Cortisone injection for tennis elbow

Halifax2TheMax · December 2011

I just had a cortisone injection in my neck for a pinched nerve between my C6 and C7 vertebrae on Monday. The injection and experience was not fun and I won't know until 5 to 8 days later if it'll work. But I think why it hurt so much was the location. A long needle going through cartiledge, lots of snapping, crackling and popping. It didn't hurt until they pulled the needle out.

A few years ago I had them in my heels for high arches. The injections hurt but with physical therapy of stretching out the tendons and wearing inserts in my shoes for arch supports, I can get out of bed and walk first thing in the morning and not be hobbled like James Caan in Misery. I'm fine now in the foot department.

I'd recommend getting them as most everyone I've spoken to has gotten relief and you can avoid surgery. I'll let you know in a few days whether it worked for my neck, which is similar in pain to what you describe except it starts in my shoulder, travels down my arm to my elbow, where it feels like I've constantly whacked my funny bone, numbs the top of my forearm and makes the tips of my index and middle fingers feel like they're asleep. So, I feel your pain! And if this doesn't work, its under the knife or grin and bear it, neither of which appeal. If you haven't already, get an MRI or consult with an orthopedic surgeon.

Good luck!

Peace.

green mountain man · December 2011

The needle size is relative to the area of inflammation.
The doctor should have discussed those other treatment options before deciding on a shot

norm · December 2011

sus have you tried icing it? 10-15 minutes every few hours combined with some anti-anflamatories might be better than cortisone

gimmesometruth27 · December 2011

ZiggyStar wrote:

Has anyone had cortisone injected into their elbow....or another joint?

I've had constant tennis elbow flare ups since 2009. My doctor said the only thing I can do now is inject it with cortisone which may work for 2 months or up to 2 years. It varies with each person. He'll inject me a couple of times with local anaesthetic so the actual injection won't hurt too much (apparently the injection by itself hurts a lot). So I'm not too worried about that.

However, last night I was doing some "research" online and came across a forum which said a few hours and up to 1-2 days after the injection, it HURTS LIKE FUCK!! I read the following comments:

* Worse pain than my 5 caesareans put together
* The pain feels like broken arm pain....but worse
* Feels like a hammer smashing into your elbow over and over and over
* The worse pain I have ever felt in my life and I'll never EVER do it again

Supposed to go in this Friday. Now I'm shitting my pants. Someone tell me it will be okay....!! :?

:shock:

i work with an orthopedic physician and we do cortisone injections every day. we used to do the lateral epicondylar (tennis elbow injection) several times a week. now we only do 2-3 a month. if that...

the injection is not into the elbow joint. the injection is into the tendon that attaches to the lateral epicondyle. if not the tendon it is a little closer to the muscle belly just below that tendon. it depends on where the symptoms are. this injection is VERY painful because he would be injecting a painful and inflammed area. with this injection, the way the research says it should be done, and the way we do it, it is not just a straight injection. we employ a "peppering" technique which consists of the doctor poking and redirecting the needle up to 20 times to create trauma to help "jump start" the healing process. many times the body will create scar tissue in a chronically inflamed area and the body will "call it good" and stop trying to heal the area. the peppering technique creates trauma to the area and the body's response is to begin the healing process there again.

this injection is something that my doctor will not repeat until 4 months after the prior injection, and will limit them to 3 injections per calander year. side effects such as tendon weakening with increased chance of rupture and thinning of the skin and fatty tissue at the injection site can happen with prolonged repeated exposure to cortisone. we will not inject more than that because the more you inject the more likely those complications can occur.

in our experience patients describe 2-3 days of pretty intense pain and then gradual reduction in pain. the key is to REST for 4-5 days after the injection. sometimes people feel so good afterward that they "overdo it" with too much activity too soon and the injection will have been wasted. we do not use a numbing injection before hand. instead we include marcaine, a local anesthetic, in the injection. just prior to the injection i numb the skin with a freezing spray called ethyl chloride and it lessens the pain of the procedure but it does not numb the deep tissues ebcause the spray does not penetrate.

all of that above said, there is some hope for you, if you can find someone in australia that can do these techniques...the reason we do not do many of these injections anymore is because we have found 2 treatment modalities that are very effective for treating tennis elbow, and all other tendinopathies.

they are called:

1. the ASTYM technique

2. the Graston technique

both are designed to break up fibrosis in the affected muscle group and the entire extremity. we recommend ASYTM more often because the tools they use are acrylic and it is a gentler technique, while the Graston uses metal tools and is a little more aggressive and we have some patients complain that it hurts. it usually takes at least 8 visits of physical therapy with ASTYM to get you over the worst of it. I have had DeQuervain's tenosynovitis and was facing cortisone injection as well. I chose the ASTYM route and got better in 5 visits. It does not help everyone, but it is worth a shot in your case. along with the ASTYM and the other modalities that have been recommended in thie thread, you must use strengthening exercises as well, specifically ECCENTRIC exercises. the current research suggests that eccentric exercise is the most important component of a rehab protocol relating to tendinopathies.

