Rheumatoid Arthritis and treating shoulder pain – corticosteroid injection

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shoulder-anatomyAnother day, another steroid shot…

Actually, that’s not really accurate.  I haven’t had a steroid shot in a year.  This time last year I had a whole bunch of them, shoulder, hips, SI joint, even my jaw.  Now I’ m wondering why I didn’t ask for one sooner.

Magic.

90% of the pain gone.  Instantly.  Now, I know from previous experience that this relief might not last long.  But it might last for months.  Right now it is bliss!

This procedure is done under ultrasound.  First the radiologist visualises the tendons, bursa and synovium and assesses whether there is active inflammation that a steroid injection will tame.

Corticosteroids are powerful anti-inflammatories, and injected directly into the joint, they can bring instant and lasting relief.  Sometimes the effects take a few days to fully be felt.

Some people are afraid of the needle…getting a needle into a joint doesn’t sound like fun.  But I’ve had several.  And trust me, the sting of the needle is nothing compared to the pain of the inflammation!

Additionally, when you have a corticosteroid injection directly into the joint, you are treating the cause of the problem – the inflammation.  The pain is decreased as a side effect of reducing the inflammation.  So you are treating the problem directly, not just treating the pain.

It’s a simple, quick procedure (in the hands of a trained radiologist) with few side effects.

This most serious is the risk of infection.  The stats I found put this at about 1:20,000.  Not something I’m going to lose sleep over.

Rarely, the cortisone injection causes a flare, where the joint becomes more painful for a day or two.  This usually doesn’t last long, and the pain can be reduced by icing the joint.

Most physicians will limit cortisone shots to 3 or 4 per joint.  Reading through the available literature, this attitude is starting to change, because there is no evidence that repeated injections degrade the joint, as had been previously thought.  Animal studies have shown a weakening of tendons, and cartilage after repeated cortisone shots, however.  For this reason, caution is still used, and most doctors prefer to limit treatment.

My cortisone shot was in my right shoulder.  It has been very painful for about three years now.  Three years ago I had an MRI that showed bursitis.  I rested it.  That obviously didn’t help, because my oral treatments were not controlling my systemic inflammation. They still are not.

So I just pushed through the pain, safe in the knowledge that I am not actually doing any further damage. It just hurts.  Quite a lot some days.

A year ago I got a shot into this joint.  It helped for a few weeks.  Then gradually the pain returned.

Pain is a funny thing.  Like anything, if it slowly increases, you don’t notice so much.  You just adjust.  It’s like weight gain…if you’re gaining a few grams every week you really don’t notice.  Suddenly at the end of the year, you’re 20 kilos overweight, and you didn’t really see it happening.

Pain is the same.  It gets worse and worse, but you just tolerate it, and tolerate it, and get used to it.

Until it is gone.  Then you wonder why you put up with it for so long!

This time my radiological findings are much worse.  Both the bursa and the synovium were inflamed, but the radiologist felt that the AC (acromioclavicular) joint was the main source of pain.  (This is where the clavicle (shoulder blade) joins with the clavicle (collar bone).  The surrounding tendons also showed inflammation, particularly the supraspinatus tendon (the tendon that joins the main shoulder muscle to the humerus). From my symptoms he decided to inject the AC joint this time, whereas last time I had the bursa injected.  So far I am feeling more relief this time.

So in summary, bursitis, tendonitis, synovitis…every kind of ‘itis’ of the shoulder.  And some erosions.  Typical RA findings.

That double edged sword again – good because after all my years of denial, it’s clear that I do have RA, and taking heavy duty, scary drugs is my only option.

Bad because, well, I DO have RA!

But for now, I am having a little period of bliss.  And thinking about calling up my doctor to see if I can have a cortisone shot in each hip!  And my SI joint….and my knees…and my…

3 COMMENTS

  1. I hope you get really good lasting relief from this shot. I’ve had several over the years, in my hips, knees and shoulders. My rheumy once offered me a shot in each finger, I chickened out of that one but the others I have to say aren’t awful to have done. I don’t mind needles personally and like you would rather have the relief for a few moments discomfort. I’m having my 3 year old nephew for my sister this weekend, all weekend, might need a shot or two afterwards myself!! I will have help luckily 😉

  2. It’s great that it offers you at least some relief. I have had them in my hands, knees and feet, unfortunately they never work for me. The ones I have had through the top of my foot were almost unbearable. If I was able to get relief from having them I would definitely go through it again.

  3. From last couple of month I am really facing a great problem with my shoulder . It’s badly hampered my daily activities. I am already getting some suggestions from my doctor. He suggest me for daily exercise myself. I am already follow his every suggestion and it’s really help me to get rid off from this pain. Now my life became so comfortable than earlier.

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