A cortisone shot in the shoulder is usually as painful as regular immunisation injections. The site of the injection and the size of the needle are two elements that can affect how painful a shot may be. It should come as no surprise that larger needles typically hurt more than smaller ones. However, your doctor might also apply an anaesthetic spray to numb the area of the shot where the needle will be inserted. Thus only some pressure is felt upon the insertion of the needle.

After the shot

The site of the shot may be tender and painful for a few days, similar to the after-effects of taking any jabs. Avoid any heavy lifting with the arm until the pain subsides. However, what is important is to monitor for signs of infection. Pain out of proportion, redness, swelling, and fever should all be immediately reported to your doctor.

Corticosteroid shots are used when shoulder pain is significant and has not reduced by over-the-counter medications. Although the injection may be uncomfortable, the treatment should be worth it to reduce pain and inflammation in the shoulder, so you can continue with your rehabilitation exercises effectively. 

Are You Suffering from Shoulder Pain?  Download Reflex: Shoulder Mobility App

Shoulder pain can be all-consuming. Recovery can seem so far away without having the tools to track your progress, or know that you’re doing the right exercises. Reflex if your physio in your pocket. Accurately measure your shoulder range of motion without visiting a clinic.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

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Intra-articular corticosteroid injections quickly relieve shoulder pain by effectively controlling the swelling brought on by the SLAP tear. Corticosteroid injections are less intrusive, more patient-acceptable, and more affordable than surgery. The quick and long-lasting pain relief provided by these injections promotes the early initiation of muscle-strengthening exercises and yields greater satisfaction among patients. 

SLAP injuries can cause rotator cuff and scapular muscular weakness and dyskinesis, as well as change the intricate role the labrum plays in glenohumeral kinematics. In order to treat this illness and lessen the mechanical symptoms linked to SLAP lesions, shoulder strengthening exercises may be beneficial.

Non-operative management using an appropriate regimen of combined intra-articular corticosteroid injection with rotator cuff and periscapular strengthening exercises has proven to provide satisfactory clinical outcomes in patients with a symptomatic SLAP (superior labrum from anterior to posterior) lesion. 

Speak to your doctor about finding the best treatments for your shoulder. Cortisone shots may be advised if shoulder pain does not subside after regular pain killers. Your doctor, surgeon, or physio will examine your shoulder through flexion, abduction, extension, and rotation ranges of motion and where you feel the pain the most.

Measure Your Shoulder Range of Motion and Track Pai  from Home for Free.

The Reflex App allows you to measure your shoulder’s range of motion and track pain simply using the front-facing camera of your iOS device. Take control of your recovery and gain insights into your shoulder health.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

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However, the best time to resume exercising or even begin exercising is multi-factorial. It would depend on your primary aetiology, age, overall health status, secondary medical problems, and most importantly, pain. 

Once you are comfortable to start exercising, gentle range of motion exercises can be started. 

Range of motion exercises to do after a cortisone shot in the shoulder;

1. Flexion and extension range of motion exercises for the elbow, wrist, and fingers should be started. These can be started a day or two after your shot depending on your symptoms.
2. Shoulder pendulum exercises.
3. Active-assisted Shoulder flexion. This can either be done using your other arm or with the help of a stick.
4. Similarly, Active-assisted Shoulder extension.
5. Gentle scapular retractions.

Are you ready to start exercising your shoulder? Reflex: Shoulder Mobility App 

The Reflex App allows you to measure your shoulder’s range of motion and track pain. As your shoulder recovers from the cortisone shot, you can keep track of your pain levels and monitor your range of motion recovery. You can access gentle shoulder exercises in the app and move on to strength and mobility exercises as your shoulder heals.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

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The most common adverse effects of cortisone shots in the shoulder are:  

• Pain: Pain after a cortisone shot at the area of insertion of the needle is a common temporary side effect
• Skin atrophy and Depigmentation: Cortisone use induces skin atrophy, leading to thinning and fragility of the skin
• Gastrointestinal reactions: Multiple gastrointestinal effects correlate with corticosteroid therapy, including gastritis, peptic ulcer disease, and abdominal distention may occur
• Cartilage damage: Cortisone shots cause damage to the cartilage forming cells with destruction and thinning of joint cartilage with a decrease in cartilage cell growth and repair
• Hyperglycaemia: Cortisone injections are the most common cause of drug-induced diabetes mellitus. Corticosteroid treatment also increases insulin resistance in patients with diabetes mellitus.
• Osteoporosis: Corticosteroids have also been shown to cause a decrease in bone formation

Reflex: Shoulder Mobility App 

Monitor pain and shoulder range of motion using the Reflex app on iOS.

