I do not know everything so I am looking for some input from hopefully an expert- Medical Doctor well versed in giving steroid injections.

I have had pain in my left shoulder area for about 12 years after a slip and fall on ice in which I landed on my back. I braced the fall some with my left elbow which jammed my shoulder somewhat.

I have also had pain in my right hip/rump area for 19 years. I do not recall any specific injury but I was doing a lot of scouting and bear hunting in the mountains that spring. I am 55 years old now.

I had surgery on my left shoulder late June of this year. The MRI before the surgery revealed a torn rotator cuff, damaged biceps tendon and arthritis in my collar bone area so the surgeon fixed those 3 things. The area of pain that sent me to seek help had no obvious surgical fix, no damage in that area was indicated by the MRI.

I have had a lot of physical therapy this year for the shoulder and hip area and none of that has seemed to help the unresolved pain in those areas but it has of course helped me to recover from the shoulder surgery.

So 6 months after the surgery I was still having pain in that same area (basically where the Teres Minor muscle attaches to the humerus). Maybe a bit higher where the Infraspinatus attaches? I met with the surgeon and he suggested a steroid injection into that area as well as in my Piriformis. I told him that it has been a bit difficult to get the therapists to find the sore areas as they are kind of deep and that it requires digging in their with a thumb or elbow to really find the sweet spot. He said that I should share that with the other doctor in their practice who would be doing the injections at a later date.

So I went to get the shoulder injection and just before the doctor injected me he was pushing on my shoulder area to identify the location of the Teres Minor and I told him that I was not sure that he was actually on the really painful spot yet. He said that he did not care where I hurt most, he was just going to inject the spot that the shoulder surgeon told him to. What could I do but hope for the best? Hope that they both knew what they were doing? Well it did seem to help for about a week but the pain is coming back in that same area. I can't help but wonder if he had taken the time to inject the sweet spot it might have been more effective.

A week later (Monday of this week) the same doctor (not the shoulder surgeon but the injection doctor) injected my right Piriformis muscle. Again as he was starting I mentioned that he was setting up to inject an area that was removed from the most painful area and asked if the steroid would migrate through the whole muscle. He said yes. Still I can't help but wonder if it would be more effective to inject the sweet spot. The injection sight is 3" removed from the worst spot. So it is closer to the crack of my butt than where the muscle attaches to the leg bone.

I think the pain in my rump is less but it still hurts. Maybe it will improve? Anyway I wonder if this is standard practice for doctors to not care so much about injecting the exact worst area of pain. Does the steroid truly migrate adequately throughout the entire muscle so that it does not matter?

I have tried some dry needling in the shoulder and rump area this year as well as the physical therapy and that did not seem to help.

I am really frustrated. My sleep is negatively affected. I have had 75 therapy visits this year between my shoulder, hip/rump and thumb surgery repairs and still hurt in all areas. God help me!!!

Those steroid injections have effects, you're sure to have a Kim Kardashian azz and great breasts soon.

I have scar tissue and bone growth where he would normally inject.

So after talking about it with him i had it done.

The medicine took a few days it seems but it did make it bearable.

Sometimes it just takes some windage to get there.

Sometimes its the only way to get the swelling down so things can heal.

Give the shoulder time, it's only been 6 months.

My dad had his shoulder worked on almost 4 years ago, took almost a year for him to feel 100% pain free.

I’m curious how you knew it was the Teres Minor vs Infraspinatus.

DF

There’s that ole piriformis muscle mentioned.

My wife got about 6 months of repeated injections from some specialty chiropractor with a nurse practitioner.

Sometimes weekly.

Didn’t do a damn thing for her, she went to an MD, rheumatoid specialist, ruled it sciatica. Pretty much just sucked it up and walked it off after about a year.

As for the back I have 3 bulged discs. Most of my pain was in my left cheek, way down in there and felt like a hot coal, some numbness towards my left knee.

Doctor injected me right in the top of my crack, went back 6 months later and have been pain free for right around 7 years.

Supposedly my issue was a tensed up muscle pushing against the sciatic nerve. once the steroid took effect the muscle could relax and the pain was gone.

Have done the injections and my understanding is they need to be exact area at least speaking to an injection specialist.


Ive had a lot injuries and surgeries over the years so lots of aches and pains.Restricting carbs, some intermittent fasting has seemed to help with aches and pains ( less inflammation) and sleep better.

