Can Prednisone Cause Shoulder Pain? A Look at Serious Musculoskeletal Side Effects

October 9, 2025 •

4 min read

According to research, high-dose or long-term prednisone use is a known risk factor for avascular necrosis, a condition where bone tissue dies from lack of blood supply, and this can cause shoulder pain. It is essential to be aware of the potential musculoskeletal complications associated with this powerful corticosteroid medication.

Quick Summary

Prednisone use, particularly at high doses or for extended periods, can lead to serious conditions causing shoulder pain. These include avascular necrosis, myopathy, and increased osteoporosis risk. Recognizing symptoms and discussing them with a healthcare provider is crucial.

Key Points

Avascular Necrosis (AVN): A serious side effect of high-dose, long-term prednisone use is avascular necrosis, or bone death, which can directly cause severe shoulder joint pain.
Steroid-Induced Myopathy: Prednisone can cause muscle weakness and pain, particularly in the shoulders and upper arms, which is more likely with higher doses and prolonged use.
Risk of Osteoporosis: Long-term prednisone therapy can lead to weakened bones (osteoporosis), increasing the risk of fractures, including those near the shoulder.
Report Pain Immediately: Patients should report new or worsening shoulder pain to their doctor immediately, especially if it occurs with movement or persists at rest.
Proportional Risks: The risk of serious musculoskeletal side effects like AVN and myopathy is directly related to the dose and duration of prednisone therapy.
Tapering is Crucial: Never stop taking prednisone abruptly without a doctor's supervision, as this can cause withdrawal symptoms and other health issues.

Prednisone and Musculoskeletal Side Effects

Prednisone is a corticosteroid medication known for its potent anti-inflammatory and immunosuppressive properties. It is prescribed to treat a wide array of conditions, including autoimmune disorders like rheumatoid arthritis and lupus, severe allergies, and inflammatory bowel disease. While effective, prednisone is also associated with a range of side effects, including serious musculoskeletal issues that can manifest as shoulder pain. The potential for these complications is often tied to the dosage and duration of therapy.

Avascular Necrosis (Osteonecrosis)

One of the most serious and direct links between prednisone and shoulder pain is avascular necrosis (AVN), also known as osteonecrosis, or "bone death".

What is Avascular Necrosis?

AVN occurs when there is a disruption in the blood supply to a section of bone. Without a steady flow of nutrients, the bone tissue dies and can eventually collapse. The shoulder joint is one of the most common sites for AVN, along with the hip.

How Prednisone Triggers AVN

The exact mechanism by which corticosteroids cause AVN is not fully understood, but several theories exist. High doses and long-term use are significant risk factors. Some experts believe that prednisone may lead to fatty deposits blocking the small blood vessels that nourish the bone, particularly in the femoral and humeral heads. This compromises the blood flow and leads to bone death. The risk for AVN increases with higher cumulative and daily doses.

Symptoms of AVN in the Shoulder

In the early stages, AVN may be asymptomatic. As the condition progresses, symptoms often include:

Pain in the shoulder that gradually worsens over time.
Pain that may be mild or severe and is felt even at rest.
A grinding, catching, or crunching sensation (crepitation) with movement.
Limited range of motion in the shoulder.

Steroid-Induced Myopathy (Muscle Weakness)

Another way prednisone can cause discomfort is by inducing myopathy, a condition characterized by muscle weakness and pain.

What is Steroid-Induced Myopathy?

This side effect most commonly affects the muscles of the upper arms, shoulders, and legs. It can develop in individuals taking prednisone for long periods or at high doses. This is different from the inflammation that the medication was originally intended to treat; it is a direct effect of the steroid on the muscle tissue itself.

Signs of Myopathy in the Shoulder

Muscle weakness can lead to pain and tenderness. Symptoms may include:

Pain, stiffness, or cramping in the shoulder and upper arm muscles.
Decreased energy levels and fatigue, especially with activity.
Feeling easily tired or weak.

Osteoporosis and Fracture Risk

Long-term prednisone use can significantly weaken bones, a condition known as glucocorticoid-induced osteoporosis. While not a direct cause of shoulder pain, weakened bones increase the risk of fractures, including vertebral compression fractures and fractures of the arm bones near the shoulder. An acute fracture would cause severe pain and is a risk associated with long-term steroid use. The bone loss can happen relatively quickly, even within the first six months of therapy.

