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  • Steroids

    In 2008, I had a series of steroid shots in my left knee to postpone knee replacement until after the Olympic trials. They enabled me to walk but I don't recall they relieved the pain much.
    During our recent February ice storm, I slipped on the steps from my kitchen door to the patio, landing on my butt on the patio and right shoulder on the top step. Hurt like hell. I was holding the storm door latch in my right hand and apparently yanked something out of place. For several days, I had virtually no range of motion in my right arm. X-rays do not show anything broken, just arthritis and "tilted cartiledge", whatever that is. I have had a torn rotator cuff in my right shoulder for 65 years. It affects throwing but was I advised at the time that if my livelihood did not depend on throwing a baseball or football, live with it. And, I have.
    My range of motion improved but I had a constant ache, only slightly relieved by Ibuprofen with no lifting or pushing strength in my right arm. Last Friday, my diabetes doc gave me a steroid treatment in my right shoulder, alternating three steroid and "pain" shots. Almost instantaneous relief. I was able to wave and rotate my arm without pain. I think it is wearing off a little but the ache is duller.
    Is that the way steroids work?

  • #2
    Originally posted by lonewolf View Post
    Last Friday, my diabetes doc gave me a steroid treatment in my right shoulder, alternating three steroid and "pain" shots. Almost instantaneous relief. I was able to wave and rotate my arm without pain. I think it is wearing off a little but the ache is duller. Is that the way steroids work?
    I'm pretty sure that was just the pain shots. Steroids take much longer to repair the damage.

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    • #3
      Originally posted by Atticus View Post
      I'm pretty sure that was just the pain shots. Steroids take much longer to repair the damage.
      That's not quite correct. We routinely give corticosteroid shots in the shoulder with a local anaesthetic "chaser" (usually bupivacaine / Marcaine), which I assume is the pain shot lonewolf is referring to. That works fairly rapidly. I also combined it with Lidocaine (xylocaine), which is almost instantaneous pain blockage. Patients loved it and had a reaction like lonewolf. The corticosteroid effect usually kicks in at about 48-72 hours (not quite "much longer" as Atticus said) so I used to tell patients the worst day may be tomorrow, but many times the pain relief from the injection lasted long enough for the steroid to kick in and help.

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      • #4
        Thanks, guys. Three days in, the constant dull ache is now tolerable, with some improvement in range of motion, still reduced lifting strength, like a gallon of milk, cannot push up out of a chair with right arm. This is going to seriously affect my decathlon score.

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        • #5
          Originally posted by bambam1729 View Post
          The corticosteroid effect usually kicks in at about 48-72 hours
          But doesn't cortico- stand for cortisone, which itself is a pain killer?

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          • #6
            IMG_20210504_165519.jpg
            I decided to take my sympathy for you Lonewolf that extra step by walking into the corner of a low table at a restaurant. Chipped the right patella and made a bit of mess out of the surrounding sift tissue.

            Oh well, I guess no more trying to perfect my hopeless hammer turns for a few days.

            ​​​​

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            • #7
              Originally posted by Tuariki View Post
              HEY, I'm tryna eat here!!

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              • #8
                I get the Dex steroid twice a month because research shows they make my Multiple Myeloma drugs more effective. It does eliminate my usual aches and pains for up to 36 hours, but leaves me wired often messing up my sleep two nights, and plays havoc with my blood sugar making me diabetic. At least since my competition days are long over, I am not violating any rules.

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                • #9
                  Originally posted by Atticus View Post
                  But doesn't cortico- stand for cortisone, which itself is a pain killer?
                  Cortisone is one of my many different corticosteroids - dexamethasone, triamcinolone, predinsone being others commonly used. They are not pain killers as that term is usually reserved for narcotics (opioids). The exact mechanism of action of corticosteroids on musculoskeletal problems is poorly understood but basically they work as anti-inflammatory drugs - the most powerful we have. Things like Motrin, Advil, Celebrex, Voltaren are in a class of drugs we call NSAIDs = non-steroidal anti-inflammatory drugs, as opposed to corticosteroids, which are steroidal anti-inflammatory drugs.

                  The other things I mentioned - Xylocaine, Lidocaine, Marcaine, Bupivacaine, Ropivacaine, Novacaine (which is almost never used anymore) - are local anaesthetics. They block pain but are not usually called pain killers.

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                  • #10
                    Originally posted by Halfmiler2 View Post
                    I get the Dex steroid twice a month because research shows they make my Multiple Myeloma drugs more effective. It does eliminate my usual aches and pains for up to 36 hours, but leaves me wired often messing up my sleep two nights, and plays havoc with my blood sugar making me diabetic. At least since my competition days are long over, I am not violating any rules.
                    The complications of corticosteroids are myriad. They definitely keep you awake. Two years I had a terrible clogged ear that would no go away after a cold/flu for a week or two. I went to an ENT who prescribed a short dose of Prednisone. We were about to drive to New Hampshire for the summer which is a 20-hour drive. Did it in one day - I drove the whole way and then stayed awake the entire night.

                    Steroids also can be dangerous in diabetics, raising the blood glucose levels to dangerous heights if not carefully monitoried.

                    There are a bunch of other well-known steroid complications - mostly from prolonged use, but for short-term use they can be very effective for relieving inflammation and the pain from it

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                    • #11
                      My turn? Intermittent inguinal pain, both sides, the last few years, slowly getting more prominent. I and one PT thinking it was hip flexors from 2000 miles/yr of biking the last 13 years. Finally saw an orthopedist and had X-rays....moderate to severe arthritis on the L and mild to moderate on the R. Corticosteroid injection on the left three weeks ago has settled that side down a good bit. I’ll get one on the right. I was only running about 20 miles a month the last few years but that was really aggravating it. Probably ran three times in February, three times in March, not in April and it’s not bothering me nearly as much. But expecting hip replacements in the next 3 to 5 years.Too many miles running, then climbing, skiing, biking. Plus, I also have a cam-type femoral head, which bambam certainly would understand more about, which apparently predisposes to some arthritis. Funny, I’ve been to the NCAA cross country meet in Louisville the three times they’ve had it there and caught up with some old high school running buddies. Last time I believe was 2017. We all stood around tailgating before the meet, everyone comparing orthopedic ailments, age range 54 to 58.

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                      • #12
                        And just a teaching point from Jay's post - many times people will come in with "hip pain" and think they have arthritis. Hip arthritis pain hurts in the groin or inguinal area, as Jay described, and does not usually cause pain on the outside of your hip. Pain on the outside or backside of your hip is usually from either hip bursitis (technically greater trochanteric bursitis) or something in your lower back. Lumbar disc pain frequently presents as pain in the buttocks area or hip area

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                        • #13
                          Originally posted by bambam1729 View Post
                          The exact mechanism of action of corticosteroids on musculoskeletal problems is poorly understood but basically they work as anti-inflammatory drugs - the most powerful we have.
                          Things I learned today.

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                          • #14
                            I hope there's not a quiz at the conclusion of today's class.

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                            • #15
                              Originally posted by NotDutra5 View Post
                              I hope there's not a quiz at the conclusion of today's class.
                              Usually, when the math or med guys splain something, I get MORE confused, but I did understand that.

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