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View Full Version : Cortisone injection for SLAP tear



Ingie
25-04-2007, 09:41 AM
Hi All, I have been poring over your posts with interest.. I just saw a shoulder surgeon on Monday after having seen my GP had x-rays, ultrasounds, MRI, referral to a rheumatologist...lots of dollars later...the Surgeon is fairly certain I have a SLAP tear and quite a large one. But to rule out impingement he's suggested getting a cortisone shot. I've read that this can also help with a SLAP tear too. Has anyone had a cortisone shot in the shoulder? Are they painful? I'm a bit of a wuss when it comes to needles...
BTW the surgeon I saw was Jeff Petchell, trained under David Sonnabend...

crazyjack
25-04-2007, 10:12 AM
hi
i dont know much about cortisone shots but i dont recommend them
they are usually very painful and they are only a part time fix
if u have a large tear i suggest that you try something else
good luck keep me posted on how u are doing

crazyjack
25-04-2007, 10:13 AM
by the way my name is jack
and if u need help just drop me a post

Ingie
25-04-2007, 11:02 AM
Hi Jack, thanks. I also have a very small ganglia that's why he thinks it's a tear and the MRI shows it...so I was rather confused when he said try cortisone to rule out impingment..he said SLAP tears were very difficult to diagnose.
Anyhoo...I hate the thought of a painful shot just to rule out impingment..when I was walking out the door he said "you'll be back for surgery". So I did a bit of research on the net and I found that the shot could also help with the SLAP tear..might calm it down and I won't need surgery... other than the shot, I'm under the distinct impression that nothing else you can really do to repair a SLAP tear except surgery...I've had the pain for about a year now...and it's getting worse week by week, can't sleep on the arm at all now...

angieliu
25-04-2007, 11:45 AM
Hi there,

I would be careful with cortisone injections as they do only offer temporary relief and it is not very good to inject large doses of cortisone into your muscle. As for SLAP lesions, when I saw the spe******t he said only a few types of the SLAP lesions require surgery and that most will heal with time and conservative treatment is the best option. It really depends on the type of SLAP lesion and there are quite a few.

I would consider getting a second opinion before you jump into surgery. Surgery is very invasive, and the shoulder is very complex with lots of muscles, nerves and major arteries. I understand that you have been in pain for a year, that's about the same for me. I can't sleep on my right shoulder as well but I'm not training myself too because my poor left side is getting sore. But I have found that exercise rehab has been really helpful, I've been doing that for a couple of months and have noticed some of my strength coming back.

Let us know how you go and you know your surgeon is right that SLAP lesions are very hard to diagnose and they tend to be over diagnosed these days.

crazyjack
25-04-2007, 12:03 PM
like i said before i would stay away from the injections they are only temporary
and dont always help
anyway
i dont know to much about SLAP tears but if u have a large tear surgery might be a
good decision for u to make
like angie said the conservative can be helpful but
if that doesn't work u will need surgery
it really just depends on what you want to do
i would seek a second opinion like agnie said,
and i would stay away from the cortisone shots!

angieliu
25-04-2007, 03:48 PM
Where abouts are you based? I'm sure that someone can refer you to a good sports doctor or a surgeon. The sports doctor I saw is in Sydney, and I also know that there are a number of really good surgeons there.

I know that means more money is required to be spent but sometimes it is worth it. But because it is a SLAP tear, and they are hard to diagnose I think it is good to get a second opinion because it may be worth exhausting the option of conservative treatment before going through with surgery.

It would also be good to find out the type of SLAP tear that you have. I know that types 1 and 2 can be done arthroscopically as all it is cleaning up the cartillage. Type 3 normally requires surgery.

ah-oh
25-04-2007, 04:39 PM
Hi Ingie,

I had a cortisone injection into my shoulder last week and it didn't hurt a bit - though I was nervous. However, different injury to yours (supraspinatus) but the following info was given by my ortho and I trust his expertise.

He has opted for the 'conservative' treatment first - cortisone injection - because surgery is agressive and rehab is long, therefore, if a conservative option works we should try it first. His opinion was that one injection will not deteriorate the tendon should surgery still be required - but more injections will.

