Diagnostic Injections About the Shoulder

Edward McFarland, MD; Johnathan Bernard, MD, MPH; Eric Dein, MD; Alex Johnson, MD


J Am Acad Orthop Surg. 2017;25(12):799-807. 

In This Article

Abstract and Introduction


Injections about the shoulder serve diagnostic as well as therapeutic purposes. Diagnosis of shoulder conditions, such as rotator cuff tears, acromioclavicular joint pathology, subacromial impingement or anterolateral pain syndrome, glenohumeral joint pathology, suprascapular nerve entrapment, and biceps tendon pathologies, is often complicated by concomitant conditions with overlapping symptoms and by inconclusive physical examination and imaging results. Injections of anesthetic agents can often help clinicians locate the source of pain. However, technique and accuracy of needle placement can vary by route. Accuracy is often improved with the use of ultrasonography guidance, although studies differ on the benefits of guided versus unguided injection.


Injections about the shoulder serve two main purposes for the patient and the clinician. The first purpose is diagnostic. Symptoms around the shoulder can be caused by many different pathologies, and a patient may have more than one pathology at one time (eg, coexisting cervical radiculopathy and adhesive capsulitis). In addition, physical examination of the shoulder is inexact and is not diagnostic for some conditions. Imaging, which should be obtained before injections are performed, can detect shoulder pathologies but cannot by itself depict the relationship between pathologies and symptoms. In some patients, this imperfect relationship between shoulder-related symptoms and physical examination and imaging results can complicate accurate diagnosis.[1] In these situations, injections of short- or long-acting anesthetic agents can help to confirm the location of a patient's pain.

The second purpose of shoulder injections is therapeutic. Corticosteroids combined with local anesthetic can provide long-term pain relief. Immediate relief of pain after an injection implies that the cortisone has been delivered to the source of the pain. In contrast, pain relief that occurs hours or days later may be attributable to systemic absorption of the corticosteroid.

Here, we review the current evidence and updates regarding diagnostic and therapeutic injections about the shoulder, their role in determining a diagnosis when findings from the physical examination are unclear, and the accuracy with which they reach their intended anatomic locations. Information about the most successful methods for delivering diagnostic and therapeutic injections around the shoulder can provide additional guidance for orthopaedic surgeons in diagnosing and managing shoulder pathology.