you should google ASTYM and graston techniques and see if there are providers in your area and then ask your doctor if it is something worth trying. it works for our patients, and the proof of that is in the significantly reduced number of tennis elbow injections we have done the last 2 years when compared to the 4 years before that. the 2 doctors i work with swear by those techniques, and if a physical therapy company does not have those techniques, we don't refer patients to them. as a result, every physical therapy location in a 30 mile radius of our office has gotten at least one ASTYM or Graston certified physical therapist. believe me, it is worth looking into. good luck with whatever course of treatment you take!

norm · December 2011

what gimmie said

ZiggyStar · December 2011

norm wrote:

sus have you tried icing it? 10-15 minutes every few hours combined with some anti-anflamatories might be better than cortisone

No, I haven't iced it. Strapping it works sometimes....makes it harder to bend.

I can't take anti-inflammatories because I'm trying to conceive.....dammit! :x

gimmesometruth27 · December 2011

here are some links...

http://astym.com/default.asp

http://astym.com/patients/default.asp

http://www.grastontechnique.com/

this last one is the site for my office.....shameless plug :oops: :oops:

http://www.ilsportsdoc.com/

green mountain man · December 2011

I think you should change your MD, You have recieved better advice in this forum than the Doc's office.

ZiggyStar · December 2011

gimmesometruth27 wrote:

i work with an orthopedic physician and we do cortisone injections every day. we used to do the lateral epicondylar (tennis elbow injection) several times a week. now we only do 2-3 a month. if that...

the injection is not into the elbow joint. the injection is into the tendon that attaches to the lateral epicondyle. if not the tendon it is a little closer to the muscle belly just below that tendon. it depends on where the symptoms are. this injection is VERY painful because he would be injecting a painful and inflammed area. with this injection, the way the research says it should be done, and the way we do it, it is not just a straight injection. we employ a "peppering" technique which consists of the doctor poking and redirecting the needle up to 20 times to create trauma to help "jump start" the healing process. many times the body will create scar tissue in a chronically inflamed area and the body will "call it good" and stop trying to heal the area. the peppering technique creates trauma to the area and the body's response is to begin the healing process there again.

this injection is something that my doctor will not repeat until 4 months after the prior injection, and will limit them to 3 injections per calander year. side effects such as tendon weakening with increased chance of rupture and thinning of the skin and fatty tissue at the injection site can happen with prolonged repeated exposure to cortisone. we will not inject more than that because the more you inject the more likely those complications can occur.

in our experience patients describe 2-3 days of pretty intense pain and then gradual reduction in pain. the key is to REST for 4-5 days after the injection. sometimes people feel so good afterward that they "overdo it" with too much activity too soon and the injection will have been wasted. we do not use a numbing injection before hand. instead we include marcaine, a local anesthetic, in the injection. just prior to the injection i numb the skin with a freezing spray called ethyl chloride and it lessens the pain of the procedure but it does not numb the deep tissues ebcause the spray does not penetrate.

all of that above said, there is some hope for you, if you can find someone in australia that can do these techniques...the reason we do not do many of these injections anymore is because we have found 2 treatment modalities that are very effective for treating tennis elbow, and all other tendinopathies.

they are called:

1. the ASTYM technique

2. the Graston technique

both are designed to break up fibrosis in the affected muscle group and the entire extremity. we recommend ASYTM more often because the tools they use are acrylic and it is a gentler technique, while the Graston uses metal tools and is a little more aggressive and we have some patients complain that it hurts. it usually takes at least 8 visits of physical therapy with ASTYM to get you over the worst of it. I have had DeQuervain's tenosynovitis and was facing cortisone injection as well. I chose the ASTYM route and got better in 5 visits. It does not help everyone, but it is worth a shot in your case. along with the ASTYM and the other modalities that have been recommended in thie thread, you must use strengthening exercises as well, specifically ECCENTRIC exercises. the current research suggests that eccentric exercise is the most important component of a rehab protocol relating to tendinopathies.

you should google ASTYM and graston techniques and see if there are providers in your area and then ask your doctor if it is something worth trying. it works for our patients, and the proof of that is in the significantly reduced number of tennis elbow injections we have done the last 2 years when compared to the 4 years before that. the 2 doctors i work with swear by those techniques, and if a physical therapy company does not have those techniques, we don't refer patients to them. as a result, every physical therapy location in a 30 mile radius of our office has gotten at least one ASTYM or Graston certified physical therapist. believe me, it is worth looking into. good luck with whatever course of treatment you take!

