Steroid Injections for Shoulder Pain Relief May Do More Harm Than Good

Michael Greger M.D. FACLM · September 30, 2026 ·

Corticosteroid shots may offer brief shoulder relief, but studies show they can increase the risk of subsequent rotator cuff tears up to sevenfold.

Discuss

Transcript

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

After low back pain and knee pain, shoulder pain may be the third most common musculoskeletal issue that sends people to their doctors. At any one time, about one in six of us is suffering from shoulder pain, and the lifetime prevalence of shoulder pain may approach 70 percent.

On average, as many as half of people presenting to their doctor with shoulder pain are still reporting symptoms six months later. Most patients with long-term shoulder pain prefer to opt out of treatment entirely, presumably due to the disappointing results they’ve had with various treatments on offer. When surveyed, most said they’d only consider new treatment options if they could be guaranteed highly favorable outcomes, like a 90 percent success rate. Unfortunately, nothing doctors or surgeons have to offer comes close to that.

The most common cause of shoulder pain is rotator cuff tendinosis, the chronic degeneration of tendons considered part of aging. This is an encompassing term that includes descriptors like “impingement,” “rotator cuff fraying,” “partial thickness tears,” and “tendinitis.” An injection of a corticosteroid like cortisone into the shoulder can provide short-term relief by suppressing inflammation, which explains why millions of joints are injected every year in the United States alone.

Up to 96 percent of musculoskeletal clinicians consider such injections to be an effective treatment. In fact, as many as one in five people seeking help from their primary care physician for shoulder pain may get an injection on their first visit. Imaging-guided injections (for example, using ultrasound) don’t appear to offer any benefit over traditional targeting based on anatomic landmarks, and multiple injections at a time don’t appear to be more effective than a single injection.

Shoulder corticosteroid injections are said to “provide, at best, minimal pain relief in a small number of patients,” yet as many as one in five say it reduced their symptoms when assessed between four and eight weeks after the injection. The benefit may be gone by twelve weeks, but isn’t even a 20 percent chance of feeling at least some pain relief for a month or two make it worth getting the shot? Unfortunately, the downsides to shoulder corticosteroid injections are more than just the transient discomfort of the needle. Any potential short-term symptomatic relief has to be balanced against the potential for long-term damage to the joint, as corticosteroids likely worsen the underlying disease process, accelerating tendon degeneration.

Animal studies demonstrate that corticosteroid injections lead to decreased bone volume density, anchor pullout strength, load to failure, and tendon stiffness. It’s thought that the steroids interfere with the healing process that is normally triggered by the inflammatory process. What about in people?

In an innovative way to ethically test the effects of steroid injections on tendons, fifteen patients scheduled for lower limb amputations had their Achilles tendons injected with hydrocortisone at varying intervals prior to surgery. The researchers showed significant collagen fiber degeneration within three hours of the shot at the injection site, demonstrating a “definite damaging local effect on human tendons.”

But we don’t tend to inject steroids directly into people’s tendons. It’s true that even oral exposure to corticosteroids like prednisone may increase the risk of tendon disorders, but more definitive evidence of harm wasn’t available until researchers took biopsies of rotator cuff tendons taken before and after patients with shoulder pain received steroid injections. The researchers saw the same kind of negative effects found in surgical specimens of tendons exposed to corticosteroids in a petri dish and concluded that steroid injections may, ironically, “exacerbate the underlying tissue pathology responsible for the pain for which the glucocorticoids are prescribed to treat in the first place.” What may make us feel better in the short-term may make us feel worse in the long-term.

Steroid injections in the shoulder may raise the risk of subsequent rotator cuff tears by as much as sevenfold. And, not only may they increase the risk of surgical intervention, but steroid injections can also make that surgery riskier, increasing the likelihood of such complications as post-operative infections, which can have devastating consequences…. This may be due to the injections directly seeding the joint space with bacteria and/or the steroids having an immunosuppressive effect.

If steroid injections can be detrimental in the long run, why are they still endorsed in clinical practice guidelines? Continued use is chalked up to force of habit, financial incentives, and a desire for a “quick fix.”

Please consider volunteering to help out on the site.

Sources

Acknowledgements

Motion graphics by Avo Media

Topics

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

After low back pain and knee pain, shoulder pain may be the third most common musculoskeletal issue that sends people to their doctors. At any one time, about one in six of us is suffering from shoulder pain, and the lifetime prevalence of shoulder pain may approach 70 percent.

On average, as many as half of people presenting to their doctor with shoulder pain are still reporting symptoms six months later. Most patients with long-term shoulder pain prefer to opt out of treatment entirely, presumably due to the disappointing results they’ve had with various treatments on offer. When surveyed, most said they’d only consider new treatment options if they could be guaranteed highly favorable outcomes, like a 90 percent success rate. Unfortunately, nothing doctors or surgeons have to offer comes close to that.