Straight after the shot, he walked me into his spec*****t (why does everyone do that?) physio who has given me more exercises to do for the next 6 weeks after which time we will know whether the injection is likely to work or not. If not, surgery will be the only option.

I was given a 60% chance of success with the injection.
Pre-needle: limited shoulder movement and plenty of pain.
Post-needle: (which included a local anaesthetic) much better movement with no pain. Impingement currently more pain related than strictly mechanical.

The aim is to do physio to strengthen surrounding muscles to take the pressure off the injury site and thus return to strength. My understanding of ortho's opinion was that the cortisone does not fix anything, rather it shrinks the tendon / bursa dramatically so that the surrounding muscles can begin to work to assist recovery. With everything swollen, it becomes a vicious cycle. I understand the tendon shrinkage does weaken it for the duration of the cortisone so you do need to be careful not to load it other than physio recommended.

After the first week I have more movement than pre-needle, and far less pain (and I can sleep pretty well all night) but still cannot do the only movement I want to do which is for swimming/bodysurfing/kayaking - not that I've been able to try any of these. I'm being careful. I'm hopeful it will work.

My understanding is that because my tear (though quite large) is still not full thickness and the remaining tendon will be stronger that a repaired one. Hence, I'm aiming to go for the option that is going to give me the strength as well as the movement.

My aim is to return to (punters) level competition in time for next year's season as I've now missed the 2007 season (injured at Christmas).

Good luck. Seek a second opinion if unsure.

Ingie
25-04-2007, 07:39 PM
Hi all thanks for the info. Angielu I am based in Sydney, Newtown area, and yes I had a list of questions to ask the surgeon, and I didn't ask what type of SLAP I had. Doh! However he did say that it looked like 180 degrees of it was ripped off the bone..So half...I would think that is more than debridement. He did mention it could be done arthroscopically though.

Before all of this I have done Physio for 2 months. I even had a personal trainer to help with doing the exercises.. Whilst it did reduce the pain, the pain didn't disappear and as soon as I started doing weights again, the pain was as bad as ever especially around the bicep tendon area. So I stopped doing everything in fear I might be doing more damage by not knowing what the hell it was.

That's when I got ultrasounds, MRi's etc. Saw a rheumatologist and now surgeon and here I am today with suspected SLAP tear. I think having a ganglia you can be 99% sure that you have a SLAP because you don't see ganglia without a SLAP. However I think as ah-oh said, they will try conservative, and by that I mean conservative in their eyes, treatment before surgery, such as cortisone shots.. which from some of the posts I've been reading here some are against...

I would get a second opinion, except I waited two months to get to see the surgeon... and I'm restricted from a lot of things I want to do, such as weights in the meantime.

It's a difficult one, but I'm of a mind to get the shot and see how it goes. Although my ortho didn't ask me to do exercises he just said to ring him a week after the shot and tell him how my shoulder feels.

Ah-oh thanks for the reassurance that it didn't hurt too much..phew. Though I'll still be nervous I'm sure I'll get through it.

debbie clarke
26-04-2007, 07:01 AM
Hi Ingie. I can relate to not knowing what to do for best as I am in same position with a susp...... tear. I am now 9 weeks into the injury. 2 weeks ago I had a cortisone into shoulder and it made it more aggrevated. I read up afterwards that it can actually weaken the area in some cases. Apparently mine was one of them. Last week when I returned to G.P. he was intending to put another in but I refused. He has now forwarded me on to spe******t who I see Monday week. I dont partic... want surgery just to be put on right track. Like some other members physio made mine worse but I make sure I keep it rotated so it doesn't get frozen. Keep smiling although its very hard at times there are people who care.

Ingie
26-04-2007, 07:16 AM
Hi Debbie...hmm that doesn't sound good. I 'm getting my shot done via ultrasound..not at a GP.. I'm not sure GPs are spe******ed enough to do them properly..though I'm not an expert..as you say it's difficult to know what to do for the best.. I dont want surgery either.. and I've still got a few days to decide not to get the shot...I'm taking Naprosyn..which helps with the pain, but doesn't eliminate it. GOod luck with your appointment.

angieliu
26-04-2007, 09:51 AM
Ingie,

Would you like me to send you the details of the sports physician I saw in Sydney? He is in North Sydney and also works out at Olympic park.