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post Side effects of a cortisone shot in the shoulder appeared first on Siphox Health.

That being said, patients’ responses to corticosteroid injections vary significantly. Patients with diabetes may find less relief from the corticosteroid injection as compared to non-diabetic patients. 

Another factor affecting the duration of the cortisone shot is the technique of delivery. It is currently unclear whether image-guided injections relieve shoulder pain more effectively than landmark-guided injections. More high-quality prospective studies are needed to define the role of ultrasound guidance.

Research has also found that combined corticosteroid injection and physiotherapy treatment may result in more significant improvements in SPADI score (a questionnaire used to measure shoulder function. Higher the score, better the function of the arm) and range of motion of the shoulder. 

This would make sense because the steroid simply reduces inflammation and helps with pain relief. If the primary cause of pain is muscle imbalance or weakness, it needs to be corrected.

Measure your shoulder range of motion over time using our App

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

The post How long does a cortisone shot last in the shoulder? appeared first on Siphox Health.

What happens if a cortisone shot in the shoulder doesn’t work?

It is not uncommon for the cortisone shot to not work. Every patient responds differently to different treatments and thus, this does happen.

The main reason for this could be that the injection has failed to reach the specific target tissue. Usually, to avoid this, doctors use X-ray or ultrasound-guided techniques.

Since cortisone is primarily an anti-inflammatory, it will work only if there is an inflammation to suppress. If the primary aetiology of the pain is not inflammation, a cortisone shot may not prove to be beneficial.

Sometimes, a single dose of cortisone is not enough. In this case, the doctor may decide to try a second injection. This is usually done four to six weeks after the first injection. However, it must be noted that cortisone does not heal the underlying pathology so symptoms may flare up after the effect of the steroid subsides.

Cortisone shots should reduce pain and inflammation in the shoulder, which means increasing your shoulder’s range of motion.

Click here to measure your shoulder range of motion using Reflex: Shoulder Mobility App

More on Cortisone Shots

1. What happens if a cortisone shot in the shoulder doesn’t work?

2. How long does a cortisone shot last in the shoulder?

3. Side effects of a cortisone shot in the shoulder

4. How soon can I exercise after a cortisone injection in the shoulder?

5. Will a cortisone shot help a torn shoulder labrum?

6. How painful is a cortisone shot in the shoulder?

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Most common rugby injuries in the shoulder affect the following structures:  

Soft tissue around the shoulder

The shoulder complex, which consists of the clavicle, scapula, and humerus, connects the upper extremity to the thorax by a carefully crafted arrangement of three joints- the glenohumeral, acromioclavicular, and sternoclavicular. The articular structures of the shoulder complex are largely intended for mobility, enabling us to move and position the hand within a large range of space.

While being a primary joint responsible for the movement of the upper limb, stability is very important for the joint. Passive stabilization is provided by the bony architecture, the ligaments, the capsule, and the labrum. Additionally, muscles around the shoulder complex also provide dynamic stabilization to the joints.

Figures 1 and 2 below show the soft tissues present around the shoulder. (Images taken from Magee, David J. (2014). Orthopedic Physical Assessment (6th. Ed). St. Louis, Missouri: Elsevier Saunders.)

Acromioclavicular joint (AC joint injuries)

The acromioclavicular (or AC joint) is a joint that connects the clavicle (collarbone) to the acromion (a bony projection on the top of the shoulder blade). It is a gliding joint that allows the shoulder blade to move up and down.

