Corticosteroid Injections Delay Shoulder Replacement, Study Finds | Orthopedics Today

Shoulder pain can be debilitating and for many, total shoulder arthroplasty—replacement surgery—looms as a potential solution. But new research suggests a less invasive approach might significantly delay the demand for surgery: corticosteroid injections. A study presented at the American Academy of Orthopaedic Surgeons Annual Meeting in March 2026 indicates that these injections may be the most impactful nonoperative treatment for delaying total shoulder arthroplasty, offering a valuable option for patients seeking to postpone or potentially avoid surgical intervention.

The Power of Injections

The findings, led by Nabil Mehta, MD, of EmergeOrtho, retrospectively reviewed data from 82 patients (105 shoulders) aged 55 to 70 years who were managing glenohumeral arthritis—arthritis affecting the shoulder joint—without surgery. Patients were asked to rank the effectiveness of various treatments they received in delaying the need for shoulder replacement. The results revealed that corticosteroid injections were cited as the most impactful modality in delaying total shoulder arthroplasty by nearly 42% of patients.

“From the patient perspective, injections are the most impactful modality in delaying shoulder replacement,” Dr. Mehta told Healio. “When a clinician has a patient in front of them with shoulder replacement or shoulder arthritis, injections are the most powerful tool that they have. And This represents probably the most impactful intervention that is going to potentially delay surgery, which is beneficial for both the patient and the surgeon.”

Corticosteroids are potent anti-inflammatory medications. When injected into the shoulder joint, they can reduce pain and inflammation, improving range of motion and function. The Mayo Clinic explains that corticosteroid injections are often used as part of a broader treatment plan for shoulder pain, alongside physical therapy and other conservative measures. But, this study highlights the potential for injections to be a particularly powerful tool in delaying more invasive procedures.

Physical Therapy: A More Nuanced Role

While physical therapy is often considered a cornerstone of nonoperative shoulder arthritis management, the study revealed a more complex picture. Approximately 17.1% of patients reported that physical therapy helped delay shoulder replacement. Interestingly, the benefit of physical therapy appeared to be more pronounced in patients with milder forms of arthritis.

Perhaps more surprisingly, nearly 18.5% of patients reported that physical therapy actually worsened their symptoms. Only around 11.1% experienced complete relief of their pain through physical therapy alone. These findings challenge the conventional wisdom that physical therapy should be a universal prerequisite before considering shoulder replacement.

It’s important to understand that physical therapy aims to strengthen the muscles around the shoulder, improve range of motion, and reduce pain through targeted exercises. However, in some cases, particularly with more advanced arthritis, these exercises may exacerbate inflammation and discomfort. The optimal role of physical therapy likely depends on the individual patient’s condition, the severity of their arthritis, and their response to treatment.

Understanding the Study’s Limitations

The study, as presented at the AAOS meeting, was a retrospective review, meaning researchers looked back at existing data. This type of study can identify trends, but it cannot definitively prove cause and effect. For example, while the study found an association between corticosteroid injections and delayed surgery, it doesn’t prove that the injections caused the delay. Other factors, such as patient lifestyle, overall health, and adherence to other treatments, could also have played a role.

The study population was also relatively small (82 patients) and focused on individuals aged 55 to 70. The results may not be generalizable to younger or older populations, or to individuals with different types of shoulder arthritis. The study relied on patients’ self-reported rankings of treatment effectiveness, which can be subject to recall bias and individual perceptions of pain and function.

Implications for Clinical Practice and Insurance Approval

Dr. Mehta suggests that these findings should prompt a reevaluation of how shoulder arthritis is managed, particularly regarding the role of physical therapy. “Our findings challenge the conventional wisdom that physical therapy should be a universal prerequisite for undergoing shoulder replacement,” he stated. He further suggests that insurance companies should reconsider requiring physical therapy as a condition for approving shoulder replacement surgery, especially in cases of moderate to severe arthritis.

The current process for obtaining insurance approval for shoulder replacement can be lengthy and frustrating for patients. Often, insurance companies require documentation of a failed course of physical therapy before authorizing surgery. This study suggests that this requirement may not be necessary—and could even be detrimental—for some patients.

What’s Next for Shoulder Arthritis Research?

Dr. Mehta and his colleagues plan to conduct larger-scale studies to further investigate the effectiveness of corticosteroid injections and the optimal role of physical therapy in managing shoulder arthritis. They also aim to collaborate with physical therapists to better understand how to tailor treatment plans to individual patients and identify those who are most likely to benefit from physical therapy versus those who might be better served by other interventions.

Future research could also explore the long-term effects of repeated corticosteroid injections, as frequent injections can potentially have adverse effects on cartilage and other joint tissues. Versus Arthritis notes that while corticosteroid injections can provide short-term pain relief, they are not a cure for arthritis and their effects may wear off over time.

the goal is to develop a more personalized and effective approach to managing shoulder arthritis, one that considers the individual patient’s needs, preferences, and the severity of their condition. For now, the findings from this study offer valuable insights into the potential benefits of corticosteroid injections and the need for a more nuanced approach to physical therapy in the treatment of shoulder pain.