Also, you mentioned that it is hard to sleep on the injured side. I find the same thing and have been sleeping on my left side for over a year. It's time to swap sides because I'm getting a sore left side now. Has anyone given you any advice on how you should sleep on your sore side?

Debbie. sorry to hear that the cortisone treatment didn't work. Physio has been helpful for me because my injury is now quite old (almost a year). You could consider getting a shoulder support brace which will help take the weight off a bit more during the day. I find using my shoulder brace especially when I'm at work really helpflul.

Ingie
26-04-2007, 03:10 PM
Angielu... thx for your offer. I went back to my GP today and got a referall to a sports physician.., I think the same one as you...though my GP said that the shoulder surgeon was probably best qualified to deal with the problems because he spe******es in just the shoulder.. Re: sleeping, I only sleep on my right side now... it's only been for the last week or so...so I haven't been doing it too long..I'm already starting to get sick of it, so I do'nt know how I'd go over a year..

It's never ending isn't it...

angieliu
26-04-2007, 04:47 PM
Ingie,

I've sent you the details of my the sports doctor I saw in a private message. Just in case.
His speciality is shoulders.

It is never ending but there is light at the end of the tunnel. Our shoulders will eventually get better. well that's what I'd like to think. :)

Ingie
26-04-2007, 06:55 PM
Angielu..I'm starting to think our shoulders will get better but only if we bite the bullett and get surgery... well mine anyway, but that's negative thinking for you...

angieliu
26-04-2007, 07:13 PM
see how you go. You might be surprised. for me surgery or an arthroscopy is the last resort and I haven't exhausted all my options yet.

ah-oh
26-04-2007, 09:58 PM
I found that you can get comfortable by putting a couple of pillows sort of like a long narrow boomerang. You sort of then lean along it on your tummy/side and your head on the other one but suporting your back enough so you don't roll onto your shoulder. It supports your body so takes the wieght off your shoulder (which is sort of in the space between the pillows).

You'll still wake up every time you want to move but is OK.

It's simple but kind of hard to explain.

Rexdog84
18-09-2007, 01:11 PM
Hey....I was reading through the replies to your problem...although it seems like it has been a while since your injury... My story short.....a had a partial supraspinatus tear...coupled with a slap tear of the labrum... I go to a clinic in the U.S.....a military hospital to be exact. The doctors here are almost always conservative. My injury was in februraryish....the doctors finally gave me a cortizone shot in May..... It is now coming back to haunt me.....I believe that the wearing off has begun lol. My pain was dramatically reduced....it was almost as if it was a miracle medicine or something. Today, I feel as if I fell down just yesterday (not February). I have not reinjured it....but I feel as though it is karma for not listening to my gut feeling on not just having it repaired the correct way!.....

angieliu
20-09-2007, 10:18 PM
Hey there,

Sorry to hear that the cortisone is no longer having it's effect. It has been suggested that I try a cortisone injection and like you my sports doctor is conservative and because nothing showed up on the ultrasound I didn't get one. So I have been managing the pain with acupuncture which has been really effective. It might be something that you can try.

Angie

Jeanie
25-10-2007, 02:00 PM
I had my first cortisone injection into my shoulder yesterday, for a work related repetitive injury and im wondering if i have done the right thing ? im in more pain now than i have been for the past 4 months does anyone know if this is a normal thing to have more pain after the injection and if so , how long this will last ?

rlh
25-10-2007, 07:41 PM
I have a slap tear in my shoulder but up until last yesterday that was the least of my worries.

I had a sore shoulder for about 2-3 months so i went and saw a sports medicine doctor. He ordered an x-ray and ultra sound and said it was probably burstitis and would need a cortisone injection. Two days later i went back and was told i needed to be referred to an ortho surgeon as i had a unusual large mark on my humerus that shouldn't be there. He said he couldn't give me the shot. My results also showed i had tendonitis, capsulitis & a wobbly ac joint.

After waiting 3 1/2 weeks to get into ortho surgeon he told me he was 99% sure i had an enchondroma (benign tumour) but he needed to be 100% so i needed an MRI and a bone scan. He said i would be back for a ultrasound guided cortisone shot.

