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Old 10-12-2009, 05:55 AM   #11
Everett Steinbarger
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Re: Cortisone : yay or nay?

There are a few studies out there.

http://www.pubmedcentral.nih.gov/art...gi?artid=28251 (WFS)

The above study deals with lateral epicondylitis. It should be noted that we can demonstrate Lateral Epicondylitis is NOT an inflammatory condition, however local steroid injection seems to be a rather effective option for treatment.

I also read another study this AM that showed that in osteoarthritis of the knee, steroid injection could reliably give 1 week of pain relief. IMHO, 1 week is not so great. However, that study was a literature review. There was actually no research performed, and there may have been no consistency in the severity of the arthritis, or what was defined as arthritis.
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Old 10-12-2009, 10:05 AM   #12
Steven Low
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Re: Cortisone : yay or nay?

Hmm with a little more research it seems that single and maybe double shots do provide effective treatment... but repeated use of shots may lead to detriment.

So yes, may be effective for the OP.

I'll edit tendonitis article as well.
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Old 10-12-2009, 02:51 PM   #13
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Re: Cortisone : yay or nay?

Steven, would you care to let the rest of us know where you get your information that further injections may lead to detriment?
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Old 10-12-2009, 06:39 PM   #14
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Re: Cortisone : yay or nay?

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Originally Posted by Everett Steinbarger View Post
Steven, would you care to let the rest of us know where you get your information that further injections may lead to detriment?
wfs
http://www.spine-health.com/conditio...is-medications
http://www.sandersclinic.net/shlder_rotatorcuff.html

etc.
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Old 10-13-2009, 01:52 AM   #15
Everett Steinbarger
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Re: Cortisone : yay or nay?

Those are great policies for a practitioner or clinic to follow as guidelines, but they don't give any reasons as to why.

I should have been more succinct : I'm curious as to where the research is that supports this viewpoint that repeated injections degrade tendons. I would also like to know at what concentrations and frequency this degradation happens. If this truly happens, then many of us need to change our practices.

So that you know where I'm coming from, I practice with the same set of parameters, but for different reasons. If I've injected someones "X" 2 or 3 times, and there has been no appreciable gain in recovery or decrease in pain, that is when I begin to steer them away from injections. At that point surgery may be an option, if there is something that can be done.

On the flip side, if "X" gets 6 months to a year of relief after an injection or 2, and that patient returns to my office for another injection to help them get through a season of work, I'm gonna help that person out.
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Old 10-13-2009, 04:24 AM   #16
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Re: Cortisone : yay or nay?

It's because any of the corticosteroids are extremely strong anti-inflammatories, but they're also sympathetic stress inducing. As you may know, chronic stress is very bad for the body and leads to degradation in most tissue. Recovery goes to crap, and all other bad things.

I dunno I'll keep looking for something more concrete.
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Old 10-13-2009, 04:56 AM   #17
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Re: Cortisone : yay or nay?

Sympathetic stress induction from a corticosteroid injection?

I'm understanding this less and less.
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Old 10-13-2009, 06:42 AM   #18
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Re: Cortisone : yay or nay?

http://www.ncbi.nlm.nih.gov/pubmed/7150716?ordinalpos=1&itool=EntrezSystem2.PEntrez.P ubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pu bmed_Discovery_RA&linkpos=2&log$=relatedarticles&l ogdbfrom=pubmed (WFS)

http://www.ncbi.nlm.nih.gov/pubmed/7112037?ordinalpos=1&itool=EntrezSystem2.PEntrez.P ubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pu bmed_Discovery_RA&linkpos=1&log$=relatedarticles&l ogdbfrom=pubmed (WFS)

Forgive me for belaboring the point, I'm finding this rather interesting. I also found these abstracts interesting. (I can't get at the entire document.)

Let me state that I understand that humans are very different from rats and albino rabbits.......for the most part. It also needs to be understood that I would not propose carrying out these research experiments as treatments. Nor would I suggest that changing the structure of tissue is healthy and justifies repetitious corticosteroid use.

What I find interesting is this:

1. Different tissues respond in different ways to excessive corticosteroid injection.
2. Tendon strength was not reduced by excessive local cortisol injections.
3. Collagen/Elastin structure and tendon strength were independent of each other in these studies.

This gives me no satisfaction as I have always held the belief that if the tendon was changed structurally that it would be more susceptible to rupture. Maybe my beliefs have been in error. I am unsure of what to make of these studies on the whole. It has been shown time and time again in the human tendo calcaneus that corticosteroid injection increases the incidence of rupture.
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Old 10-13-2009, 01:44 PM   #19
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Re: Cortisone : yay or nay?

Just take a look at any of the diseases that involve excessive production of glucocorticoids. Cushing's syndrome is one of them specifically that involves a huge amount of production of cortisol.

wfs
http://en.wikipedia.org/wiki/Cushing%27s_syndrome

There's nothing in there on tendons unfortunately and I have to leave now.. but I wouldn't be surprised to see degenerative changes on tendons especially if they are disrupted like you said. It depends how badly they're stressed I guess. I'll look later.

In the case of repetitive cortisol injections I would *assume* that the person is still in pain and thus their tendon structure is still disrupted which will probably lead to degenerative changes.
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Old 10-13-2009, 03:18 PM   #20
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Re: Cortisone : yay or nay?

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Originally Posted by Steven Low View Post
Just take a look at any of the diseases that involve excessive production of glucocorticoids. Cushing's syndrome is one of them specifically that involves a huge amount of production of cortisol.


It's because any of the corticosteroids are extremely strong anti-inflammatories, but they're also sympathetic stress inducing.
Right, I understand Cushings Dz/Syndrome. I also understand that cortisol is secreted in excess during prolonged crisis and as a result of stress.

What I can't wrap my head around is the idea of corticosteroids being inducers of Sympathetic Stress Syndrome (aka Fight-or-Flight). They arise from it, but excessive corticosteroids do not keep people in a constant adrenalized state.
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