Corticosteroid Injection vs Nerve Block for Shoulder Arthritis

Overseen By Allison Rao

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Minnesota

Disqualifiers: Uncontrolled diabetes, Allergy to steroid, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 25

Duration: Immediate intervention

40 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores two methods to manage shoulder pain from arthritis: a corticosteroid injection and a nerve block. The goal is to determine which treatment offers better pain relief for individuals with shoulder arthritis who are not suitable for surgery or choose not to undergo it. Participants should have glenohumeral osteoarthritis, rheumatoid arthritis, or rotator cuff issues that hinder daily activities. As an unphased trial, this study provides participants with the chance to explore alternative pain management options that could enhance their quality of life.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that corticosteroid injections are commonly used to relieve joint pain. They are generally safe and effective, but some risks exist. A review found that receiving a corticosteroid injection within six months before rotator cuff repair surgery can almost double the risk of complications. This suggests a higher chance of issues if the injection is administered too soon before certain surgeries.

Conversely, studies have shown that suprascapular nerve blocks, often using bupivacaine, are safe and effective for reducing shoulder pain in conditions like arthritis. The nerve block numbs the nerves around the shoulder, helping to relieve pain. Reviews have generally found it to be a safe method for managing chronic shoulder pain without surgery.

In summary, both treatments have been studied for safety. Corticosteroid injections are common and safe but should be carefully timed around surgeries. Nerve blocks are also safe and effective for pain relief. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about these treatments because they offer alternatives for patients with shoulder arthritis who are not suitable for surgery. Unlike the standard options, which often involve oral medications or physical therapy, the intraarticular corticosteroid injection (IACI) directly delivers anti-inflammatory medication into the shoulder joint, potentially offering quicker relief. The suprascapular nerve block (SSNB) works differently by targeting specific nerves with a combination of bupivacaine and triamcinolone, which may provide effective pain management without directly affecting the joint. Both approaches could offer more targeted and immediate relief compared to traditional treatments.

What evidence suggests that this trial's treatments could be effective for shoulder arthritis?

This trial will compare two treatments for shoulder arthritis: intraarticular corticosteroid injection (IACI) and suprascapular nerve block (SSNB). Research has shown that corticosteroid injections, such as methylprednisolone acetate, can help with shoulder arthritis, with about 30% of patients experiencing meaningful improvements. Participants in one arm of this trial will receive this treatment.

The trial also studies the suprascapular nerve block, which involves injecting medication to block pain signals in the shoulder. Studies have found this method safe and effective for reducing shoulder pain caused by arthritis. Participants in the other arm of this trial will receive this treatment. Both treatments offer potential benefits for managing shoulder pain without surgery. ^{1 2 4 6 7}

Who Is on the Research Team?

Allison Rao, MD

Principal Investigator

University of Minnesota

Are You a Good Fit for This Trial?

This trial is for patients with shoulder arthritis, specifically glenohumeral osteoarthritis or rotator cuff arthropathy, who are considering injection treatments for pain relief. Participants must have a confirmed diagnosis and be candidates for conservative management.

Inclusion Criteria

I have been diagnosed with shoulder arthritis or rotator cuff issues and am being offered an injection.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either intraarticular corticosteroid injection or suprascapular nerve block for shoulder pain relief

Immediate intervention

1 visit (in-person)

Follow-up

Participants are monitored for changes in pain and shoulder function using various assessment tools

3 months

Multiple assessments at 24 hours, 3 days, 1 month, and 3 months post-intervention

What Are the Treatments Tested in This Trial?

Interventions

• Corticosteroid Injection
• Nerve Block

Trial Overview The study compares two types of injections to manage shoulder pain: intraarticular corticosteroid injections (IACI), which are common treatments, against suprascapular nerve blocks (SSNB), which are less commonly used but may offer pain relief.

How Is the Trial Designed?

Group I: suprascapular nerve block (SSNB) with bupivacaine and triamcinolone Experimental Treatment 1 Intervention

Patients with glenohumeral osteoarthritis, rheumatoid arthritis, or rotator cuff arthropathy who are poor surgical candidates or who are not interested in pursuing surgery randomized to suprascapular nerve block (SSNB)

Group II: intraarticular methylprednisolone acetate injection (IACI) Experimental Treatment 1 Intervention

Patients with glenohumeral osteoarthritis, rheumatoid arthritis, or rotator cuff arthropathy who are poor surgical candidates or who are not interested in pursuing surgery randomized to intraarticular corticosteroid injection (IACI).