I then had to wait another 3 weeks to get in for the mri at a private hospital. I had the two tests (over $1200) and was then rang by the doctors receptionist at work that my results were inconclusive and need to have a whole body Thallium scan ($900).
More nuclear stuff. I got a bit scared. Plus the mri guy wanted a copy of my x-ray for teaching purposes as he was a uni lecturer.

MRI showed slap tear (type 1), synovitis, tendonitits, capsulitis, a tumour 6.2x2.8x2.7 plus a whole lot of other stuff i didn't understand. Bone scan also said a lot of scary stuff about activity, trauma & aggressive pathology.

I reluctantly had the thallium scan - that came back positive and was told i had a chondrosarcome (malignant tumour) and was referred to see a muscularskeletal tumour surgeon. The whole family was freaking out. The report said it needed excision and the tumour was so large! and I had googled some really scary stuff about chondrosarcoma.
This was all done over the phone with ortho surgeon.

Saw the next doc within a week. He examined & tested area, took history & throughly studied my numerous films. He didn't agree with the reports from the scans. He sent me off for a ct and a Dmsa scan ($650 - nuclear - 3 in 3 weeks, bit of a worry in its self) at a public hospital, one that specialised in cancer. Saw him within 2 days of the tests - He said everything was fine and to leave the tumor in my arm and to come back and see him in 6 months when i will be retested in case of any changes.

He has now referred me back to the orginal ortho surgeon to treat my frozen shoulder, slap etc. Really, really cross today when i rang to make an appointment and was told i had to wait 3 weeks to be seen as this has been going on for over 3 months. Especially as all i need is a referral as he wont be doing the shot anyway. Considering just taking my 7!!! diagonstic images and just going back to see original sports medicine doctor and get a referral of him for guided shot at a local radiology.

Sorry to go on for so long but just wanted to get it off my chest. It has been an emontional roller coaster, damn expensive and with absolutely no treatment or relief.

So should i wait and see the ortho, see sports medicine or just try and let it get better by itself?

Ramirez
12-11-2007, 02:08 PM
Mate of mine had a SLAP lesion post dislocation. Had an op under Des Bokor and physio on macquarie st with the physios at SSOP (www.ssop.com.au)
Awesome results. The physios reckonned that if the slap was bad enough then surgery is the only option to ensure a full reutrn to function. But bad rehab is just as bad as bad surgery.

Ingie
17-11-2007, 02:21 PM
Hi all..can't believe my old message is sill going strong. The cortisone injection really didn't do that much for me..just a slight reduction in pain for a few weeks. I ended up with frozen shoulder and five months of agony but the pain is gone now, just stiff and still can't sleep on it. I also have a slap tear... depending on the severity of the tear, some tears don't require surgery. I'm hoping mine is one of them but time will tell. It's a long slow process with shoulders and I've learnt just to accept it. Once you accept it, it's much easier to deal with.

Surfchick
18-11-2007, 11:39 AM
Hi all!

Had clicking and clonking, aches and severe pain in rt shoulder for 3 months now.
Last 3 years I have had probs with hip. April 2007 i had a redo hip arthroscopy to shave bone and fix labral tear - successful now.

I had a strong suspicion that I had a labral tear in shoulder as it felt like my hip did. A trauma surgeon whom I saw for knee pain sent me for an MR arthrogram on shoulder = SLAP lesion, 26-10-07.

I am seeing shoulder surgeon on Tues and then a rheumatologist to see if we can find out why 2 joints have torn! My GP says I don't fit criteria for steroid injection as I have full range of motion in shoulder but severe pain and clicking.

From my hip history, 2 steroid jabs gave approx 2 months relief, first was worse for 110 days then felt cured. Due to the fact I know problems return - I just want the arthroscopy yesterday!

i am desperate - off work for 7 months, initially from hip, now shoulder. Am right handed and struggle with most daily activities - getting washed and dressed and moving in bed. I have no help, other than pain killers, hard to sleep, this is worse than my hip.

I really want surgery - I know I will struggle with 4 - 6 weeks in sling but I think it would be worth it as chronic acute pain is really dragging me down coupled with trying to help my mom who has liver cancer!

Anyone else have any thoughts on just jumping in with both feet and going for surgery?

Surfchick