Cortisone Injection

[paininthenuts]

As much as I love playing golf, my body doesn't. I presently have two painful shoulders and a sore elbow. As a result of playing golf I have had tennis elbow for a year now. I have tried all the exercises, ice pack, and just about every cream on the market, and nothing has helped it. I have been holding off having a Cortisone jab, but alas I have now given in and booked one for a few weeks time. I was wondering how many of you have had to do the same, did it work, and how much did it work ? 

[jsgolfer]

1 hour ago, paininthenuts said:

As much as I love playing golf, my body doesn't. I presently have two painful shoulders and a sore elbow. As a result of playing golf I have had tennis elbow for a year now. I have tried all the exercises, ice pack, and just about every cream on the market, and nothing has helped it. I have been holding off having a Cortisone jab, but alas I have now given in and booked one for a few weeks time. I was wondering how many of you have had to do the same, did it work, and how much did it work ? 

I had it for my shoulder earlier in the year, takes the inflammation down and with a little rest, I was back to playing in a week.   Worked wonders for me.  Although I still have bad elbows, but i didn't take a shot there yet.

[woodzie264]

As an orthopedic PA of 10 yrs, I've given prob close to a thousand steroid injections for various issues, tennis elbow (lateral epicondylitis) being one of the most common. The effectiveness of the injection largely depends on the duration of symptoms. For those having issues for 3-4 months (or more) tendinopathy may start to develop wherein the chronic inflammation starts to degrade the tendon quality and essentially  parts of it "decay." In surgery a healthy tendon is pristine white, but the patches of tendinopathy are gray.

Once tendinopathy develops, the injections will provide relief, but it tends to be temporal and not permanent. In these cases surgical debridement can be indicated if symptoms are persistent. If an injection is administered earlier in the inflammatory process, usually you will have resolution of symptoms if you work or some stretching exercises and perhaps use a tennis elbow strap for a few weeks.

if you've been having symptoms for a year, certainly try an injection coupled with formal physical therapy as the literature indicates this gives you the best chance of avoiding surgery. Good luck!

Edited October 6, 2016 by woodzie264

[paininthenuts]

23 minutes ago, woodzie264 said:

As an orthopedic PA of 10 yrs, I've given prob close to a thousand steroid injections for various issues, tennis elbow (lateral epicondylitis) being one of the most common. The effectiveness of the injection largely depends on the duration of symptoms. For those having issues for 3-4 months (or more) tendinopathy may start to develop wherein the chronic inflammation starts to degrade the tendon quality and essentially  parts of it "decay." In surgery a healthy tendon is pristine white, but the patches of tendinopathy are gray.

Once tendinopathy develops, the injections will provide relief, but it tends to be temporal and not permanent. In these cases surgical debridement can be indicated if symptoms are persistent. If an injection is administered earlier in the inflammatory process, usually you will have resolution of symptoms if you work or some stretching exercises and perhaps use a tennis elbow strap for a few weeks.

if you've been having symptoms for a year, certainly try an injection coupled with formal physical therapy as the literature indicates this gives you the best chance of avoiding surgery. Good luck!

Thanks, that's very interesting. Is it going to be very painful, and will I be playing within a few days afterwards

[woodzie264]

5 minutes ago, paininthenuts said:

Thanks, that's very interesting. Is it going to be very painful, and will I be playing within a few days afterwards

Not terribly painful, but the purpose of the shot is to calm down the tendon....if you immediately return to an activity that exacerbates it, your response to the injection will be reduced

[CarlSpackler]

I've had pains in many different parts of my body. Most have been cleared up with physical therapy and others with a chiropractor.

[JxQx]

I've struggled with soreness in my elbow for quite awhile and it wasn't until I went to see a sports therapist/chiropractor that he mentioned it could be due to tightness in my forearm. Sure enough I had some major knots in my forearm and after working them out with some exercises the pain in my elbow went away. Would be worth checking out. The same could be the case with your shoulder if you have a ton of tightness in your chest or back near the shoulder. I have had cortisone shot's but it seemed to only give me relief for a few months before coming back.