Comparison of Musculoskeletal Side Effects


Feature	Avascular Necrosis (AVN)	Steroid-Induced Myopathy	Osteoporosis/Fracture Risk
Underlying Mechanism	Lack of blood supply leads to bone cell death.	Direct effect on muscle tissue causing weakness and breakdown.	Decreased bone formation and increased bone resorption.
Common Location	Hip and shoulder joints are most frequently affected.	Proximal muscles, including the shoulders and upper arms.	Spine and ribs are most common fracture sites, but any bone can be affected.
Primary Symptom	Joint pain, particularly with weight-bearing or movement.	Muscle pain, cramps, weakness, and fatigue.	Bone fractures, which can cause severe pain.
Diagnostic Method	Magnetic Resonance Imaging (MRI) is key for early diagnosis.	Physical examination, muscle strength tests, and possibly electromyography.	Bone mineral density (BMD) scan (DXA scan).
Treatment Focus	Core decompression surgery in early stages; joint replacement in advanced cases.	Tapering prednisone dose (under medical supervision) and exercise.	Calcium and vitamin D supplements, plus prescription medications to increase bone density.

What to Do if You Experience Shoulder Pain

If you are on prednisone and experience new or worsening shoulder pain, it is crucial to speak with your doctor promptly. Do not stop or alter your medication dosage without medical guidance. Your doctor will need to evaluate the cause of the pain to determine the appropriate course of action. This may involve:

Medical Evaluation: Your doctor will likely conduct a physical exam and may order imaging tests like an MRI to check for AVN or other joint-related issues.
Dosage Adjustment: If the prednisone is causing side effects, your doctor may consider lowering the dose or switching to an alternative medication. This should always be done with a gradual tapering to avoid adrenal insufficiency.
Physical Therapy: For muscle weakness or stiffness, physical therapy can help with stretching and strengthening exercises.
Lifestyle Changes: For osteoporosis risk, your doctor may recommend calcium and vitamin D supplements and weight-bearing exercises.

Conclusion

While prednisone is a vital medication for many inflammatory conditions, its potential to cause shoulder pain through serious complications like avascular necrosis and myopathy is a significant concern, especially with long-term or high-dose therapy. Awareness of these risks is essential for patient safety. By working closely with a healthcare provider and being vigilant about monitoring for symptoms, patients can help manage potential side effects. Promptly reporting any new or worsening shoulder pain is the best way to ensure early detection and treatment of any prednisone-related complications. For more information, consult reliable medical sources like the MedlinePlus Drug Information site.

Frequently Asked Questions

Avascular necrosis (AVN) is the death of bone tissue due to a lack of blood supply. While the exact cause is unclear, high-dose, long-term prednisone use is a major risk factor, believed to cause fatty deposits that block blood flow to the bone, leading to its collapse.

Severe shoulder pain from serious conditions like avascular necrosis is not a common side effect of prednisone, but the risk increases with higher doses and longer durations of use. Muscle weakness (myopathy) causing shoulder and arm pain is also a known side effect.

Steroid-induced myopathy is a condition where prednisone causes muscle weakness and pain. It most often affects the larger muscles, such as those in the upper arms and shoulders, and is associated with high doses or prolonged use of the medication.

If shoulder pain is caused by avascular necrosis and results in bone collapse, the damage can be permanent, potentially requiring surgery like a joint replacement. However, pain from myopathy often resolves or improves once the prednisone dose is reduced or stopped under a doctor's care.

You should contact your doctor immediately. They can evaluate the cause of the pain, which may require imaging like an MRI. Never stop taking prednisone without medical supervision, as this can cause serious withdrawal symptoms.

Early avascular necrosis may not be visible on a regular X-ray, but it can be detected with a Magnetic Resonance Imaging (MRI) scan. A doctor will also perform a physical exam to assess your pain and range of motion.

For some conditions requiring long-term corticosteroid therapy, doctors may use the lowest possible dose of prednisone, explore intermittent dosing schedules, or switch to non-oral forms like inhalers. For managing pain and bone health, supplements like calcium and vitamin D are often recommended.