Daily stretching and exercises for shoulders, hips, lower back helps too. I take turmeric, boswelia, joint supplement too every day and of course moving every day. sucks getting older

18 months ago, I woke up one morning while on a camping trip and my right shoulder hurt like crazy. Whatever it was didn't go away. I finally went to a Dr. and they took x-rays and found nothing. He though it must be some kind of strain in the rotator cuff so he sent me to physical therapy. That accomplished nothing and I figured I'd just have to live with it. It wasn't nearly bad enough for surgery.
I work with our church's Trail Life troop. This summer we got the boys into archery. I hadn't shot my bow in years but I got it out of storage and figured I'd shoot until my shoulder couldn't stand it then quit. It turned out that the shooting (right handed) was exactly the physical therapy my right shoulder needed. I'd go out and shoot maybe 10 arrows several times a day. After a month, my shoulder felt better than it had for a year. I have almost nothing at all in it now.

I’ve had 5 injections in my back. Like some have stated it was a short term fix. I still hurt daily but have stayed off opioids, just take Aleve and Tylenol as needed which is 4 to 5 times a week. Someone mentioned turmeric, I’ve heard that before and am going to try it.

Dirt Farmer, none of us seem to really know. By pushing in the area and looking at anatomy the pain is in the teres minor or infraspinatus area. The therapist that was doing the dry needling thought it was the infraspinatus because of where she had the needle positioned when I told her she had hit the sweet spot.

I do not have any pain or numbness down my leg so it does not appear that my sciatic nerve is impinged. I had a low back MRI recently (before the injection) and I have some minor bulging but the doctor didn't think it was causing my piriformis pain.

I'm no expert. But I've had injections in the shoulder and ankle, and problems on and off with the hip that I've worked with a physical therapist on..

First, if you have a chronic condition like arthtritis, steroid injections only give temporary relief. It might be dofferent with soft tissue injuries. My doctor told me the maximum pain relief is about two weeks after the injection, then it gradually wears off which is about what I found.

Second, as far as the location for the injection vs. where the pain is, my understanding os that the two don't always coincide. For my ankle, my doctor told me that regarlesss of where the pain was, there was an ideal spot to place the injection so that it got into the center of the joint and I'd get the most benefit if it was injected into the center of the joint.

For my shoulder I had a torn supraspinatus and biceps tendon. The biceps tendon caused the most pain but the pain that I felt wasn't located in exactly the same spot as the damage, it's called "referred pain." I got two injections in the shoulder, same with the ankle they weren't placed where the pain was but where it was easiest to get the needle into the center of the joint. I had rotator cuff surgery, and they released the biceps tendon, I'm pain free on that side now. For the ankle, I had fusion surgery, pretty much pain freee there too.

For my hip and lower back, every now and then one or the other will get sore. I had a hip specialist look at it, he did an x-ray and saw that the hip bones were a little mis-aligned. So he had me work with a therapist to stretch some muscles including the piriformis, and do exercises to strengthen other hip muslces to bring the hip back into alignment. Seems to be working.

It’s a long acting steroid that is used. You do not need to inject exactly at the most painful sight, just be close as it will spread out and effect the whole region. So that shouldn’t matter much

Remember steroids are to reduce inflammation. Inflammation causes pain. Steroids can resolve pain completely, but most likely won’t.

piriformis syndrome and sciatica are btw caused by same root problem. MRI lumbar spine and pelvis would help to differentiate sciatic nerve impingement from other possible issues.

If not resolving physiatrist could do blocks and more precise injections to try to minimize pain. Keep doing PT

I would stay away from steroid injections.The negative effects can far outweigh any positive outcomes.My brother got severe osteoporosis from steroid injections for arthritis pain and was a major factor in his death.

Piriformis problems are a function of sacroiliac dysfunction. A master physical therapist is my choice. Physical medicine specialists can help.

Sciatica and Piriformis synd affect the same sciatic nerve but for different reasons and at different sites. You can have both, but generally one is the main pain generator. Finding which is the main actor is important. Treatment is different.

DF

this exercise has helped a lot with lower back, hip pain

https://youtu.be/DWmGArQBtFI

I’ve had steroid injections in the shoulders, spine, and hip. At the time, the prevailing shoulder issue was tendonitis, and injections really helped.

In the spine, the pain cause was an “impressive” [medical term that proves Docs are steeped in hubris] bulging disc + Osteoarthritis. Shots hurt like a bitch and did little good. Decompression surgery hurt very little and worked wonderfully.

In the hip, shots hurt like a bitch and did no good. Cause of pain is osteoarthritis. New hip scheduled for January.

My take is that if shots get you over an inflammation issue and the joint is sound, they are a net gain. Otherwise, they buy a little time at best, and come with their own downside.

Hope your recovery is complete.

Talus, best of luck on your new hip!