Acromioclavicular injuries are found to be the most common shoulder injury in rugby players.

Mechanism of injury

Most common mechanism of injury is a direct fall on the shoulder, especially with the area above the shoulder blade striking the ground first. This causes a dislocation of the AC joint as the ligaments that keep the joint in place get torn by the impact.

Symptoms

Pain, limited motion in the shoulder, swelling, bruising, tenderness at the top of the shoulder.

Rotator cuff injuries

Rotator cuff injuries encompass a range of severity, from mild cuff contusions to partial and full thickness tears and can all occur in players. Rotator cuff tendinitis is also a common issue in rugby players.

Mechanism of injury 

These types of injuries are mostly sustained by a direct blow to the shoulder from direct contact with an opposing player or a fall. Usually, the mechanism of injury is an impact or less commonly, could be an ABER (abduction-external rotation) dislocation.

Symptoms

Difficulty and pain caused by raising your arm, popping, or clicking sounds or when moving your arm, shoulder weakness and struggling to lift items.

Sternoclavicular joint

The sternoclavicular joint is a joint located in the middle of the chest, between the sternum (breastbone) and the clavicle (collarbone). It allows the shoulder to move up and down, and helps to keep the shoulder in its socket. The Sternoclavicular joint is also responsible for rotated shoulder movements.

Mechanism of injury

A compressive or violent force either directly over the medial clavicle or to the posterolateral aspect of the shoulder can cause a sternoclavicular injury.

Symptoms

Bruising, pain, swelling or tenderness over the joint, a deformity where the clavicle or scapula has moved, limited range of arm motion.

Glenohumeral joint

The glenohumeral joint is the primary shoulder joint, and is responsible for a wide range of motions. The glenohumeral joint is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The humerus is attached to the scapula at the shoulder joint, and the clavicle attaches to the scapula at the acromion process.

Mechanism of injury

Tackle injury is the most common cause of dislocation. The rugby player tackling are more prone to have a dislocation as opposed to the players being tackled. The five-eight position on the field are at the highest chance of enduring this injury. For all rugby players, player-to-player contact results in trauma with the elbow in an extended position forcing the shoulder to exceed the limits of the normal range of motion causing anterior shoulder dislocation. Trauma with the elbow in a flexed position and the direction of the injuring force along the longitudinal axis of the humerus causes posterior shoulder dislocation. Fall, ruck, and impact are the lesser common mechanisms of injury. 

Symptoms

A visibly deformed shoulder, inability to move your shoulder joint, excruciating pain, swelling, and tingling sensation from your neck that can radiate to your arms.

Superior labrum anterior-to-posterior lesion (SLAP) tears

The superior labrum is a cartilage that attaches the shoulder blade to the humerus (upper arm bone). It helps to keep the shoulder in its socket and allows for a wide range of movement. The superior labrum can be injured in a number of ways, including a direct blow to the shoulder.

Superior labrum anterior to posterior (SLAP) tears are the most common labral tears in rugby players.

Mechanism of injury

The typical mechanism of injury is usually a direct blow, consisting of a tackle where the shoulder is driven into an opposing player or, more commonly, landing on the ground directly onto the adducted shoulder while holding the ball or an opponent. Less commonly, an injury can occur if the arm is in an abducted internally rotated position for a tackle, with a direct blow to the upper arm, forcing the arm into hyperextension and internal rotation.

Symptoms

Shoulder pain along with mechanical symptoms such as locking, catching, popping, or snapping in the shoulder.

Biceps tendon injury

The bicep tendon attaches the bicep muscle to the shoulder blade. The bicep muscle is responsible for bending the arm at the elbow, and the bicep tendon helps to keep the muscle in place.

Mechanism of injury

Traction forces on a flexed elbow can cause injuries to the long head of biceps.

Symptoms

Swelling in the front of the elbow, bruising in the elbow and forearm, weakness in bending the elbow, weakness in twisting the forearm (supination).

Fractures

Fractures are a minority injury type in rugby players. However, upper limb fractures are more common than lower limb fractures in rugby players.

