Briefly: I know there are guidelines on how many cortisone shots a person should get within the space of a single year. I do NOT know if there are guidelines on how many a person may have over a lifetime. But are there? Are the side effects potential or assured, are they cumulative over many years, and does a steroid-weakened tendon never heal if left alone long enough? One million details follow.
You are not my doctor, and I know this to be true because my doctors will not answer these questions. if you have relevant medical knowledge, please give me as much information as you are willing to. Technical language & links to studies are welcome.
Background:
I need (=want) a cortisone shot in the vicinity of my bicep tendon where it attaches to my shoulder. That tendon was undamaged when I went in for a supraspinatus repair some years ago and damaged when I came out, for reasons never investigated or disclosed to me. The surgeon told me directly after he was finished that my bicep tendon was in fine shape; this had not been clear from the pre-op imaging and I had consented to have it stapled back on during the course of surgery if it turned out to need it: but he said he had done nothing to it; this was meant to be good news.
However, it was pain-free before surgery and very painful both immediately after surgery and ever since. he did not offer an explanation when I asked why this might be; he did not refer me for another MRI; he did not respond to the alarmed letter from my physical therapist describing my unusual rehab difficulties and requesting a consult.
SInce that time it has gone in cycles of pain, worse whenever I use my right arm. which I do regrettably often. Cortisone shots helped substantially for months at a time. however, the last doctor I saw for this cut me off after 2 injections 2 years ago. He did not tell me I could have more cortisone after enough time had passed, and I am reluctant to start another round of begging unless I have reason to believe I might succeed.
as noted above, I do understand that there is some risk of the tendon tearing after repeated injections. but...I do not know, and am not able to find out, whether it is torn already. it very well could be! whether my surgeon missed a pre-existing tear or himself did the damage I do not know. Furthermore, it is my understanding that if the tendon was unquestionably torn, I could have it surgically repaired - and as long as it is presumed to be only irritated, I cannot. for this reason -- but mainly for the reason that it hurts - I would like another cortisone shot. In my layperson's ignorant opinion, it is not clear that I have anything to lose. but if there is some universal policy or guideline preventing me from ever having another, I will not waste my time persecuting more innocent doctors over it. especially if there is a good reason.
Secondarily: same question, but about oral steroids (methylprednisolone specifically, for nerve pain from osteoarthritis and/or inflammation.) How long between dose packs must a person wait, and how many packs may safely be taken per year? I have variously heard that 2 or 3 may be prescribed in a calendar year, either back-to-back or months apart. But I do not know how severe the risks are, or how much worse it is to take 3 vs. 2 (or 4 vs. 3) in one year. As with the injection problem, I am willing to take a flat No for an answer (to the question Please, may I have some more?) but need to understand the rationale. I do know that steroids are prescribed in other amounts & schedules for other conditions. How is risk/benefit calculated for this drug? and/or is 2-3 packs per year the official maximum that all responsible doctors follow? To be clear, this is not in reference to the bicep tendon -- separate issue.
to pre-empt two obvious questions: 1. yes, I have consulted several very good physical therapists over the years and am about to restart PT again. All of the standard rotator cuff exercises & stretches make things worse. yes, I overuse OTC anti-inflammatories and ice packs already. no, topical diclofenac doesn't do anything. 2. I recently had spine surgery and the offending nerves are officially Decompressed. I had held onto some sliver of hope that the bicep tendon pain was actually nerve-related, not a rotator cuff issue at all, as it clusters with the nerve pain in my neck and shoulder blade and the origin is sometimes difficult to distinguish. sadly, it does appear to be a separate problem.
In conclusion, I have already allowed both a shoulder and a spine surgeon to do their worst and their best, respectively. The official messaging to me has consistently been that life-altering major surgery is much safer for me than either temporary steroids or any other useful pain medication. this is extremely hard for me to believe, but I am, after all, not a doctor.
If you are also not a doctor, please do not advise me to push for another shoulder MRI at this time. I would like one, but we cannot always get what we want. If you are a doctor, feel free to advise anything at all. even if it's mean.]
thank you for reading. |
Video
Web
Image
Music
BlogU
