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Old 10-19-2006, 07:00 AM   #1
Don King
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I have had a wicked case of tendonitis in my elbows since starting Crossfit and can't seem to get rid of it. I have stopped doing pull-ups as well as done the whole ice, ibuprofen, brace thing with no results. I have even done a round of steroids to bring down the inflammation, which seemed to initially work.

I am at the point where I am considering getting cortisone shots in my elbows to bring down the inflammation. Does anyone have any experience with cortisone shots?

Thanks,
Don
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Old 10-19-2006, 08:08 AM   #2
Jerimiah Childress
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From my experience most they seem to work for most people with shoulder inflammation.
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Old 10-19-2006, 08:32 AM   #3
Elliot Royce
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I had the cortisone shots in the elbows and yes it did work. The key is that you really have to lay off your elbows for quite a while afterwards and then come back slowly with strengthening exercises. If you just bang the cortisone in there and go back to your workouts, the problem will come back. That happened to me. And it can take a couple of months to really get the problem to go away. Work with a good PT.

I'm very surprised they gave you corticosteroids first. I assume you mean prednisone. That acts on the whole body. Cortisone is a much more targeted treatment. If it was prednisone, be very careful - that stuff can be very dangerous and destroy bone (although usually when used over time).
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Old 10-19-2006, 10:14 AM   #4
Don King
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Elloit -
Yes, I believe it was Prednisone that was prescribed. I stay away from that stuff as much as I can but have taken it in the past for my asthma.

When you say to lay off the elbows for quite awhile afterwards, do you mean lay off just the exercises that cause pain(i.e. pull-ups, curles) or all exercises that invlove the elbows? I can still do quite a few exercise that don't cause pain like bench press, high-pulls, dips, push-ups, jerk, push-press, etc. It seems to be the pulling motions that cause pain(medial epicondylitis).
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Old 10-19-2006, 01:54 PM   #5
George Cazenavette
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Back to the shoulder thing, it has been two months now and my right shoulder still is sore. The mri was neagative and my time with the pt has expired after a handful of visits. I should really re-up the persrciption (in Louisiana you need an MD to right a referal before a PT can treat you, is that unique). I can finally do push ups with only mild discomfort, but cocking my shoulder forward still is very uncomfortable. This all came upon me after doing the bench, clean dead lift routine. Elliot, i believe you answered an earlier posting of mine regarding this issue. I do not want to sit out any longer but i also do not want to make the problem worse when it seems to be getting better. Don, as with you i can do certain exercises. In my case, i can do pull-up without discomfort.
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Old 10-20-2006, 07:18 AM   #6
Elliot Royce
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Don:

It's surprising to me that your doctor would prescribe prednisone instead of a cortisone shot. I've been on prednisone for my neck herniation a few times but you can't just bang a needle into the neck in a doctor's office. However, for the elbow, the doctor should have started with PT and icing and then moved to the injection before ever trying prednisone. I'd be cautious with that MD.

To answer your question, my experience was, if it doesn't hurt it's ok. Focus though on strengthening your forearm muscles since that's the underlying cause of the tendonitis. I found bench presses tough because the forearm muscles need to control the movement of the bar as you push it and also because you need to grip hard.

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Old 10-26-2006, 07:18 AM   #7
Steven Ross
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If you are having chronic tendon pain at the elbows it is more likely a tendonosis than a tendonitis. The difference being tendonitis is an inflamed tendon and tendonosis is a tendon that is suffering repetitive trauma and is healing with poorly formed (and weak) scar without an appropriate inflammatory response.

The best study on injected corticosteroids for this problem showed significant symptom relief for 3 months but no significant benefit after 3 months. Oral steroids would presumably do similarly but it is a little odd to give an oral dose to treat such a localized and accessible problem.

I am an MD but this is not my field of practice so think of this more as advise from a fellow crossfitter not as medical advise please. I suffered with this problem myself for three years. I went through PT, NSAIDs, steroid injections x 3, steroid iontophoresis, bracing and splinting without lasting relief.

I was fortunately referred to a PM&R doctor that does prolotherapy. This is an injection of essentially caustic or irritant substances that causes inflammation in the tendon. The theory is the acute inflammatory response promotes appropriate healing instead of the weak scarred healing that was occurring without the inflammation. It is essentially the opposite of steroids and NSAIDs. The doc I saw said the steroid injections make it much more difficult to heal with prolo. I had to go through monthly injections (very painful) for 6 months and it is now resolved. I am happy.

Now the caveat. Case report medicine is weak. What I mean is just because it worked for me does not mean it would work for you. I could not find any decent studies showing this therapy to be effective. None saying ineffective either, it is just not out there in the medical literature last time I checked. Some docs consider this voodoo or alternative. I just felt I had done everything "traditional" short of surgery so I gave it a try. Consider looking into it or asking your doc. If you are going to consider it, do it prior to more steroids as they are antagonistic therapies. Good luck!
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Old 10-26-2006, 09:03 AM   #8
Elliot Royce
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Steve:

Would you consider prolotherapy for a hip flexor tendon? Also, please take into account that I have hip implants so any infection in that area would be catastrophic.

Elliot
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Old 10-26-2006, 08:00 PM   #9
Don King
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Steve -

Great info...thanks!
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Old 10-26-2006, 08:13 PM   #10
Steven Ross
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Elliot,

Not to beat a dead horse, I am a prolotherapy patient, not a prolotherapy practitioner. From my knowledge, the hip flexor tendon is treated with prolotherapy.

For your case, with prosthetics, you are appropriately concerned. I would have the same concern for steroid injections that I would for prolo. Maybe even more for steroids since they are immune-supressant. Injecting the hip flexor tendon by an experienced injectionist should not go anywhere near the joint itself so the implant should be just as safe as it would be with an injection anywhere else in the body. Obviously, it should be done with aseptic technique.

Prolo is relatively new and as with many new medical concepts if you look on the internet it is being billed as a cure all. I am sure it is not a cure all, but it does make sense to me for chronic tendon issues. This newness and excitement also brings in poorly trained practitioners, quacks, etc looking to open a clinic and make a quick buck. Certainly with implants I would avoid getting injected by anyone that did not have the credentials and training to assure you that they would not mess it up. Remember, well informed doctors love well informed patients. Poorly informed doctors will react negatively to appropriate questions. If you are thinking about this, sit down with the person doing the injections and ask about your concerns. They should be able to give you reassuring anwers.
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