Hip and shoulder soreness can have different causes

Hip soreness often appears while walking or turning

Hip soreness often shows during walking, turning, or rising from a chair. Swelling or worn cartilage may also make the hip stiff.

An X-ray can show whether the gap between the hip bones has narrowed as cartilage wears. Ultrasound can help a doctor watch the needle enter this deep joint.

Cortisone relief may begin within days and is often strongest during the early weeks. Much of the benefit may be gone by later months.

Shoulder motion helps separate stiffness from weakness

Reaching overhead, serving a ball, and sleeping on one side stress the shoulder differently. Marked stiffness may suggest frozen shoulder, which limits how far the arm moves.

The rotator cuff is a group of muscles and strong cords called tendons that lift and turn your arm. Weakness may mean that group is sore or torn.

A shoulder cortisone injection may ease soreness for a while, but results differ. The exam can suggest the cause, though the exact cause may stay unknown.

Small joints benefit from a precise exam

Thumb, hand, and foot soreness may start in the joint or the soft tissue beside it. Careful movements help a doctor find the tender area.

Ultrasound guidance uses moving pictures on a screen to help place the needle in a small joint. It can't show how long the chosen medicine will ease soreness.

At home, reduce the grip or step that brings soreness back. Note any swelling and next-day soreness, then take those notes to your visit.

Sources

1. A systematic review of five small trials of intra-articular steroid injection in HIP osteoarthritis found a large treatment effect at one week that declined thereafter, a moderate effect persisting to eight weeks in two trials, and an odds ratio of 7.8 for meeting OMERACT-OARSI response criteria at eight weeks (NNT 2.4).

   McCabe PS, et al. — The efficacy of intra-articular steroids in hip osteoarthritis: a systematic review.. Osteoarthritis Cartilage, 2016. DOI: 10.1016/j.joca.2016.04.018.

2. The HIT randomized trial (198 participants) found that adding a single ultrasound-guided triamcinolone-plus-lidocaine hip injection to best current treatment improved hip pain over six months (mean difference -1.43, 95% CI -2.15 to -0.72), but that the triamcinolone arm was NOT better than ultrasound-guided lidocaine alone; benefit was concentrated in patients with ultrasound-confirmed synovitis or effusion.

   Paskins Z, et al. — Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial.. BMJ, 2022. DOI: 10.1136/bmj-2021-068446.

3. In a controlled cohort of 1,471 patients injected in the hip, 106 (7.2%) developed rapidly progressive idiopathic arthritis; compared with controls they were older, had narrower joint spaces and higher Croft scores before injection - so pre-injection joint severity, not the injectate or the anaesthetic, marked the at-risk group.

   Boutin RD, et al. — Rapidly progressive idiopathic arthritis of the hip: incidence and risk factors in a controlled cohort study of 1471 patients after intra-articular corticosteroid injection.. Skeletal Radiol, 2021. DOI: 10.1007/s00256-021-03815-7.

4. A meta-analysis estimated the incidence of rapidly progressive osteoarthritis after hip corticosteroid injection at 6% (95% CI 3-9%) among the 10 studies designed to detect it, while noting definitions varied widely, many cases were not severe, selection bias is likely, and 17 of 27 studies - including every study cited in the AAOS recommendation - could not have detected the outcome at all.

   Sabatini FM, et al. — Incidence of Rapidly Progressive Osteoarthritis Following Intra-articular Hip Corticosteroid Injection: A Systematic Review and Meta-Analysis.. Arthroplast Today, 2023. DOI: 10.1016/j.artd.2023.101242.

5. The GRASP factorial randomized trial (708 patients with rotator cuff disorders) found subacromial corticosteroid injection provided NO long-term benefit over 12 months, and progressive exercise was not superior to a single best-practice advice session with a physiotherapist.

   Hopewell S, et al. — Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial.. Lancet, 2021. DOI: 10.1016/S0140-6736(21)00846-1.

6. A network meta-analysis of frozen shoulder treatments (65 studies, 4,097 participants) found intra-articular corticosteroid was the ONLY intervention both statistically and clinically superior to others - and only in the short term.

   Challoumas D, et al. — Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis.. JAMA Netw Open, 2020. DOI: 10.1001/jamanetworkopen.2020.29581.

7. A systematic review and meta-analysis of 15 randomized trials (1,023 subjects) assessed intra-articular hyaluronic acid for glenohumeral (shoulder) osteoarthritis pain, evaluating hyaluronic acid plus physical therapy against physical therapy alone among other comparisons.

   Familiari F, et al. — Efficacy of intra-articular injections of hyaluronic acid in patients with glenohumeral joint osteoarthritis: A systematic review and meta-analysis.. J Orthop Res, 2023. DOI: 10.1002/jor.25648.

8. A meta-analysis of six level-I/II trials (408 patients) found PRP and hyaluronic acid produced SIMILAR short-term outcomes in hip osteoarthritis on WOMAC, VAS and Harris Hip Score, with no difference even when the analysis was restricted to leukocyte-poor PRP.

   Belk JW, et al. — Platelet-Rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis Yields Similarly Beneficial Short-Term Clinical Outcomes: A Systematic Review and Meta-analysis of Level I and II Randomized Controlled Trials.. Arthroscopy, 2022. DOI: 10.1016/j.arthro.2021.11.005.

9. A systematic review of ultrasound versus anatomic (landmark) guidance found needle-placement accuracy was greater with ultrasound guidance at every anatomic site, and short-term (<6 weeks) symptom onset improved, but long-term outcomes were NOT shown to differ between the two techniques; the accuracy advantage was largest in small joints.

   Gilliland CA, et al. — Ultrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review.. Phys Sportsmed, 2011. DOI: 10.3810/psm.2011.09.1928.

10. FDA's HCT/P guidance sets out the minimal-manipulation and homologous-use criteria that decide whether a human cell or tissue product is regulated solely under 21 CFR Part 1271 (section 361) or requires a biologics licence; cell-based orthopaedic injections that fall outside those criteria are unapproved drugs and biological products, and no cell-based product is FDA-approved to treat osteoarthritis.

    U.S. Food and Drug Administration — Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use - Guidance for Industry and FDA Staff. U.S. Food and Drug Administration, 2020.