Mechanism of injury

Most commonly, a tackle injury causes a fracture. The clavicle (collar bone), proximal humerus, scapula (shoulder blade) are most commonly fractured.

Symptoms

Pain, swelling, discolouration at the site of the fracture.

Brachial plexus traction lesion

The brachial plexus is a network of nerves that runs from the neck to the arm. It controls the movement and sensation in the arm and hand.

The Brachial plexus traction lesion is a type of shoulder injury that occurs when the nerves that run from the neck to the arm are damaged. This injury is often caused by a direct blow to the shoulder, such as in a rugby tackle.

Mechanism of injury

Traction and/or compression forces acting on the brachial plexus are the primary means of injury, with traction accounting for 95% of injuries. Such injuries most commonly occur in players playing the fullback position. The injuries result from a tackle causing a depression of the shoulder and lateral flexion of the head to the contralateral side. Less commonly such an injury can occur from a direct compressive force onto the supraclavicular region. 

Symptoms

Numbness or loss of feeling in the hand or arm, inability to control or move the shoulder, an arm that hangs limply, burning, stinging or severe and sudden pain in the shoulder or arm.

Pectoralis major tears

A rare but serious injury is a rupture of the pectoralis major muscle. Given the demands placed on the shoulders of these players, when such an injury occurs, it will usually require surgical repair, and an extended period of rehabilitation before return to professional play is possible.

Mechanism of injury

A tackle that involves a relative increase in the amount of shoulder abduction, a higher point of contact on the attacking player, and an initial point of contact from the defending (injured) player more distal on the arm than is usual.

Symptoms

Pain in your chest and upper arm, weakness when you push your arms out, bruising in your chest and arm, a dimpling, or pocket, just above your armpit where the tear is located.

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There is no fixed timing of the day for when the ROM exercises should be done. For some people, mornings may be suitable. For some people, it could be in the evenings after work. However, sometimes physiotherapists prescribe shoulder and cervical (neck) ROM exercises that can be done at the desk or while taking work breaks. Furthermore, regardless of when the ROM exercises are performed, they must always be done gently and slowly. They must be started as small gradual movements and then increased, instead of a single jerky large movement.

Restrictions in the ROM for a joint can arise due to several soft tissues surrounding the joint. Research has shown that using hot packs or any form of heat, can relax these soft tissue structures and make them more distensible. Thus, it may be advisable to incorporate some form of heat into the exercise regime prior to ROM exercises. 

Along with ROM exercises, it is important to do some strength training as well. Improving the range of a joint without improving the strength of the muscle to adapt to this new range may be injurious.

Read More on Range of Motion Exercises:

1. How Often Should You Do Range of Motion Exercises?

2. Who Should Do Range of Motion Exercises? 

3. When Should You Do Range of Motion Exercises? 

The post When Should You Do Range of Motion Exercises? appeared first on Siphox Health.

Acute Injury

If you have suffered an acute injuryROM exercises may be avoided initially as pain and inflammation may hamper any movement. Gradually, active ROM or active assisted ROM exercises can be started depending upon the person’s pain tolerance and other symptoms. These exercises help to regain mobility and assist in recovery. 

Repetitive Strain Injury

For someone with a repetitive strain injury, you may start with active ROM exercises. Although, along with ROM exercises, strengthening exercises are equally important to prevent further damage to the tissue.

Frozen Shoulder or Degenerative Issues

For someone with frozen shoulder or degenerative issues, reduction in ROM is usually present. Because there is no active injury in these patients, therapists can use passive ROM exercises. However, eventually, the patients must be trained to do active ROM exercises.

Elderly People

For the geriatric population, due to aging flexibility reduces and joints start to become stiff. To prevent this from happening or to maintain the available ROM, active assisted exercises which then progressed to active ROM exercises can be done.

Athletes

For the population involved in skill based activity, active ROM exercises are preferable as reduced ROM at the joint may hinder the activity as a whole making it less skillful.  

Neurological Conditions

The role of passive ROM exercises is present mostly only in neurological conditions to maintain the ROM of the joint as some patients are unable to perform a full movement as their strength is affected. 

