Cortisone Injections Are No Longer The Preferred Treatment For Tennis Elbow

People whom suffer from certain joint and tendon pain have long known about cortisone injections, which relieved the pain.Now, medical science tells us that these cortisone injections actually harms the tendons, not help them.

Tendonitis, Achilles Heal Ache, Sore knee or Shoulder Joint Pain?

As a sufferer of shoulder pain stemming from what I believe began as a forceful over-extension injury over a decade ago, I have had intermittent, long-term shoulder pain.

Unable to sleep on my left side for any extended period, I have adapted to sleeping almost exclusively on my right side.The few times that I do roll over and end up on my left shoulder within an hour or so I awaken and am in so much pain that I cannot move my left arm.I would rate the pain on a scale of 1-to-10 as being a 8 or 9.By comparison, I passed several kidney stones some years ago and the pain is almost on par to this.

To get myself right I have to literally grasp my left arm with the right hand and draw the limp limb to my chest and cowboy-up, take a deep breath and roll away from where it hurts to where it hurts less.

It takes minutes for the pain to go away and my quasi-paralyzed arm muscles to begin to respond to my command.I have always assumed that this is tendonitis, as have several doctors over the years.

Medical Exam was Unrevealing

Several times now over the last few years I have had my shoulder examined by competent and well-meaning general practitioners in the medical field without any real prognosis.

Most have simply told me to ‘let the arm rest, don’t ever-work it and it will recover on its own.’ I tell them that the injury occurred over 10 years ago and that the pain never really goes away.

It is much less painful during the day when I am upright, but sleeping or laying down exacerbates the pain.Lifting my left arm over my head is impossible for the extension ceases at about chin-level.Lifting anything much heavier than a gallon of milk at arm’s length poses a real danger that I’ll drop it.

The pain interferes with my sleep almost every night, sometimes influencing my dreams.At times I could almost scream.I tell that the pain is intense and can point with great precision to the exact spot in the joint where the pain emanates, a spot less than half the diameter of a dime.The tip of my index finger covers the entire spot completely.

The pain ‘feels deep,’  a ‘bone ache‘ that is an inch or two deeper than where I indicate when I press my finger against the offending spot.It is most assuredly NOT muscular in nature.No amount of therapeutic massive or heat wraps affects the pain.The pain can however, sometimes extend down a thin ‘ribbon’ on the outer part of my upper arm all the way to my left elbow.This has repeatedly led doctors to diagnose the pain as being tendonitis.

Seeking a Diagnosis for my Chronic Shoulder-Joint Pain

Several years ago I had a sonogram done on the offending shoulder, and a series of x-rays taken.The sonogram did not reveal anything drastically wrong.The x-ray however, the doctor that examined it explained that he saw ‘…a rare form of arthritis that does not typically affect the shoulder.‘ He did not sound completely convinced.He failed to impress me of his convictions as well.He cited that it was neither Osteoarthritis (a loss or thinning of cartilage) nor was it in his opinion, rheumatoid (inflammatory disorder) in nature.There are over 100 different types of arthritis conditions which in addition to rheumatoid and osteoarthritis, include gout, pseudogout, psoriatic arthritis, and fibromyalgia, etc.

For my pain he only recommended Extra Strength Tylenol and advised me to ‘allow the shoulder to rest and it will feel better in several months.’ -The same old ‘wait and see‘ diagnosis that I am used to.

More recently (just a few years ago) I convinced my new family doctor to give me a corticosteroid injection.I had read and heard great things about the how it helped other long-term sufferers of joint and tendon pain.

He was reluctant, but admitted that I had a definite and measurable mobility issue with the arm.He acquiesced to my suggestion and did administer the cortisone injection.The pain relief was immediate and my mobility and strength in that arm vastly improved.Within minutes my mobility improved tenfold! I could lift my left arm completely vertical, right then and there in the examination room! Even he was impressed but said that in cases where cortisone was required, often it has very rapid results just like mine.For the next few weeks I slept like a baby.Pain-free, was sleeping uninterrupted by waking and dreams of torture.I was even able to sleep on my left side again if I so desired.

The reduction of pain and improved mobility lasted just several months before the pain and stiffness returned.

I returned to his office, complaining yet again of shoulder pain, stiffness and marked loss of mobility.I asked if a ‘top-up’ of cortisone could be administered but the doctor quite flatly refused my request.He cited that new evidence has shown that corticosteroid injections for tendon pain relief in and around joints (especially in elbows and Achilles tendon, but also knees and shoulders) actually damage the tendons, it does not help them.

While I may have been diagnosed with tendonitis and/or possibly arthritis in the shoulder joint, neither of these may in fact not be the entire case.You see, any ailment that suffixes “~itis” to its title means “~swelling of.” New studies have shown that even though the anti-inflammatory drug cortisone does reduce swelling where swelling is present, the overuse-injuries of my type are in fact degenerative, and not caused by swelling after all!

Corticosteroids interfere with neural receptors, causing the marked reduction in pain.That is counterproductive if it does nothing to actually aid healing.The tendons are in fact not swollen but physically damaged, in addition to being in pain.Remove the pain and you continue to injure the tendon unabated.Treating a damaged non-inflamed tendon with anti-inflammatory/pain-suppressing drugs is not ethical.

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It is now believed that most ’sore joint’ problems are not “tendonitis” (swelling of the tendon) but are instead “tendinopathies” which means something else.It  means “diseased tendons.” Damaged, but not swollen.Shaken, but not stirred.-Whatever.

It is now believed that damaged tendons are actually frayed.Cortisone merely interferes with the neural pain receptors and actually hides the pain in these cases and nothing more.It prolongs the actual healing time and allows more damage to occur in the tendon.

So what was my doctor’s advice? Exercise.He said to bend my sore arm to the point of pain and then, -force it even farther.And, repeat often.Stretch it, get that scar tissue that he surmises is present, stretched.It will (according to him) eventually stretch to the proper length and my mobility will improve.

He told me to take up tennis or two-handed ping-pong.Or left-handed bowling.Think ‘Karate Kid’ and ‘wax-on, wax-off.’ He actually said that to me.

Anything that would cause me to repeatedly extend and over-extend the stiff shoulder but with the caveat to ‘not over do it.’ And of course, to continue to use Extra Strength Tylenol for pain relief.

None of this is what I wanted to hear of course.It’s either a case of ‘that hurts? So stop doing that!” or “that hurts? Do it some more, -but just don’t hurt yourself.” Oh joy.

Pain is supposed to be good for the soul, not that this is much comfort right now.I’d almost rather have the pain-relieving injection and forgo the soul-improving pain, truth be known.

Source: Corticosteroids: short-term gain for long-term pain? Published Online: 22 October 2010 in The Lancet

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