Index Home About Blog
Subject: Re: Shoulder Rotator Cuff problem
From: (Jay Mann)
Date: Jun 16 1997


: Can anyone give me some advice on what to do about this problem.
: I went to a Orthopedic M.D. and he said the pain in my shoulder
: was caused by inflammation in my right shoulder rotator cuff. It
: does not hurt all the time, it hurts worst when I try to reach 
: behind my back or try to swing a golf club. I can work it and 
: it seems to improve but the next day it's back to square one.
: Has anyone had experience with relieving this type of problem?
: Thanks.

I went to a physician who injected a mixture of xylocaine and cortisone 
directly into the inflamed area.  The local anesthetic stopped the 
immediate pain of cortisone, and the fact that my shoulder felt better 
instantly confirmed that the injection had reached the correct spot. 

The first time I had this treatment I felt so good I went back to the gym 
and resumed full-length pressups.  When the problem returned, I went back 
for a second injection.  This time I was a lot more cautious, and the 
problem has never returned even though I do pressups again.

There is some kind of limit to how many cortisone injections you can have 
a year, but I only needed two.  Without this relief, the swollen tissue 
was constantly being re-irritated every time I lifted my arm.   The 
physician said that without treatment it might take two years for the 
problem to resolve, instead of a month or so with cortisone.  (I didn't 
have or need any physiotherapy, by the way.)

Don't even think about taking cortisone pills instead of getting a 
localized injection.  Why would you want to fill your whole body with 
a potent hormone when only one area is in need of it.  

Jay D Mann  <>
Christchurch, New Zealand

From: (Steven B. Harris )
Subject: Re: adrenal insufficiency
Date: 20 Sep 1995

In <43l2kh$> (Matthew)

>Damien Barkan ( wrote:
>: I'm confused--it seems like there's a paradox here: if one were given
>: cortisone because their cortisone tested low--presumably because of
>: primary adrenocortical insufficiency--it sounds like this could cause
>: secondary adrenal insufficiency!
>By golly, you're right! So, let's say someone had primary adrenal
>insufficiency that resulted from an auto-immune disease which was
>destroying the adrenal glands. Then we might give cortisone to counteract
>the auto-immune disease process. But the cortisone we gave would cause
>the pituitary to stop producing ACTH. So the adrenal glands (which now
>were not being destroyed by the auto-immune process) would not be
>producing cortisone. Then, if we stopped the cortisone, the auto-immune
>process would resume. I'm not a rheumatologist or an endocrinologist, but
>I would suspect that we would probably give the cortisone anyway, since
>the adrenal glands also produce other hormones (most notably
>aldosterone). And aldosterone is important. But since we'd have to keep
>on giving cortisone, the patient's adrenals would never be able to
>produce their own cortisone. On the other hand, we might just give some
>exogenous equivalent of aldosterone, I guess. I really don't know.
>The point you bring up is an example of the complexity of medicine. It's
>just the sort of thing you'd find a room full of doctors discussing on
>rounds on any given day in a teaching hospital.

   Cortisone in large enough doses to stop autoimmune processes does
lead to pituitary insufficiency.  But cortisone given at replacement
doses (30 mg a day = 5 mg prednisone) doesn't.  So it depends on what
you're treating.  With Addison's, most endocrinologists just give
replacement doses (when the patient is not under stress) and let the
gland be destroyed if necessary.  You can always replace aldosterone
with fluorinef (one more pill a day).

                                           Steve Harris, M.D.

Index Home About Blog