Who Is Running the Clinical Trial?

University of Minnesota

Lead Sponsor

Trials

1,459

Recruited

1,623,000+

Published Research Related to This Trial

In a randomized, double-blind, placebo-controlled trial involving 83 participants with chronic shoulder pain due to rheumatoid arthritis or degenerative disease, suprascapular nerve block significantly improved pain, disability, and range of movement compared to a placebo injection.

The treatment was found to be safe, with no significant adverse effects reported, making it a promising option for managing shoulder pain in patients with these conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Shanahan, EM., Ahern, M., Smith, M., et al.[2022]

In a study of 82,561 patients undergoing various shoulder arthroscopic procedures, the use of regional nerve blocks increased significantly over 9 years, but there was no overall difference in postoperative opioid prescription filling between patients who received nerve blocks and those who did not.

However, for patients with a history of preoperative opioid use, those who received a nerve block had significantly lower rates of opioid prescriptions filled in the first two weeks after surgery, suggesting that nerve blocks may help reduce early postoperative opioid consumption in this specific group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure. Trasolini, NA., Bolia, IK., Kang, HP., et al.[2022]

Corticosteroid injections are effective for treating shoulder issues, providing relief for patients.

However, there is a significant risk associated with these injections, as improper administration directly into a nerve can lead to severe complications like permanent axillary palsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurovascular Complications Resulting From Corticosteroid Injections. McFarland, R., Dugdale, TW., Gerbino, P., et al.[2016]

In a study of 50,478 shoulder arthroscopy patients, those who received corticosteroid injections within 2 weeks before surgery had significantly higher rates of overall infections (8.86%) and severe infections (6.33%) compared to those with no injection history (1.56% and 0.55%, respectively).

The findings suggest that to minimize the risk of postoperative infections, it is advisable to wait at least 2 weeks after a corticosteroid injection before performing shoulder arthroscopy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preoperative corticosteroid joint injections within 2 weeks of shoulder arthroscopies increase postoperative infection risk. Bhattacharjee, S., Lee, W., Lee, MJ., et al.[2020]

The TIFFS study is a randomized clinical trial designed to compare the effectiveness of corticosteroid injections given as either glenohumeral joint (GHJ) injections or suprascapular nerve blocks (SSNB) in treating frozen shoulder, with a minimum of 40 patients participating.

The primary outcome will be measured using the Oxford Shoulder Score (OSS) at three months post-injection, which will help determine which injection method provides better relief of shoulder pain and improved function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized clinical trial of glenohumeral joint steroid injection versus suprascapular nerve block in patients with frozen shoulder: a protocol for the Therapeutic Injections For Frozen Shoulder (TIFFS) study. Jump, CM., Mati, W., Maley, A., et al.[2023]

In a study involving 67 patients with chronic shoulder pain, both CT-guided and anatomical landmark approaches for suprascapular nerve blocks resulted in significant reductions in pain and disability over 12 weeks, demonstrating their efficacy.

There were no significant differences in outcomes between the two methods, and both approaches were found to be safe with high patient satisfaction scores for pain relief.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block in chronic shoulder pain: are the radiologists better? Shanahan, EM., Smith, MD., Wetherall, M., et al.[2022]

The interscalene brachial plexus block technique was found to be the most effective in reducing postoperative pain and opioid consumption after arthroscopic shoulder surgery, based on a meta-analysis of 36 trials involving 3,124 patients.

However, this technique was associated with a higher frequency of adverse effects compared to other methods, such as the suprascapular nerve block, which had fewer complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and adverse effects of peripheral nerve blocks and local infiltration anesthesia after arthroscopic shoulder surgery: A Bayesian network meta-analysis. Liu, Z., Li, YB., Wang, JH., et al.[2022]

In a double-blind study of 29 rheumatoid arthritis patients, a suprascapular nerve block (SSNB) using bupivacaine alone provided significant pain relief and improved range of motion compared to the standard mixture of bupivacaine and methylprednisolone.

