hi everyone....I've read somewhere about the possibility of shoulder tendon issues after long/ish term steroid use for PMR. Can anyone clarify or add info? Thanks.
After 7 years of (now) low dose use - I've got a rotator cuff tendon tear..and am wondering if it might be due to steroid use.
I am not experienced enough to say it's the pred but I am an expert on shoulders!. I have had 9 on one shoulder which includes a total replacement and one op on my other!! It is remarkably easy to tear your cuff and small tears dont always give any symptoms. One of mine was only discovered whilst surgeon was in trying to sort other issues out. Even with big tears if you dont have a lifestyle that requires certain moves like certain sports you again may only get a little pain. Do you recall doing something specific to tear the cuff or have you had pain and they have done MRI and seen the tear? Obviously pmr does cause issues with our muscles and I am sure you will hear from people who know more about how the muscles are affected. What are they considering doing? X
Tendons around joints are thought to be affected if the person has too many steroid injections for problems and that is why they are usually limited to not more than 3 in a given time, usually a year. OTOH, this study didn't agree:
ncbi.nlm.nih.gov/pmc/articl...
and they say "The aetiology of rotator cuff disease itself is multifactorial. We accept that there are confounding variables which might affect rotator cuff tear incidence. However, we have attempted to minimise the influence of these variables by our exclusion criteria.
There is evidence in the literature to link full-thickness tear of the rotator cuff with increasing age,20,21 a factor confirmed from our data. Both of our study groups (less than three injections and three or more injections) have a similar age distribution, and the incidence of rotator cuff tear in both groups would be the same prior to steroid injection.
Genetic factors are also known to play a role in rotator cuff disease. The relative risk of symptomatic full-thickness tears in siblings versus controls has been estimated to be 2.42 in a retrospective cohort study.22 The role of smoking in the pathogenesis of rotator cuff tear is questionable.23 None of these were identified as risk factors in our study."
It isn't uncommon for shoulder issues to be confused - PMR shoulder bursitis may be initially identified as a rotator cuff injury for example. You can develop shoulder injury with or without PMR and so with or without pred.
patient.info/bones-joints-m...
Use of oral corticosteroids has been associated with specific forms of tendinitis - of the achilles in particular. But from what I can see there doesn't appear to be any real evidence of causation in other areas - it is something that happens, happens more in some people because of their genes and happens more as we age. Just like PMR I suppose.
I originally wrecked my shoulder diving and didnt have any tears but developed them later but there was never a definite cause. That was before I started taking pred. My surgeon has now said that some of the reasons my previous ops didnt work is that pmr was already affecting me even though it was only diagnosed 2 years after my replacement!! For most people a tear just appears but there was never a specific incident they can attribute it to. Like you say we know genetics play a part in most illnesses so it stands to reason rotator cuff tears can be genetically based. I particularly like reminding my mother that shes is responsible for everything me and my sister get that can even vaguely be blamed on genetics.
Pre PMR and pred the tear in my rotator cuff became evident sitting on a plane where I had to hold my shoulders forwards really hard for 2hours, as I was in centre seat. Since pred I had bursitis in my knee (it was previously injured in my 30s), golfers elbow (previous injury at 17years) and most recently tendonitis in my ankle (no idea except being fat). I think all the muscle strength has started to decline due to PMR, pred and age (I am 58 but have had health issues for 20years so i think my body older). Any additional stress or strain from.changed gait etc. Seems to cause "little" aches and pains. For me - age, mechanical, PMR, pred and neurological issues.
The thing about changed gait is a big issue for a lot of people and not just those with pmr. OH broke his back and though most people wouldnt notice too much wrong with his walk, I can see its changed and its then put a strain on his knees which he then changes his way of walking to relieve the pain.
Yes. Mine is from a back issue and the time i broke a leg at 17, which may have contributed to my back. There wasn't much physio when I broke my leg!!
This isn’t an unusual problem unfortunately. When I first went on steroids I felt so good that I was out scrubbing my decks and paving slabs. I have both rotator cuffs gone and various tendon tears as a result. I do wish someone had told me to take things easy even although feeling like Superwoman. Be very careful not to do anymore damage.
I fell in the shower and snapped rotator cuff tendons. Orthopaedic surgeon said I had acute tear on top of chronic damaged probably by trying too hard in the gym - I had carried on as normal when felt OK on the first Pred doses. Surgeon was sure this was because of the steroids and said impossible to repair because tendons would be like tissue paper. Physio exercises have restored normal movement by training other muscles, but I can’t lift anything except the arm above shoulder level.
Tendon issues 
Frozen Shoulder
Painful shoulder
Steroid myopathy (muscle/ tendon weakness)
