Shoulder Tendinopathy - Would you recommend a cortisone shot?

Medical Q&A [Moderated]
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Hello,

First of all, an immense amount of respect for having an open forum here for these types of questions. It’s been years since I participated in a barbell program or watched related content, but I got dragged back in after finding through a Reddit comment an article that Dr. Baraki wrote on aches and pains.

I’ve dealt with pain from shoulder tendinopathy over almost two years in my right shoulder. It is a constant, dull pain throughout the day that originated in my shoulder and spread to the outer-upper edge of my right pec. I primarily feel the pain in that pec area now.

It happened when I participated in an obstacle course race. On the second obstacle of the race, I pulled myself up a slanted wall. I heard a crunch and knew I did something to my shoulder. I pushed through any pain and finished the race. About a week later, I started a job in construction doing fairly heavy labor. The pain in my shoulder did not get altogether better. Overall, the intensity lessened, but on the other hand it also spread to the outer edge of my right pec. After 9 months, I quit the construction job, citing pain, and took less physically demanding work.​

To address it I saw my orthopedic. We tried physical therapy, but it did not change the pain. We then performed an MRI and these were the results: 1. Mild subdeltoid bursitis.
2. Mild supraspinatus and infraspinatus tendinosis.
3. Degenerative subcortical cysts are present at the anterior and

posterior superior aspects of the humeral head. ​
Afterwards, my orthopedic suggested a cortisone shot or, for a conservative approach, two weeks of rest and then light physical therapy. I took the two weeks rest. It did not make a difference for the pain unfortunately. At this point, I’m back to my exercise hobbies (which is now hippie rock climbing or other outdoor sports) after putting them on halt, and am wondering what on earth I should do for this pain. It’s not unbearable, but I’d like to make it go away if I can. I’m tempted to get a cortisone shot. Would you have any precautions against this idea?

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I only recommend corticosteroid injections in very limited circumstances, and this is not typically one of them (outside of severe symptoms, early adhesive capsulitis, and certain other situations). A corticosteroid injection is also not going to “fix” anything in terms of tissue structure/function/capacity, either. In order to better understand why, check out this free article specifically on tendinopathy:

https://www.barbellmedicine.com/blog/the-barbell-medicine-guide-to-tendinopathy/

You did not give much specific information about what the nature of your physical therapy treatments were, however, I trust our rehab team above all others for this kind of thing, and think it would be worthwhile to at least pursue a consultation with them to get some input (if not ongoing rehab guidance, depending on your needs). While it would not be particularly risky to get a one-time injection, you will still end up in the same place of needing to figure out how to rehab the area and re-build its capacity / tolerance for loading, anyway.

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