Zilreta, time release. Came out in 2017 for knees. However, it works for other applications as well. One injection, need to take it easy for 24hrs so it can establish itself in your muscles. Great stuff, not cheap. $2200 a shot but you only need one.

I have arthritis all thru my body. About every major joint,hands ,neck and up and down the spine, and plantar faciitus in my feet. Two spinal surgeries, one replaced shoulder and many steroid injections, plus chemical and electric de-nervation of nerves in my lower back.I have come to the conclusion that these damn doctors only guess at what they think will work.They will do a ct scan and MRI and only look at one thing.

As stated the steroid injections to arthritic joints only last about three weeks and it needs to be right in the area of inflammation. It does travel thru out the body, but with limited help.

Since elk season my right knee has been swollen ans sore.Steroid injection between ML season and rifle season but it wore off in three weeks

To get thru it I have been using Sombra Cool Therapy cream mixed with CBD oil twice a day

Meloxicam is a great NSAID. Went from a dozen ADVILs a day to 1 Meloxicam.

I have used Meloxicam for years.

Vince, have you tried Voltaren gel? Works pretty good, the generic is called diclofenac. I used a lot of it on my ankle and have a metric ton left over.

Good video.

DF

They took that off the market here.I tried it but didn't have much success.They took the oral capsules off the market before the gel.

friend of mine swears by the cbd oil, you really think it's helpful?

[quote=RoninPhx
friend of mine swears by the cbd oil, you really think it's helpful?[/quote]

Don't want to hijack this thread but,

Yes, I do. BUT you have to be very careful of what product you buy and how much it has in it.Some brands sold have none in it.

I use CBD oil on my knee mixed with Sombra ( Try that You can buy on Amazon, Miracle stuff) and a CBD cream every night before I go to bed on my hands. It doesn't cut the pain 100% but sure takes the edge off. Also helps me sleep. When my back acts up, I use it there also. It definitely helps that.

In the morning I also stick my hands in a paraffin bath. These can be bought at Bed Bath and Beyond for about $30. It is an electric heated plastic pot that the paraffin melts in.You dip you hands in it about 6 times and let it on until it cools.Helps get rid of that stiff feeling when it feels like your hands are encased in green rawhide that cured.

Might try some Turmeric/Circumin.
Get the capsules that have 1200mg/100mg of both.
The brand we use is made by Vimerson Health and costs about 21 bucks off Amazon.

I have arthritis bad in my hands and had to quit working on guns and other small stuff.

My regular doc when asked told me to ask the pain specialist when i saw him a day later.

I showed my newest medical charts after having my gut redone and he wrote it down.

It took 2 days for the swelling to go down and in 4 days i was able to work on small stuff again.

The wife works sitting most times but when she has to get up and help folks she had to stand for a minute before her knees to work right and not hurt.

The instructions say to take 2 but after being re done i just take 1 and it has worked for about a year.

It won't make you have the runs or drive you the other way.
Just take them when you eat lunch.

I don't own a part of this company and had never heard ot this stuff till that day.
Give it a try.

I am family friends with my doc. He has gave me a bunch of injections in my shoulder so i can keep working. last time he told me its time to get it fixed. Winter this year cause he wasnt doing it anymore.

The Docs only do this stuff for a living. what the hell do they know?

There are reasons for particular injection sites. Perhaps they want to avoid a nerve. Stick a needle in one and you will wish they chose another location and they do extensively study such things. Or perhaps a vein that should be avoided. A muscle is usually the best place in that they usually have a decent blood supply which allows the drug to circulate quickly. 3 inches from the spot of pain is center punch.

I had (have) similar pain in my right shoulder. My Dr, first said it was just from working hard, then he said I needed meds, then he said I needed PT, then he said I needed more meds, then he said I should find another line of work, then he said I needed injections in my shoulder.

At the time my wife was the manager of the Neurological dept and one of the local hospitals. She got me an appointment with the Dr she trusted the most.

Turns out that there was nothing wrong with my shoulder and all this pain through all these years was(is) caused by stenosis and arthritis in my Cervical spine. Now I take injections for my shoulder pain in my cervical spine, works wonders.

You might want to get a second opinion on those bulged disks as well. If I was a betting man I would bet that your Dr is mistaken and your back problems are indeed the cause of your butt pain.

I thought I had a torn rotor cuff, and a really good doctor gave me steroid shots. It felt worse for a few days, the cleared up like magic. That was over a year ago and everything healed up. I thought it was amazing.

They dont hurt that bad , but feel really strange going in .

My doc says 3 per calander year total dont matter if its is back and neck.
3 total.

