Shoulder Pain Treatment: Shoulder Injection

Shoulder pain?

The syndrome shoulder pain est un motif de consultation très fréquent en médecine.  L’épaule est une articulation très fragile et elle est très sollicitée par vos gestes quotidiens. De plus, l’épaule est une articulation très complexe, constituée de plusieurs structures (comme vous l’avez déjà constaté). L’atteinte de n’importe quelle structure peut être à l’origine d’un ensemble de symptômes, entre autres la pain.

Qu’est-ce qu’une infiltration de l’épaule ?

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

Shoulder Injection can be used for :

• Un but diagnostic : quand il y a plusieurs origines possibles de la pain theshoulder.

• Un but thérapeutique : en général, on commence à traiter l’épaule douloureuse par un traitement non médicamenteux (bonne posture, repos) et plus ou moins médicamenteux (antalgiques et anti-inflammatoires). Si malgré les traitements de première intention la douleur persiste, une infiltration de l’épaule sera indiquée.

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 :

• L’articulation gléno-humérale : C’est l’articulation entre le bras et l’omoplate.

• Acromioclavicular joint: Injection is performed at the joint between the acromion and the clavicle.

• Bourse sous-acromiale.

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?

L’efficacité n’est pas immédiate. Il faut attendre 1 à 2 jours pour avoir une diminution de la douleur. Un repos sera donc indiqué pour augmenter la chance d’efficacité du traitement. En cas d’échec, une réinfiltration sera donc indiquée. Un maximum de 3 infiltrations est recommandé. Si malgré tout cela, la douleur persiste, d’autres stratégies thérapeutiques seront adoptées par votre médecin traitant.

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.