Cortisone shot or raise prednisone level

[slopers]

Hi,

I haven't posted in a while but have been reading and appreciating the daily posts.

I have been slowly tapering by .25 and am currently at 2.25mg pred. I had a fall a month or so ago and have developed tendonitis in my left shoulder (MRI shows no rotator damage). It's extremely painful now and I can barely raise my arm or put on a coat. I'm scheduled to begin physical therapy and the Doctor (my rheumy) recommended a cortisone shot as well as the PT. He also gave an option of raising my prednisone to 20mg a day for a while instead of the injection to help with the inflammation. I expressed my displeasure for this because I have been doing well with no flares or PMR issues in a very long time and did not want to raise my level of prednisone.

Has anyone had any experience similar to this and have any advice? We agreed to start the PT without either the shot or extra prednisone and see how I manage.

Thanks.

[PMRpro Ambassador]

In my experience a steroid shot is more effective for what is essentially an add-on to PMR than upping the oral dose. Oral pred is general, a shot is concentrated on the area affected but with some systemic effect.

[slopers in reply to PMRpro]

Thanks for your quick response. I was leaning towards the shot as well. I think when the Dr. saw that I wasn't very happy about the injection he gave me the pred option! Hopefully the PT isn't unbearable and if so, the cortisone will be available.

[HeronNS]

If you can avoid the cortisone shot that will be good. It isn't a cure, any more than pred cures PMR, and can actually be detrimental in the long run to the health of the joint. I believe the issue is that nsaids, and, unfortunately, corticosteroids, interfere with cartilage renewal.

[PMRpro Ambassador in reply to HeronNS]

There is a difference between an intraarticular injection and a subacromial one though - it is usually the intraarticular ones that cause problems.

[HeronNS in reply to PMRpro]

I have read that they now limit the number of cortisone shots you can safely have. I didn't know there were two kinds. no one ever offered me one when I was having so much knee trouble, so hadn't done detailed reading - just enough to know I'd turn it down if suggested! Of course my doctor at the time was doctor, "I'm not worried about that"!

[Bcol in reply to HeronNS]

Morning, back in the 80's when I was having the shots in my knees I was told that three was the maximum they could give.

[PMRpro Ambassador in reply to HeronNS]

As Bcol says - it has been 3, max 4, per year for decades in the UK at least. Mind you - still a lot of doctors who don't know the difference and that was the problem tangocharlie had with i.m. injections for management of PMR as her doctor wouldn't allow them monthly. i.m. or other soft tissue injections are a different matter, especially if well away from a tendon/ligament

[slopers in reply to PMRpro]

I also didn't realize there were two kinds of cortisone shots. I'm headed in today for an appointment with a specialist shoulder ortho and am curious to see what he recommends. Thanks

[HappyDiamonds]

Hi, I have had exactly the same thing and can honestly say its been blooming miserable (polite version) especially as it was my right arm. I have had physio and ultrasound, was given 3 simple exercises which did help. I still can't put my arm behind my back to do up my bra although I can now raise it and do my hair. I swore by Voltarol, the 2.3 one and I watched Bob and Brad on Youtube. My biceps were really painful and B & B recommended finding the bits that hurt most and massaging for a minute or two several times a day. I though what a load of tosh but surprisingly it helped. Its almost like a pleasurable pain when you massage 😀. Hope you get shot of it soon.

[slopers]

Ha! I did see the Bob and Brad video but could not get my arm behind my back to do the massage. Hopefully with the PT I'll get to that point and be able to massage it and see if it works for me as well. They have quite the following! I'll keep you posted.

[pegpowell]

I had the shot early on during PMR and that solved the problem. Highly recommended.

[AyJayBass]

I had a Cortisone shot in my left shoulder a few years back (pre-PMR) and it did the trick, it took a couple of weeks for the pain to abate completely. The tendonitis has not returned.

[slopers in reply to AyJayBass]

Thanks for sharing. I went to the specialist yesterday and we're going to try PT a couple of times without a shot and see how it goes. It's really painful with terrible range of motion so hoping to see some improvement soon. Either way they didn't seem too concerned about having the cortisone while tapering down on the pred.