical therapy program.

Making an Informed Decision: Consult Your Healthcare Team

The decision to receive a cortisone shot for frozen shoulder should always be made in consultation with your healthcare provider, which typically includes an orthopedic surgeon or sports medicine physician, and your physical therapist. They will assess your specific condition, stage of frozen shoulder, medical history, and overall treatment goals.

Considerations for Discussion:

• Your current pain level and functional limitations.
• The stage of your frozen shoulder.
• Your medical history, especially diabetes or bleeding disorders.
• The potential benefits versus the risks.
• How the injection will integrate with your physical therapy plan.
• Alternative treatment options, such as oral medications or hydrodilatation.

Ultimately, a cortisone shot can be a valuable tool in managing the acute symptoms of frozen shoulder, particularly pain, thereby enabling more effective participation in the essential physical therapy that drives long-term recovery and restoration of shoulder function.