[paininthenuts]

2 hours ago, JxQx said:

I've struggled with soreness in my elbow for quite awhile and it wasn't until I went to see a sports therapist/chiropractor that he mentioned it could be due to tightness in my forearm. Sure enough I had some major knots in my forearm and after working them out with some exercises the pain in my elbow went away. Would be worth checking out. The same could be the case with your shoulder if you have a ton of tightness in your chest or back near the shoulder. I have had cortisone shot's but it seemed to only give me relief for a few months before coming back.

I have done all that, and to be honest I think it is nothing but ineffective witch craft.

[Brad W]

I'm doing self prescribed / researched strength building in my lower arms to help with my elbows and that seems to be effective.

I'm on my second shot in my shoulder and I'm doing formal PT guided strength building.  I do have the degraded tendon mentioned.

none of this is due to golfing and playing actually doesn't aggravate my shoulder anyway (fortunately).  Playing did aggravate my elbows but the strength building I'm doing has been very effective.  I no longer take naproxen before/during/after playing.

as far as pain is concerned for the injection, it isn't bad.  In my case she freezes the skin, which takes just a moment, then jabs the needle in.  It isn't 100% pain free, but its certainly tolerable.  Its kind of a sharp pinch.  Then the fluid push which creates some pressure, then its over.  Maybe a brief bit of residual pain, but its OK.  I actually played golf same day on my second shot.

Dr. said if the strength building does help after this shot wears off that I'll be faced with the  debridement  mentioned

22 minutes ago, paininthenuts said:

I have done all that, and to be honest I think it is nothing but ineffective witch craft.

the shot or the exercise?  The shots are effective, but they don't have a lot of staying power.  Essentially they relieve the pain to allow for a more comfortable physical therapy process.  Its not ineffective with craft.  I'd say things like crystals or magnets are more in that category

Edited October 6, 2016 by Brad W

[newtogolf]

I haven't needed a cortisone shot since H.S. Football days but as I remember it, it stung a bit but once he was done it felt better over time.  Hope it works out okay for you

[awmgolfer]

I don't have any personal experience but my #1 golfer on the HS golf team a few years ago had to get a shot of cortisone while they were trying to figure out the root cause of his issues. He had to wait a day to play but after he always felt much better. Definitely helped him!

[Buckeyebowman]

14 hours ago, woodzie264 said:

As an orthopedic PA of 10 yrs, I've given prob close to a thousand steroid injections for various issues, tennis elbow (lateral epicondylitis) being one of the most common. The effectiveness of the injection largely depends on the duration of symptoms. For those having issues for 3-4 months (or more) tendinopathy may start to develop wherein the chronic inflammation starts to degrade the tendon quality and essentially  parts of it "decay." In surgery a healthy tendon is pristine white, but the patches of tendinopathy are gray.

Once tendinopathy develops, the injections will provide relief, but it tends to be temporal and not permanent. In these cases surgical debridement can be indicated if symptoms are persistent. If an injection is administered earlier in the inflammatory process, usually you will have resolution of symptoms if you work or some stretching exercises and perhaps use a tennis elbow strap for a few weeks.

if you've been having symptoms for a year, certainly try an injection coupled with formal physical therapy as the literature indicates this gives you the best chance of avoiding surgery. Good luck!

As so many threads have pointed out, except the quoted above, cortisone injections treat the symptoms and not the causes of the discomfort! My buddy told me that cortisone injections destroy the joints!

That's not quite right. What cortisone injections will do is enable you to keep repeating the movements that stress the tendons connecting muscles to joints until you repeat them often enough that the tendon is shot! This is just another way of saying that the joint is destroyed! 

If you don't have a healthy tendon attached to a bone near a joint, what use is the joint?

[stealthhwk]

19 hours ago, paininthenuts said:

As much as I love playing golf, my body doesn't. I presently have two painful shoulders and a sore elbow. As a result of playing golf I have had tennis elbow for a year now. I have tried all the exercises, ice pack, and just about every cream on the market, and nothing has helped it. I have been holding off having a Cortisone jab, but alas I have now given in and booked one for a few weeks time. I was wondering how many of you have had to do the same, did it work, and how much did it work ? 

