What do cortisone injections do?

A cortisone injection usually contains a corticosteroid medicine, sometimes combined with local anaesthetic. It may be considered when pain or inflammation is limiting movement, sleep or rehabilitation.

Examples include selected cases of shoulder bursitis, joint irritation and some rotator cuff-related shoulder presentations.

Some people notice symptom relief within days. However, cortisone does not automatically correct the reason a tendon, joint or other structure became painful.

Potential benefits of cortisone

• May provide relatively quick short-term pain relief.
• May help when pain is preventing rehabilitation from progressing.
• Can be useful for selected inflammatory or joint-related presentations.
• Is widely available through appropriate medical providers.

What are the limitations?

• Relief may be temporary.
• It does not repair damaged tendon fibres.
• Repeated corticosteroid injections may carry additional tissue risks in some situations.
• The benefit depends on the diagnosis, injection site and individual health factors.

For shoulder-specific information, see our guide to cortisone injections for shoulder bursitis and rotator cuff pain.

When is PRP considered?

PRP stands for platelet-rich plasma. A clinician takes a sample of your blood and processes it to create a preparation with a higher concentration of platelets. This is then injected into the target area.

PRP may be discussed for selected longer-standing tendon or joint problems. Examples can include some cases of Achilles tendinopathy and other persistent tendon presentations.

The evidence is not the same for every condition. Results can vary with the tissue being treated, PRP preparation, injection technique, number of injections and rehabilitation program.

Potential benefits of PRP

• Uses material prepared from your own blood.
• May improve symptoms or function in selected tendon or joint conditions.
• May be considered when symptoms remain despite appropriate conservative care.
• Can form part of a structured rehabilitation plan.

What are the limitations?

• Research findings are mixed and condition-specific.
• Improvement, when it occurs, is not usually immediate.
• More than one treatment may sometimes be recommended.
• PRP can be more expensive and less accessible than cortisone.
• Soreness, bruising or bleeding can occur after blood collection or injection.

Is PRP better than cortisone?

There is no single answer for every injury. In rotator cuff tendinopathy research, corticosteroid injections tend to perform better for short-term pain relief. Some studies suggest PRP may produce more sustained improvement later, but findings remain inconsistent.

The decision should therefore be based on the specific diagnosis rather than simply choosing the injection with the strongest marketing claim.

What about nerve blocks and Botox?

Cortisone and PRP are not the only injections used in pain and musculoskeletal medicine. Other injections have different purposes and should not be treated as direct alternatives to PRP or cortisone.

What are nerve blocks used for?

A nerve block places medication near a nerve or group of nerves to reduce pain signals. Clinicians may use nerve blocks for pain control around surgery, to help identify a likely pain source or to provide targeted pain relief in selected cases.

They are most useful when the clinical question and target nerve are clear. More widespread or persistent pain may need a broader assessment of pain types and causes.

Can Botox help pain or muscle overactivity?

Botulinum toxin, commonly known by the brand name Botox, also has medical uses. It has an established role in chronic migraine prevention and may be used for selected conditions involving muscle overactivity or spasticity.

People with temporomandibular disorder or some jaw-related pain presentations may also ask about Botox. Suitability depends on the diagnosis because reducing muscle activity can also temporarily reduce normal muscle strength.

What are the main risks of injection therapy?

All injections carry some risk. The type and likelihood of complications depend on the medication or biological product, injection site, technique and your health history.

• Temporary pain or soreness after the injection.
• Bruising or bleeding.
• Infection, although this is uncommon with appropriate sterile technique.
• Temporary numbness or weakness with some injections.
• Changes in blood glucose after corticosteroid injections, particularly for people with diabetes.
• Tissue-specific risks associated with repeated corticosteroid exposure.

Why does rehabilitation still matter after an injection?

An injection may reduce pain or change symptoms, but that does not necessarily restore strength, mobility or load tolerance.

This matters in problems such as tendinopathy, where progressive loading and movement planning are often central to longer-term management.

Depending on the condition, physiotherapy after an injection may include:

• graded strengthening
• mobility exercises
• load and activity modification
• movement or technique changes
• progressive return to work, gym or sport
• monitoring how symptoms respond as activity increases

The timing of exercise after an injection should match the injection type, tissue involved and advice from the clinician who performed the procedure.

What should you do before choosing an injection?

1. Clarify the diagnosis

   Ask what structure or condition is believed to be causing your symptoms and how confident the diagnosis is.

2. Understand the goal

   Find out whether the injection is intended to reduce pain, help confirm a diagnosis or support another part of treatment.