The study found that adding methylprednisolone to the SSNB did not offer any additional benefits, with significant improvements in stiffness and active abduction observed with bupivacaine alone at specific time points.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. Gado, K., Emery, P.[2019]

In a randomized controlled trial involving 77 patients with frozen shoulder, a single corticosteroid injection into the rotator interval (RI) resulted in significantly better improvements in pain, passive range of motion, and function compared to injections into the intra-articular (IA) or subacromial (SA) spaces.

The RI group showed faster and more significant improvements starting at 4 weeks post-injection, while the SA group did not demonstrate significant changes in passive range of motion or function, highlighting the effectiveness of targeting the RI for treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Corticosteroid Injection Into Rotator Interval for Early Frozen Shoulder: A Randomized Controlled Trial. Sun, Y., Liu, S., Chen, S., et al.[2019]

In a study of 59,644 patients undergoing ambulatory shoulder surgery, the use of nerve blocks did not significantly reduce the risk of adverse postoperative outcomes, such as unplanned admissions or readmissions, compared to those without nerve blocks.

While nerve blocks were associated with a statistically significant increase in healthcare costs (about $325 more), this increase may not be clinically relevant, indicating that the benefits of nerve blocks in terms of safety and efficacy may not justify the additional costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peripheral Nerve Blocks for Ambulatory Shoulder Surgery: A Population-based Cohort Study of Outcomes and Resource Utilization. Hamilton, GM., Ramlogan, R., Lui, A., et al.[2020]

In a study of 60 patients with non-specific shoulder pain, both suprascapular nerve block and steroid injection were effective in reducing pain and improving shoulder function, with significant improvements noted in both groups after treatment.

However, suprascapular nerve block had the advantage of no complications, making it a safer alternative to steroid injections for treating shoulder pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block versus steroid injection for non-specific shoulder pain. Taskaynatan, MA., Yilmaz, B., Ozgul, A., et al.[2022]

Corticosteroid injections given within 1 month after shoulder arthroscopy are associated with a significantly higher risk of postoperative infection, with odds ratios of 2.63 for private payers and 11.2 for Medicare patients.

No increased infection rates were observed for corticosteroid injections administered at 2, 3, or 4 months post-surgery, suggesting that timing is crucial for the safety of these injections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk. Kew, ME., Cancienne, JM., Christensen, JE., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12593904/

Intra-articular injections for shoulder arthritis in adults Efficacy of hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3658381/

Glenohumeral Joint Injections: A Review - PMC A single intra-articular injection of methylprednisone acetate showed an average 21.5% reduction in serum cortisol 24 hours after injection normalizing in 3 ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S2666638324003815

Effectiveness of nonoperative treatment in patients with ... 30% of patients with GHOA who chose their nonoperative treatment regimen had clinically meaningful improvements in symptoms.

4. rapm.bmj.com rapm.bmj.com/content/early/2025/02/26/rapm-2024-105656

Use and safety of corticosteroid injections in joints and ... This guideline focuses on the safety and efficacy of corticosteroid joint injections for managing joint chronic pain in adults.

5. scholarworks.indianapolis.iu.edu scholarworks.indianapolis.iu.edu/server/api/core/bitstreams/c7a1f111-fa40-4f57-ab1e-8f54e0e54346/content

Efficacy of Corticosteroid Injections for GHOA Background: There is limited data available on the efficacy of cortisone injection for. 2 glenohumeral osteoarthritis (GHOA). The amount and longevity of pain ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT03232749?term=AREA%5BBasicSearch%5D(AREA%5BConditionSearch%5D(%22Arthropathy%22)%20AND%20AREA%5BInterventionSearch%5D(%22Methylprednisolone%22))&rank=7

Predicting Response to Intra-Articular Corticosteroid ... Patients will be excluded from the study for any of the following reasons: · Post traumatic osteoarthritis · Inflammatory osteoarthritis · Imaging confirmed ...

7. ajronline.org ajronline.org/doi/10.2214/AJR.23.30458

Local and Systemic Side Effects of Corticosteroid Injections for ... A systematic review found a nearly twofold increase in adverse outcomes after rotator cuff repair if a corticosteroid injection is administered within 6 months ...