AIM: To investigate the short- to medium-term effectiveness of ultrasound (US)-guided steroid injections for shoulder pain in patients who previously failed to respond to unguided steroid injections.METHODS: We examined 60 consecutive patients who had undergone US examination and US-guided steroid injection. Patients were categorised into having had a good response (i.e., good pain relief at time of follow-up), some response (improvement for 2-4 weeks) or no response, as documented by their usual rheumatologist in their subsequent routine out-patient review appointments.RESULTS: Average age was 64.4 ± 11.5 years and 42 were female. Median interval between US-guided injection and follow-up was four (interquartile range 2-5) months. Thirty-four (56.6%) patients reported a good response, 13 (21.7%) some response and another 13 (21.7%) no response.CONCLUSIONS: US guidance of steroid injections may achieve good short- to medium-term benefit in the majority of patients with chronic shoulder pain due to a variety of clinical syndromes.