3. Discuss benefits and risks

   Ask what improvement is realistically expected, how long it may last and which complications matter in your situation.

4. Plan what happens afterwards

   Know when you can restart normal activity and whether physiotherapy, exercise or another treatment should follow.

What to do next

If you are considering cortisone, PRP or another injection, make sure the diagnosis and purpose of the procedure are clear first.

A physiotherapist can assess movement, strength, load tolerance and other factors that may be contributing to your symptoms. They can also help you decide whether rehabilitation should come first or help plan your recovery around an injection recommended by your doctor.

Cortisone and PRP injection FAQs

Related articles

References

1. Kyaw O, Khin C. Short-Term Relief or Long-Term Repair: A Narrative Review of Corticosteroid and Platelet-Rich Plasma Injections in Rotator Cuff Tendinopathy. Cureus. 2025;17(11):e97271. doi:10.7759/cureus.97271
2. Sleeswijk Visser TSO, van Linschoten R, Vicenzino B, Weir A, de Vos RJ. Terminating Corticosteroid Injection in Tendinopathy? Hasta la Vista, Baby. J Orthop Sports Phys Ther. 2024;54(1):10-13. doi:10.2519/jospt.2023.11875
3. Niyonkuru E, Iqbal MA, Zeng R, Zhang X, Ma P. Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research. J Pain Res. 2024;17:3217-3239. doi:10.2147/JPR.S476563
4. Pozo-Rosich P, Alpuente A, Silberstein SD, Burstein R. Insights from 25 Years of OnabotulinumtoxinA in Migraine: Mechanisms and Management. Nat Rev Neurol. 2024;20(9):555-568. doi:10.1038/s41582-024-01002-5

What Is a Cortisone Injection in the Shoulder?

A cortisone injection uses corticosteroid medication to reduce pain and inflammation. It may also contain local anaesthetic. For rotator cuff-related shoulder pain, the injection commonly targets the subacromial bursa rather than the rotator cuff tendon itself.

The injection does not correct the underlying cause of shoulder pain or repair tendon damage. Instead, short-term symptom relief may make it easier to restore movement and progress strengthening.

The diagram below shows a typical subacromial injection location.

When Might a Cortisone Injection Be Considered?

A corticosteroid injection may be considered when shoulder pain remains significant despite appropriate initial non-surgical care. Current clinical guidance does not recommend corticosteroid injection as first-line treatment for rotator cuff tendinopathy.

An injection discussion may be reasonable when:

• pain continues to restrict reaching, lifting or normal daily activities;
• night pain is significantly disrupting sleep;
• pain is preventing useful rehabilitation progression;
• appropriate early treatment has not provided enough relief; or
• your physiotherapist and medical practitioner consider an injection appropriate within the broader rehabilitation plan.

Which Shoulder Problems May Be Relevant?

Corticosteroid injection may be considered for selected people with pain involving the subacromial region. Similar shoulder symptoms can have different causes, so the diagnosis should not be based on pain location or one clinical test alone.

• Shoulder bursitis
• Subacromial pain or shoulder impingement
• Rotator cuff tendinopathy
• Rotator cuff-related shoulder pain

Are Shoulder Cortisone Injections Safe?

Shoulder corticosteroid injections are generally well tolerated when used appropriately, but they are not risk-free. The potential benefits and risks depend on the injection site, dose, frequency, your health and the condition of the surrounding tissues.

Clinicians generally avoid injecting corticosteroid directly into a rotator cuff tendon. Repeated exposure may adversely affect tendon tissue, so repeated injections require careful medical consideration.

For subacromial corticosteroid injection, current rotator cuff tendinopathy guidelines recommend ultrasound guidance where available. Greater placement accuracy, however, does not mean an injection will provide a better long-term outcome than rehabilitation.

Injection or Rehabilitation?

An Injection May Be Worth Discussing When

• pain remains high and significantly affects sleep or normal movement;
• rehabilitation cannot progress because pain is too limiting;
• appropriate initial conservative care has not provided enough relief; or
• a medical practitioner considers an injection reasonable within the broader management plan.

Rehabilitation Remains Central When

• strength, control or load tolerance needs to improve;
• symptoms are responding to exercise and activity modification;
• shoulder function is gradually improving; or
• short-term pain relief is being used to help progress exercise and normal activity.

What Happens During a Shoulder Cortisone Injection?

A medical practitioner cleans the skin and places a needle into the intended bursa or joint space. Corticosteroid medication is then injected, sometimes with local anaesthetic. Ultrasound may be used to guide needle placement.