Very sorry to hear that. Ive battled golfers elbow for a while and its no fun. Ive had cortisone injections but not for that. Ive had them in my feet for a condition known as plantar fasciitis. (You haven't lived til you've had a cortisone injection in ur feet) They were excruciatingly painful and made no difference in my condition. That being said, hopefully, itll work for u. Its usually the indian, not the arrows but a few years ago, I had a set of graphite irons and that really seemed to helP with the golfers elbow. I used the graphite irons, and lower compression golf balls. Really helped me a lot.  Get better soon! Heres to relief

[woodzie264]

17 hours ago, Buckeyebowman said:

As so many threads have pointed out, except the quoted above, cortisone injections treat the symptoms and not the causes of the discomfort! My buddy told me that cortisone injections destroy the joints!

That's not quite right. What cortisone injections will do is enable you to keep repeating the movements that stress the tendons connecting muscles to joints until you repeat them often enough that the tendon is shot! This is just another way of saying that the joint is destroyed! 

If you don't have a healthy tendon attached to a bone near a joint, what use is the joint?

There is a lot of misinformation out there manifested here in the above post. 

Steroid injections don't just mask  symptoms; they reduce and clear inflammation (which is painful). Those are two distinct things. For instance, a lidocaine/Marcaine injection will mask pain, but not clear inflammation. This is an important distinction. 

An tendon may be inflamed from simply over-doing it, without there being anything mechanically wrong...in such cases a simple injection will resolve the issue completely. However, as stated in my previous post, if the inflammatory process has been prolonged, the tendon itself will start to stiffen at which point physical therapy, include stretching, exercises, and modalities, would be indicated...but one must still eliminate the inflammation via an injection. If not, all of the stretching in the world will not resolve the inflammation and lead to tendinopathy as descibed in my aforementioned post. 

Now to address the other fallacy of joint deterioration from steroid injections. While it is true that iatrogenic chondrolysis of joint surfaces has been documented, it is only relevant in the hands of someone who isn't trained or isn't responsible with their use.

First and foremost, the steroid itself isn't harmful to the joint. It's the Marcaine typically mixed in the injection cocktail that has deleterious effects on the joint chondrocytes....but even in those cases, the injection will only have adverse effects if administered within 90 days (3 months) of the previous injection...thus a provider should not be re-injecting a joint more than 3 times per year (giving a safety buffer between injections). For that reason, in today's litigenous society, most of us are no longer using Marcaine in our joint injections despite safely spacing them out. So let's be clear in what we're talking about, the steroid is not the problem and the steroid IS usually recommended in most all cases of lateral epicondylitis because the inflammation must be eliminated to prevent ensuing tendinopathy if left to it's own course. 

In the hands of a competant provider, a steroid injection is a fantastic option. It is when the patient doesn't follow through on what they are supposed to do that their symptoms return again and again. This is not a short-coming of the injection, but one of the patient.

Edited October 7, 2016 by woodzie264

[Buckeyebowman]

Thanks for the info, woodzie!

[woodzie264]

33 minutes ago, Buckeyebowman said:

Thanks for the info, woodzie!

Sure thing Buckeye! Believe me, I have this conversation 2-3 times a week to dispell the myths and misinformation. To your point though, some people do not take the time off nor do their rehab (stretching and exercises) as they should...in which case the injection seems to have only temporarily alleviated  symptoms. I believe that the doctors/providers should own some of the blame here if they are not properly educating their patients on how/why the steroid injections are used and what follow up care is needed.

cheers 

Edited October 8, 2016 by woodzie264

[paininthenuts]

had one yesterday, and whilst it hurt, it wasn't as bad as I thought. I will let you know if it works

[Bronco9798]

I've had them twice in my hips and 3 times in each shoulder in the last 12 years.  Dr. wouldn't give me more than three in each place and I have since had 3 shoulder surgeries. AC joint, shaved back two touching bones, and cleared out scar tissue in my left shoulder.  Then had both rotator cuffs repaired.  I have no issues in my shoulders now.  Hip still flares at times but not planning on doing anything with it in the near future.  Cortisone shots in the shoulder worked for me before my surgeries though.  I went about 2 years in between them.  Finally had to have the surgeries.