Read More on Range of Motion Exercises:

1. How Often Should You Do Range of Motion Exercises?

2. Who Should Do Range of Motion Exercises? 

3. When Should You Do Range of Motion Exercises? 

The post Who Should Do Range of Motion Exercises? appeared first on Siphox Health.

How often you should do range of motion exercises depends on individual factors such as the severity of your condition, your age, and your overall health. 

If you have a mild condition, you may only need to do range of motion exercises a few times a week. 

If you have a more severe condition, you may need to do them every day. The type of range of motion exercises will change as you recover from an injury and the nature of your condition changes. 

What are range of motion exercises? 

A ROM exercise is an activity aimed at improving or maintaining the ROM of a particular joint. There are 3 different types of ROM exercises: Passive Range of Motion Exercises, Active-Assisted Range of Motion Exercises, and Active Range of Motion Exercises

Passive ROM Exercises

In Passive ROM exercises the movement of the joint is completely passive. It is not accompanied by an active muscular contraction by the person performing the exercise. A physical therapist or a ROM machine applies pressure to move the joint.

Active Assisted ROM Exercise

Active-assisted ROM exercises- this type of exercise requires an active muscular contraction by the person performing the exercise to move the joint. However, it is assisted by an external force (therapist or a piece of equipment such as a wand or the other arm).

Active ROM Exercises

Active ROM exercises- In this type of exercise the joint movement is done purely by the person performing the exercise. No additional external force is given to perform the ROM

Depending upon the patient/person to whom these exercises are prescribed for, the type of ROM exercise varies. There are no strict contraindications for doing shoulder ROM exercises unless you have a fracture, a dislocated shoulder, a dislocated acromioclavicular joint, or acute and severe soft tissue trauma.

How often should you do range of motion exercises?

The American College of Sports Medicine (ACSM) has set some guidelines when it comes to physical exercises.

Frequency

According to the ACSM guidelines, flexibility exercises should be done at a frequency of at least 2-3 times a week to improve ROM.

However, that being said, the prescription of ROM exercises is multifactorial. For eg, if ROM exercises have been prescribed after a traumatic fracture or soft tissue injury, the protocol prescribed must be strictly followed. Expecting quicker and better results by overdoing these exercises in this scenario would be counterproductive and harmful.

On the other hand, if a completely healthy individual wishes to do ROM exercises for the shoulder, he/she may do them every day. The ACSM guidelines for frequency can be increased as they only give an idea about what is the minimum and not the maximum.

Intensity and Duration

Usually, stretching exercises are prescribed to increase the ROM of the shoulder joint. It is important to remember that each stretch must be held for a minimum of 30 seconds. The targeted soft tissues may not undergo any real stress and may not actually stretch enough if held for a lesser amount of time. (cite kisner) Another important factor to remember is to stretch up to a point of tightness or slight discomfort. Overstretching could cause an injury and thus should be avoided. Each stretch should be repeated at least 3-5 times.

Measuring Range of Motion

In the field of medicine, measuring range of motion (ROM) is a fundamental evaluation technique. The most acceptable medical definition of ROM is, “the extent of osteokinematic motion available for movement activities, functional or otherwise, with or without assistance.” (Osteo= bone, kinematic= motion/movement).

ROM of a joint has frequently been used to identify baseline motion restrictions, evaluate musculoskeletal system impairments, direct the selection of the most effective treatment approaches, and document the outcomes of these interventions.  

Restriction in the ROM of a joint can hamper the level of function of that joint. For a joint like the shoulder joint, it can subsequently restrict the function of the entire limb. This, in turn, can cause restrictions in activities of daily living and can make menial tasks complex and unachievable. Measurement of the ROM of a joint is done using a device called a goniometer.

Read More on Range of Motion Exercises:

1. How Often Should You Do Range of Motion Exercises?

2. Who Should Do Range of Motion Exercises? 

3. When Should You Do Range of Motion Exercises? 

The post How Often Should You Do Range of Motion Exercises? appeared first on Siphox Health.