I thought I would provide an update. I had another doctor within the same group inject my hamstring muscle where it attaches to the Ischial Tuberosity area of the pelvis. Additionally I started seeing a different chiropractor. That chiropractor took X-rays of my full spine and pelvis. It turns out I have scoliosis and my spine is twisted to some extent and my pelvis is tipped such that the right side is lower than the left side. The chiropractor recommended that I get a heel lift (a wedge to put under my heel) to try to even out the tilted pelvis. I am starting with 1/8" lift and my work up to a 1/4".

The steroid shot in my hamstring has definitely helped. I am hoping that the heel lift will also help.

PM Sent

My training was specialized to the spine but also included muscle “trigger point” injections. For the latter, you injected the exact location of the pain after localizing it by palpation. At face value there is no good reason I can think of right offhand to inject just within inches of the inflammatory locus unless there was an infection is the same area. In which case one wouldn’t inject at all.

Besides the steroid (mixed together usually) would also inject a long acting local anesthetic like Marcaine to give instant relief to maybe bridge the time it took the steroid to kick in which could be a couple days.

Like in all human endeavors not all “pain guys” are equal in training or ability.

As far as the spine being the source of pain, numbness, or tingling (radiculopathies), the most common source is the lumbar spine and it’s exiting nerve roots L1, L2, L3, L4, L5, which mostly form the femoral nerve (front) and the sciatic nerve (back) and can cause pain, numbness, or paresthesias (tingling) etc from the seat of your pants to your toes. The sacral nerve roots can be involved also.

Second, statically, is problems from the shoulder to the hands which can (not necessarily) emanate from the Cervical spine nerve roots, C1-C7.

Most radiculopathies, other than from trauma, originating from the lumbar and cervical spines are caused at least to some extent by bulging or herniated disks impinging on the nerve roots or even just crowding them. Of course trauma can bulge a disk out also. In older folks with just normal “wear and tear” we often see DDD (age-related degenerative disk disease) wherein the disk have just flattened out causing crowding of nerve roots.

Your middle, the thoracic spine is not often the source these kinds of problems with the exception and unrelated problem of shingles wherein the result is the painful rash usually hemi-laterally around the side of the rib cage.

You never mentioned which steroid. I am assuming ti is cortisone. If so, every time it is injected (to reduce swelling and increase blood flow for repair) it does damage. The site will be damaged due to the shot. They forget to tell you that. Look it up.


COrtisone shots are over prescribed and should be mainly for someone training who has to 'get in the game' or temp relief for someon who will be getting surgery at a later date.

Its a stop gap, and as many have posted, not a particularly great one.

Best of luck with the rest of your medical advice from the 'fire.

Probably..My doctor did the same thing and did not give the shot until he new where the pain was,then he put the needle into that spot and everything has been great, since November...No pain hardly at all every since..I do have to be careful because the lack of pain is having me use that shoulder more than I should be..Man,I truly recommend those shots..He wanted me to do therapy and I said NO and I have been great every since the shot..

^

Care to share your training and practice?

Care to share your training and practice?

“Best of luck with your medical advice from the fire.” Including yours? The irony....

George- I caught that as well about his sneering comment regarding medical advice and then offering his. Rather funny. People can have experience in this area to offer. I obviously need to weigh that information myself.

Good luck!

Well I have had a few steroid injections in various locations and they all fixed me right up. These were generally for injuries and not conditions.

The one thing I will point out is when my hands hurt and my wrists and hands would go numb, the doctor immediately went to my shoulder. I told him it didn't hurt up there it hurt down there. He knew what he was doing. I had a similar episode where I had pain between my bicep and tricep. Again the doctor went up into my shoulder area. Again he was right. Another time I had severe pain under my right shoulder blade. The doctor went to my neck. Again he was right; I fell down on my back but basically had a whiplash from the fall.

In short when you go to medical school and get a license to practice medicine, take your own advice. There are quacks out there for sure, but they are in the extreme minority. You do know what they call the guy who graduates at the bottom of his class in medical school? Doctor. They all aren't the best. Choose a doctor with a good reputation and trust him.

My doctor didn't forget to tell me that. But if that's something that most doctors "forget to tell you," then asking opinions of those who've had injections would be a smart thing to do, wouldn't you agree?

Mine either!..But the point here should be, the injured person should do his own research prior to agreeing to anything..I saw two doctors for the same tear..One wanted surgery immediately without offering alternatives or a standard xray while the other ordered a standard xray prior to my visit and offered alternatives to surgery..I took the second option with a steroid shot and am glad I did.

Asking an orthopedic surgeon if you need surgery is about like asking a barber if you need a haircut.......

True that. They do like to cut on people.