Wow! Thank you so much for all the info! Does ASTYM work forever? Did your problem recur after your 5 treatments?

Basically, I want to know if tennis elbow ever really goes away completely....or will I have this for the rest of my life?

norm · December 2011

ZiggyStar wrote:

norm wrote:

sus have you tried icing it? 10-15 minutes every few hours combined with some anti-anflamatories might be better than cortisone

No, I haven't iced it. Strapping it works sometimes....makes it harder to bend.

I can't take anti-inflammatories because I'm trying to conceive.....dammit! :x

well you should try icing it for a few days...as far as i know, tennis elbow really never goes away but the info that gimmie provided should keep it under control

ZiggyStar · December 2011

green mountain man wrote:

I think you should change your MD, You have recieved better advice in this forum than the Doc's office.

Hmmmm....another doctor last year told me exactly the same thing ie cortisone injection.

ZiggyStar · December 2011

norm wrote:

well you should try icing it for a few days...as far as i know, tennis elbow really never goes away but the info that gimmie provided should keep it under control

Never goes away....Noooooo!!! :x :x :x

norm · December 2011

ZiggyStar wrote:

norm wrote:

well you should try icing it for a few days...as far as i know, tennis elbow really never goes away but the info that gimmie provided should keep it under control

Never goes away....Noooooo!!! :x :x :x

well i've had it since i was a teen...but it isn't constant and when it does flare up i do the stretches, put the brace on and ice it

green mountain man · December 2011

The doc,s will make more money by giving injections, as opposed to PT referals

chadwick · December 2011

you'll be fine. tell your elbow you will work it until if falls off

btw, i am not a doctor but more of a dick or something.
when i break my knees i use them as boats or speakers
:?

ZiggyStar · December 2011

chadwick wrote:

you'll be fine. tell your elbow you will work it until if falls off

That's how this fucking problem started in the first place! :x Pisses me off!

ZiggyStar · December 2011

norm wrote:

ZiggyStar wrote:

norm wrote:

well you should try icing it for a few days...as far as i know, tennis elbow really never goes away but the info that gimmie provided should keep it under control

Never goes away....Noooooo!!! :x :x :x

well i've had it since i was a teen...but it isn't constant and when it does flare up i do the stretches, put the brace on and ice it

I've just emailed my doc and asked whether I should see the physiotherapist next door to him first.

Since I've spent soooo much on doctors and specialists this year, I have free medical appts until 31 December....so was kinda hoping to squeeze this in before Xmas. But now I've been told about that the pain, I'm thinking ice + brace might do the trick!

gimmesometruth27 · December 2011

ZiggyStar wrote:

Wow! Thank you so much for all the info! Does ASTYM work forever? Did your problem recur after your 5 treatments?

Basically, I want to know if tennis elbow ever really goes away completely....or will I have this for the rest of my life?

ASTYM can work forever. the problem is if you are in a job that requires a lot of typing or other repetitive movement there is always the chance it will come back. you might need to change the way you do those activities. i am a guitar player so my thumb and wrist gets sore quite often after playing a 3 hour show, but it does not come back anywhere near the intensity as it was before. the key is to stay on top of your symptoms and do not let them get out of control. treat with ice and antiinflammatories if you can take them.

below are 2 pictures. the first one is a microscopic slide showing damaged muscle fibers with fibrosis. this is what the fibers in your elbow look like.

do you see the erratic almost s-shaped patterns in the muscle fibers? those are supposed to be nice and straight. that is the fibrosis. when your muscle fibers look like that, the muscle does not contract as well and that impairment transfers extra load to the other normal muscle fibers and that extra load causes them to break down and get inflamed and that is what you are feeling. ASTYM, Graston, and eccentric exercise causes those fibers to straighten out and function properly again.

below is what normal muscle fibers look like under microscope...

can you tell a difference?

and the short answer to will you have to deal with this the rest of your life??

most likely not.

gimmesometruth27 · December 2011

green mountain man wrote:

The doc,s will make more money by giving injections, as opposed to PT referals

this is true. but most doctors try to do right by their patients.

my docs don't have to be rich immediately. they believe that if they do the right things by their patients they well get their financial security eventually.

gimmesometruth27 · December 2011

ZiggyStar wrote:

I've just emailed my doc and asked whether I should see the physiotherapist next door to him first.

Since I've spent soooo much on doctors and specialists this year, I have free medical appts until 31 December....so was kinda hoping to squeeze this in before Xmas. But now I've been told about that the pain, I'm thinking ice + brace might do the trick!

unfortunately for you ziggy, you have been dealing with this chronically for a long time. i do not believe that ice and a brace will fix your problem. it might make the problem bearable, but it will not fix it. and if you don't fix it now you will continue to have the problem. that is why i said ASTYM and Graston are your best bets in lieu of the injection.

Cortisone injection for tennis elbow

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