Local anaesthetic can provide temporary numbness before its effect wears off. The corticosteroid effect, when helpful, may take longer to develop.

Your medical practitioner should provide advice about activity following the procedure. Rehabilitation can then be resumed and progressed according to your symptoms, shoulder function and the advice of the clinicians involved.

How Effective Are Cortisone Injections Compared With Physiotherapy?

A 2025 systematic review and meta-analysis of 15 randomised controlled trials involving 1,785 participants found that corticosteroid injection combined with physiotherapy interventions may provide small to moderate improvements in pain and function in the short term compared with physiotherapy alone.

However, corticosteroid injection alone was generally not more effective than physiotherapy interventions, and injections were not superior at medium- or long-term follow-up. The certainty of the evidence ranged from moderate to mostly very low.

This supports using an injection selectively for short-term symptom management rather than viewing it as a replacement for active rehabilitation.

Why Does Rehabilitation Still Matter After an Injection?

Rotator cuff tendinopathy guidelines support active rehabilitation as an initial treatment. Exercise can address strength, movement capacity and the shoulder's ability to tolerate everyday, work and sporting loads.

When an injection provides useful symptom relief, rehabilitation can focus on rebuilding the physical capacity required for daily activities, work, gym or sport.

Your rehabilitation program may include:

• rotator cuff strengthening;
• scapular and shoulder control exercises;
• shoulder and thoracic mobility where appropriate;
• graded return to lifting, work, gym or sport; and
• load modification while shoulder capacity improves.

Do Cortisone Injections Fix Rotator Cuff Tears?

No. Cortisone may reduce pain, but it does not repair torn rotator cuff tendon fibres. Management of a rotator cuff tear depends on factors such as the size and type of tear, symptoms, strength, function, age, activity requirements and treatment goals.

Progressive rehabilitation is appropriate for many rotator cuff tears. Persistent weakness, substantial loss of function or symptoms following significant trauma may warrant further medical assessment or imaging.

What Are the Risks and Limitations?

Most people tolerate shoulder corticosteroid injections without a major complication, but side effects can occur.

• temporary increase in pain after the injection;
• skin thinning or colour change around the injection site;
• temporary elevation of blood glucose, particularly in people with diabetes;
• infection, although this is uncommon; and
• potential adverse effects on tendon health with repeated corticosteroid exposure.

When Should You Seek Professional Advice?

Consider professional assessment if shoulder pain continues to affect sleep, work, sport or normal daily activities. A physiotherapist can assess shoulder movement, strength, symptom behaviour and function, then help determine whether rehabilitation alone or medical review is the appropriate next step.

Related Shoulder Information

• Shoulder pain conditions
• Shoulder bursitis
• Shoulder impingement
• Rotator cuff tendinopathy
• Rotator cuff injury
• Rotator cuff tears
• Frozen shoulder
• Shoulder pain FAQs

Common Questions About Shoulder Cortisone Injections

What to Do Next

If shoulder pain is not settling, book a physiotherapy assessment. Your physiotherapist can assess the likely contributors to your symptoms, guide rehabilitation and discuss whether medical review for a corticosteroid injection may be useful within your broader treatment plan.

References

1. Desmeules F, Roy JS, Lafrance S, et al. Rotator cuff tendinopathy diagnosis, non-surgical medical care and rehabilitation: a clinical practice guideline. J Orthop Sports Phys Ther. 2025;55(4):256-285. doi:10.2519/jospt.2025.13182.
2. Lazzarini SG, Buraschi R, Pollet J, Bettariga F, Pancera S, Pedersini P. Effectiveness of additional or standalone corticosteroid injections compared to physical therapist interventions in rotator cuff tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Phys Ther. 2025;105(3):pzaf006. doi:10.1093/ptj/pzaf006.
3. Adamson NJ, Chew KS, Holst MV, Hansen TB. Ultrasound-guided versus landmark-guided subacromial corticosteroid injections in adults with shoulder pain: a systematic review and meta-analysis. Musculoskeletal Care. 2022;20(4):734-746. doi:10.1002/msc.1643.
4. Puzzitiello RN, Patel BH, Forlenza EM, et al. Adverse impact of corticosteroid injection on rotator cuff tendon health and repair: a systematic review. Arthroscopy. 2020;36(5):1468-1475. doi:10.1016/j.arthro.2019.12.006.
5. Shen PC, Su FC, Lin YS, et al. Ultrasound-guided versus landmark-guided injections for musculoskeletal pain: an umbrella review. J Rehabil Med. 2024;56:jrm40769. doi:10.2340/jrm.v56.40769.