ReviewedReviewed. The exercises, repetition counts, hold times, and order of the exercises on this sheet have been checked by Dr. Mahendira against the clinic's printed handout.
SMH Osteoarthritis Clinic · Shoulder osteoarthritis (glenohumeral) · Corticosteroid injection (Depo-Medrol (methylprednisolone acetate))
Reviewed by Dr. Mahendira against the clinic handout.
Your injection
A long-acting corticosteroid injected directly into the glenohumeral (shoulder) joint. It reduces inflammation of the joint lining (synovium), cartilage surfaces, and surrounding soft tissues, relieving pain and improving range of motion. It is not a pain reliever. It works by calming the immune-mediated inflammatory response.
After your injection
What to expect
- Mild soreness or increased pain at the injection site is normal for 24 to 48 hours (a steroid flare).
- The Depo-Medrol usually begins working within 2 to 5 days. Full effect may take up to 2 weeks.
- Shoulder pain with reaching, lifting, and sleeping should gradually improve.
- Response varies. Some people experience months of relief. Others may need additional treatment.
First 24 hours
- Rest the shoulder. Avoid overhead reaching, lifting, pushing, and pulling.
- Apply ice wrapped in a cloth for 15 to 20 minutes every 2 to 3 hours to reduce swelling and soreness.
- Keep the injection site clean and dry.
- Take acetaminophen (Tylenol) as needed. Avoid NSAIDs for 24 hours unless directed by your provider.
Days 2 to 14
- Gradually resume light daily activities as comfort allows. Let pain be your guide.
- Avoid heavy lifting and overhead repetitive tasks for at least 1 to 2 weeks.
- Begin gentle pendulum and range of motion exercises after 48 hours.
- Continue sleeping on the unaffected side or on your back with the arm supported by a pillow.
Important reminders
Limit injections to 3 to 4 per year per joint. Repeated corticosteroid injections may weaken tendons, especially the rotator cuff. If pain persists, further imaging or a surgical consultation may be recommended.
Your exercises
Begin gently after about 48 hours if you are comfortable. Move slowly and stay within a mild, pain-free range. The counts below are a guide for how much to do.
1Pendulum swings (Codman's)
Most important
Lean forward with the unaffected arm on a table. Let the affected arm hang relaxed. Gently swing the arm in small circles (clockwise then counterclockwise), then forward and back, then side to side.
10 circles each direction, 3x daily
This is the first and most important exercise. Use body sway, not the arm muscles.
2Passive forward flexion (supine)
Lie on your back. Use the unaffected hand to grasp the wrist of the affected arm. Slowly raise both arms overhead as far as comfortable, using the good arm to assist. Hold 5 seconds, lower slowly.
2 sets of 10 reps, 2 to 3x daily
The affected arm should be relaxed. The good arm does the work.
3External rotation stretch
Lie on your back with the affected elbow bent at 90 degrees and tucked against your side. Use the opposite hand or a stick to gently push the forearm outward, away from the body. Hold 15 to 20 seconds.
3 reps of a 20 second hold, 2x daily
Keep the elbow pinned to your side throughout.
4Cross-body stretch (adduction)
Use the unaffected hand to pull the affected arm across your chest at shoulder height. You should feel a gentle stretch in the back of the shoulder. Hold 20 to 30 seconds.
3 reps of a 30 second hold, 2x daily
Keep the affected shoulder relaxed. Do not shrug.
5Isometric external rotation
Start after week 1 to 2
Stand with the affected elbow at 90 degrees, tucked to your side. Press the back of the hand into a wall or doorframe as if rotating outward. Hold 5 to 10 seconds. No visible movement should occur.
2 sets of 10 reps, 2x daily
Start after week 1 to 2. Builds rotator cuff strength safely.
6Wall climb (finger walk)
Stand facing a wall at arm's length. Place your fingertips on the wall at waist height. Slowly walk your fingers up the wall, raising the arm as high as comfortable. Hold 5 seconds, then walk back down.
2 sets of 8 reps, 2x daily
Also perform sideways to the wall for abduction.
7Scapular squeeze (retraction)
Sit or stand with arms at your sides. Squeeze your shoulder blades together as if holding a pencil between them. Hold 5 seconds, then relax. Strengthens the muscles that stabilize the shoulder blade.
2 sets of 12 reps, 2 to 3x daily
Keep shoulders down. Do not shrug toward the ears.
Exercise guidelines
- Stop any exercise that causes sharp or increasing pain in the shoulder.
- Mild discomfort is fine. Sharp pain is not. Stay at 3 out of 10 or below.
- Apply ice for about 15 minutes after exercising if the shoulder feels warm or achy.
- Progress from passive to active to resisted exercises as pain allows.
Protecting the area every day
- Avoid reaching overhead or behind your back repetitively. Use a step stool to reach high shelves.
- Do not sleep on the affected shoulder. Sleep on your back or opposite side with a pillow supporting the arm.
- Carry bags and heavy items close to your body or use the unaffected arm. Avoid heavy shoulder bags.
- Avoid pushing, pulling, or lifting heavy objects with the affected arm for at least 1 to 2 weeks.
- Use both hands for tasks above waist level. Avoid single-arm overhead pressing or throwing motions.
- Maintain good posture. Slouching rounds the shoulders forward and narrows the subacromial space.
- Apply ice for 15 to 20 minutes to the shoulder after activity if soreness develops. Use a cloth barrier.
- Keep the shoulder gently moving. Prolonged immobilization can lead to stiffness or a frozen shoulder.
Returning to activity
Walking, stationary cycling, and lower-body exercises can continue immediately. Avoid swimming, racquet sports, and overhead lifting until cleared by your provider.
Tracking your progress
Tick a box each day you complete your exercises, and circle how the area feels.
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| Week 1 | | | | | | | |
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| Week 2 | | | | | | | |
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| Week 3 | | | | | | | |
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| Week 4 | | | | | | | |
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Pain level today (circle one)012345678910
0 = none10 = worst
!When to call your doctor. Contact the clinic or seek care if you notice any of the following: Increasing pain, swelling, or redness in the shoulder lasting more than 48 to 72 hours after injection; Fever above 38C (100.4F), which may indicate joint infection (septic arthritis). Seek care urgently; Sudden inability to lift or move the arm, or new significant weakness (possible rotator cuff tear); Numbness, tingling, or loss of sensation radiating down the arm or into the hand; Skin changes at the injection site: lightening, thinning, or a visible depression; Symptoms of high blood sugar in people with diabetes: excessive thirst, frequent urination, blurred vision; No improvement in shoulder pain or range of motion after 2 to 3 weeks.
This is general information, not medical advice. Your exercises and recovery depend on your own situation, and your clinician will guide you.
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