What if cortisone injection does not relieve shoulder pain?

An injection can calm inflammation around a joint or tendon, but shoulder pain may also involve a tendon tear, stiffness, neck-related nerve irritation, arthritis, or pain from how the shoulder blade moves. The medicine may have been placed near a structure that is not the main pain source, or the shoulder may need movement retraining alongside symptom control. Lack of improvement does not by itself identify one condition.

Record when the pain began, which movements aggravate it, whether sleep is affected, and how the injection changed symptoms, if at all. A clinician may repeat the examination and decide whether imaging or physiotherapy would clarify the problem. Until reviewed, avoid activities that sharply increase pain, but keep gentle comfortable movement so the shoulder does not become more stiff. Do not arrange another injection without discussing why the first one failed.

Seek urgent medical assessment for severe new pain after the injection, spreading redness or warmth, fever, marked swelling, new weakness, loss of feeling, a cold or pale hand, chest discomfort, or breathing difficulty. Contact the treating clinician soon if pain is steadily worsening or shoulder movement is becoming substantially more limited.

Ask which structure appears to be causing the pain, whether the injection reached the intended area, what examination findings support that view, and whether physiotherapy or imaging is appropriate. Ask how long to monitor symptoms and which movements should be modified while you wait.