The most common cause of shoulder pain is rotator cuff tendinosis, the chronic degeneration of tendons considered part of aging. This is an encompassing term that includes descriptors like “impingement,” “rotator cuff fraying,” “partial thickness tears,” and “tendinitis.” An injection of a corticosteroid like cortisone into the shoulder can provide short-term relief by suppressing inflammation, which explains why millions of joints are injected every year in the United States alone.

Up to 96 percent of musculoskeletal clinicians consider such injections to be an effective treatment. In fact, as many as one in five people seeking help from their primary care physician for shoulder pain may get an injection on their first visit. Imaging-guided injections (for example, using ultrasound) don’t appear to offer any benefit over traditional targeting based on anatomic landmarks, and multiple injections at a time don’t appear to be more effective than a single injection.

Shoulder corticosteroid injections are said to “provide, at best, minimal pain relief in a small number of patients,” yet as many as one in five say it reduced their symptoms when assessed between four and eight weeks after the injection. The benefit may be gone by twelve weeks, but isn’t even a 20 percent chance of feeling at least some pain relief for a month or two make it worth getting the shot? Unfortunately, the downsides to shoulder corticosteroid injections are more than just the transient discomfort of the needle. Any potential short-term symptomatic relief has to be balanced against the potential for long-term damage to the joint, as corticosteroids likely worsen the underlying disease process, accelerating tendon degeneration.

Animal studies demonstrate that corticosteroid injections lead to decreased bone volume density, anchor pullout strength, load to failure, and tendon stiffness. It’s thought that the steroids interfere with the healing process that is normally triggered by the inflammatory process. What about in people?

In an innovative way to ethically test the effects of steroid injections on tendons, fifteen patients scheduled for lower limb amputations had their Achilles tendons injected with hydrocortisone at varying intervals prior to surgery. The researchers showed significant collagen fiber degeneration within three hours of the shot at the injection site, demonstrating a “definite damaging local effect on human tendons.”

But we don’t tend to inject steroids directly into people’s tendons. It’s true that even oral exposure to corticosteroids like prednisone may increase the risk of tendon disorders, but more definitive evidence of harm wasn’t available until researchers took biopsies of rotator cuff tendons taken before and after patients with shoulder pain received steroid injections. The researchers saw the same kind of negative effects found in surgical specimens of tendons exposed to corticosteroids in a petri dish and concluded that steroid injections may, ironically, “exacerbate the underlying tissue pathology responsible for the pain for which the glucocorticoids are prescribed to treat in the first place.” What may make us feel better in the short-term may make us feel worse in the long-term.

Steroid injections in the shoulder may raise the risk of subsequent rotator cuff tears by as much as sevenfold. And, not only may they increase the risk of surgical intervention, but steroid injections can also make that surgery riskier, increasing the likelihood of such complications as post-operative infections, which can have devastating consequences…. This may be due to the injections directly seeding the joint space with bacteria and/or the steroids having an immunosuppressive effect.

If steroid injections can be detrimental in the long run, why are they still endorsed in clinical practice guidelines? Continued use is chalked up to force of habit, financial incentives, and a desire for a “quick fix.”

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

This is like the acid reflux video that showed how the standard therapy—PPI proton pump inhibitor drugs like Prilosec can actually cause the disease you’re trying to treat. It can end up causing more acid reflux. I ran into this in chapter after chapter in How Not to Hurt: things that provide short-term relief can sometimes make things worse in the long run. It’s like how taking antidepressants can make you more likely to end up chronically depressed.

Like in the last video. Take ibuprofen for acute back pain, and it can increase your risk of it turning into chronic back pain. Or take it after major surgery and end up more likely to end up with chronic pain. So they give people NSAIDs, anti-inflammatory drugs like ibuprofen after surgery instead of opioid, because we don’t want people to become addicted, but come back six months, and those who were put on the ibuprofen ended up more likely to be on opioids because interfering with the inflammatory process can undermine the healing process. That’s how the body heals. We interfere with natural healing processes at our own peril.

In this case, your shoulder hurts because of rotator cuff tendon degeneration, so you inject people with steroids that causes…rotator cuff tendon degeneration! Massively increasing your risk of rotator cuff tears, increasing your need for future surgery, and making future surgery even more dangerous. So you go to the doctor and they do something that worsens your underlying condition, and in four in five people doesn’t even result in the short term relief, so it’s all downside. Millions of joints continue getting injected with steroids. That should be all you need to know about the field pain management: something that makes the underlying problem worse endorsed by clinical practice guidelines, endorsed by up to 96% of muscular skill to clinicians and why? Force of habit, financial incentive, and desire for a quick fix.

Don’t fall for it.

This is the first video in a six-part video series. Stay tuned for:

For more on pain, check out my new book How Not to Hurt, available now for preorders. (All proceeds received from the book are donated directly to charity.)

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