Medical science would agree with you.

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Cortisone may cure the inflammation, but it won't fix what's causing the inflammation. For that reason, it's risky (you think it's all better because it feels great, but you've only alleviated the symptom, not eliminated the cause). I don't see why you would not use your arm for several months after the shot (that's why you get the shot - so that you can do whatever that was causing you pain, without pain). Just be cautious.

Sometimes it is curative, but it depends on what the diagnosis is, and what is causing it. For example, you could get an inflamed but not torn rotator cuff to settle down with a steroid injection, but you might need to change your swimming stroke to get it to stay away.

You don't need to do a steroid injection as a diagnostic test. You can inject local anaesthetic only as a test, and if this feels good temporarily, proceed later with a steroid injection.

Steroid injections about the tendons of the shoulder should be used cautiously, because they will weaken tendons if used repetitively.

Deke

Yes, it weakens the tendon greatly. Two years ago I had surgery on my left elbow to rid myself of chronic tendonits. I couldn't even rotate my arm. I had tried two cortisone shots prior to the operation. When Iwoke up, the doctor said the tendon was so damaged that several inches of it were removed and plastic tubing put in to replace it.

The surgery was the best option for me. The tubing feels normal in the warm weather but feels a little funny when I bend my elbow in the cold. Kind of a pulling feeling in my forearm.

Best of Luck

J

Deke is on the right track. Determine a confirmed, two independant diagnosis of tendonitis.

Cortisone is a BAD drug to use. Why? It doesn't go away!! It stays in that area for ever and may even CAUSE further issues by having that fluid cause friction, thereby INCREASING inflammation. (Also, - an experienced doctor is critical as it's easy to miss the inflammed area. It is also extemely painful, - I have known patients to pass out from the pain). A direct injection of a more benign anti-inflammatory is suggested. In addition, - you must rest the inflammated area. Still, - this is extremely painful and is not recommended either.

Rest is the best fix. Stroke technique will NOT affect in any way your risk of this problem. The cause is simply stress on the place where the tendon attaches to the bone.

Cortisone is dangerous!

I'm definitely leaning your way Toenail. Since the problem seems to wander around my shoulder I'm thinking on just forgetting the shot. Augh!

I got two or three cortisone shots in college because of swimmer's shoulder, more specifically tendinitis. It can be very painful to get the shot, and I did almost pass out on the last shot. It was part of a overall strategy to deal with the problem, said strategy included strengthening it, stretching it, icing the ---- out of it, and taking anti-inflammatories. I'm not sure how much was the cortisone shot and how much was everything else, but the overall treatment certainly got me through my planned college swimming career. I would definitely try this route before getting your shoulder cut, which was still fairly invasive surgery in the 1980s (not sure now) and can leave you with the shoulder being less stable in the long run. If the cortisone shot does not help you to fix the problem, you can get cut in six months or a year. But, if it works, then you can avoid voluntary surgery, which always has risks.

When I was in college they had just invented hand paddles. Being a 200 lb butterflyer I used the biggest ones (by order of the coach) for butterfly drills and swims. Go figure, my shoulders got hurt after only 3 mos.

The team Doc wanted to get the needle out , but our trainer said use ice avoid hand paddles and do about half the volume of practice. Doing 4-5 k workouts instead of 8-10k, actually made me faster in my 100 and 200 fly, but not as fast in the 500 and 1650 free. Since I scored pts in the fly at conference, coach thought that was a fair tradeoff. And my shoulders were safed for a fuller life.

My advice is to ice, lay low on workouts involving the shoulder, come back slowly and avoid the shot as long as possible. G

"Stroke technique will NOT affect in any way your risk of this problem. The cause is simply stress on the place where the tendon attaches to the bone. "

While I agree that you shouldn't rush into a cortisone injection, the above is nonsensical. Your stroke determines which muscles (which then strain their connected tendons) are used, when and how hard. It has everything to do with which tendons are stressed and how much they are stressed.

What are you spewing?! "Cortisone" hangs around forever? Really ...

Now, I'm not advocating the corticosteroid injection (most docs haven't used "cortisone" in years), but simply discuss this with your orthopedist. It is merely an option. And yes (depending upon diagnosis), it may be "curative". Obviously if you had a slap lesion/tear/etc. your MRI should have shown this. If not, your PT and rest should help. If STILL in pain - suck it up and suffer or discuss options.

I usually prefer Celestone Soluspan (if I can ever get a hold of some): mixture of betamethasone sodium phosphate and betamethasone acetate for a water soluable quick acting and long acting combo. Even after I tell my patients what this is, they still call it a "cortisone" shot. Oh well - such is the media. Same with "novacaine" vs. lidocaine, etc.

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Cortisone (or, rather, corticosteroids) is curative. Your adrenal glands make them all the time for exactly this purpose. But there's lots of misinformation out there. Corticosteroids reduce inflammation but can't reverse any anatomic variant that might be contributing to the issue at hand (AC joint degen, recurrent subacromial bursitis, etc). So you have to know: do you have such a variant? A good orthopod can help you find out.

Performed correctly, the shot is usually not too bad. Corticosteroids can weaken soft tissue, and can contribute to tendon disruption, but this is the exception, not the rule.

I tell patients that the shot should be the start of a 6-week period of relative rest. By "relative rest" I mean they should be active but refrain from overdoing. Swim, but swim gently. Go to work, but don't repetitively do whatever it was that caused the problem in the first place. This approach, in my opinion, gives the best chance of a "cure" rather than a period of painlessness followed by recurrence.

Other advice: ice for 72 hours after an injury or strain, then go to heat. Ice reduces inflammatory discomfort, but heat helps it resolve, probably by increasing blood flow. Ultrasound also works this way - it "superheats" tissue a bit more deeply.

Bottom line: if you can get it better without the shot, with rest and then gradual return to activity, then do that. If it doesn't get better, then get a good MD to shoot you in the right spot, and then go with a six-week "cooling off" period of active rest without overdoing. Hope this helps.

PS: Even though I gots good grammer and I kin do thuh speling, Yes I is a real orthopod.

There is a lot of misinformation out there.

To start, Cortisone is virtually never used. Derivatives of the family of corticosteroids ( of which cortisone is one) are used in preference. These are not natural but are synthesized purely for their benefits over natural ( or synthesized) cortisone. Celestone Soluspan is one, as used by el guapo. Kenocort is another. Depo-Medrol used to be a favourite but has been discontinued.

There is a big difference in where the stuff is placed. WRT elbows, it is used for tennis elbow / golfers elbow etc. and involves injecting into the tendon itself. It works but definitely leads to longterm tendon degeneration if repeated too often and may require surgery as previously mentioned.

For shoulders the issue is different. If you have a problem with the shoulder e.g. acromial spur or several others, then rotator cuff impingement in swimming is a problem. Cure does require modification of technique and may require surgery. The needle will have temporary very good but unsatisfactiory long term benefit. If however, the tendonitis / impingement is due to something unrelated i.e. a wrench from a crash, then injection can be curative very much more quickly than with rest and R.I.C.E. alone. There will be no long term side effects. Strongly recommended.

If you have a cuff tear e.g. from a more serious crash then the shot will help the symptoms but will actually delay the healing of the tear. For a full tear surgery is required often.

A word of caution. There are many docs injecting shoulders. Some of these are experienced orthopods but many are not. The space that should be injected is NOT the tendon but the space just outside of the tendon called the bursa and it is only 3 mm thick when inflamed ( 1 mm when normal). To do it accurately requires direct vision i.e. ultrasound guidance. It is virtually painless when done properly. If yours was painful - guess what? It was into the wrong place. ( I have done many hundreds of these and into the wussiest of triathletes without a murmur. Sometimes even with ultrasound guidance it goes into the wrong place and instantly it is sore)

So... see a good orthopod, get Ultrasound or MRI if the diagnosis is not clear ( also if it is clear sometimes) and if the shot is sore - well, it is not gonna be as good as a painless one. Also as el guapo says take it easy for a few days to let it kick in

Thanks everyone. I'm going to make an appointment today to discuss it with my ortho.

I disagree that the shot has to be painful. I had one in my shoulder a few years back and the pain was negligible. Maybe I just had a good doctor--I don't know. I do know he told me that he mixed some Lidocaine in with the corticosteriod, so maybe that helped.

What I do know is that the shot didn't cure my problem, which was diagnosed as "frozen shoulder." Only about 3 mos. of PT did that. The failure of the shot to help me did firm up the diagnosis, though--same as your doc is telling you.