Fifty Plus (50+) - Tennis elbow update: Cortisone shot (??)

Since I have shown NO improvement in my tennis elbow after several weeks of PT in spite of following doctor's orders, my physiotherapist said it's time for a cortisone shot. I have been trying to avoid that by extending my PT, but to no avail. :( I'll discuss this and other options at my appointment on Friday.

Anyhoo... I'm wondering if my elbow will be in good shape to drive home after getting a shot in the joint.:eek: My car has a manual transmission. :rolleyes:

My shoulder (rotator cuff problem) also has not improved one iota -- zip, zilch, nada. He'll address that when the elbow heals, possibly also with a cortisone shot.

4 months now off the bike... I'm learning to enjoy walking again, but it's just not the same.:(

I'd be bonkers with 4 bike-less months. Good luck with the appt. You could call the office and ask for an opinion about driving home after the injection - the staff has likely seen many folks post-injection. I would guess you will be ok driving and shifting.

I had a cortisone shot in my right elbow last summer. Had no trouble driving my manual car home. Felt good enough to start a bike ride when I got home but began to feel some discomfort after a few miles and turned back. Felt great the next day. My tendinitis calmed down for a while but is back some now, not as bad. Quite manageable with some ice and occasional Advil. Given what you shared about your PT and time off, it sounds like your situation is more serious. Good luck.
Larry

We need to get you back on the bike somehow. I have first hand experience of being off for a bit and it ain't a good thing..............

I had tennis elbow for about 2 years, had several cortisone shots (painful as hell), they helped for awhile but it always flared back up. I got very frustrated since nothing worked. I tried PT but that didn't help. I ended up just totally stopping anything that put stress on the elbow until all signs of pain were gone, then I slowly (very slowly) worked strength back. Now I no longer have problems but I avoid any undo stress in that arm. No flare ups in the last 5 years but I am still sensitive to any signs of flare ups and back off whenever anything remotely feels like it will irritate the elbow

If the cortisone doesn't work, look into this: http://www.platelettherapy.com/indication.html
According to the doc was seeing for my tendonitis, this is the next big thing.

If it helps ease your mind at all, for "tennis elbow" nothing is injected into the joint. The target is the spot where the tendons attach to the lateral epicondyle. Next, if the shot is "painful as hell", it was not performed correctly. Typically, lidocaine is mixed with the corticosteroid and should provide some immediate relief to indicate your doctor hit the "right spot". You should be able to drive. Its funny, when folks get tennis elbow the first time, they avoid the shot like the plague. After they do rest, ice, rest, PT and more rest, when that doesn't work and a PROPERLY administered injection fixes the problem, the next time it happens, they show up and say "Just give me the shot". You have to have someone that does it a lot and it is critical to follow the instructions after the shot. Ask lots of questions before hand.
Good Luck and I hope you are back in the saddle soon.
Ride Safe
Check6

And we need to get you back gardening/shoveling........

Thanks, everyone. My PT gave me my "report card" to give to my doctor tomorrow. I joked that it should say "Hopeless Case" with a grade of F-. :o

JanMM - I've asked a few people and they say the shot is the worst part and then it's either better, not better, after about 15 minutes.

jppe - if you learn of something that's guaranteed to work 100% of the time in 100% of patients, let me know :)

cyclinfool - 2 years?!:eek::eek::eek: How long did it take the pain to subside so you could start working on strength?

Check6 - I won't know if my doc gives the proper injection until I'm there and he's ready to do it. He's a very reputable sports doc who considers surgery the last resort and specializes in the treatment of shoulder and elbow problems. I'll be sure to ask a lot of questions (as usual).

Shimagnolo - thanks, I'll ask him about that.

- if you learn of something that's guaranteed to work 100% of the time in 100% of patients, let me know :)

I don't think such a thing exists :( In my experience with setbacks, what works for me is:
(1) doing your homework, (2) following good advice from good doctors, (3) having some good luck and (4) steadfast, dogged determination to get better.

Cortisone shot should cause you no problem. You just can't do any heavy lifting where you put pressure on the joint. Continue with your PT, primarily doing stretches and ice your elbow (and your shoulder) for 20 minutes on and at least 40 minutes off. This is a good time to get caught up on all your reading of the bicycle magazines that are piling up in the corner! If you don't have one, get a tennis elbow strap too, it will help take off some of the pressure. I've had tennis elbow in both elbows a number of times, and the cortisone shot has done wonders. But once the swelling and pain goes away you need to do some strengthening as tennis elbow (lateral epicondylitis) is caused by a muscle weakness.

actually, for a cortizone shot to be effective, it should hurt like, well, heck. it is true that there is a little lidocaine in there or it would be unbearable. two things are going to make it hurt: first, the target area is inflamed, so when that needle gets to the right spot its in the heart of the very area that's causing all the pain to begin with. second, a good doctor will use the needle to "stir up", (for lack of a better word) the part of the tendoncthat is inflamed. this promotes blood flow and healing. although it will make you feel like Braveheart just poked a spear into you, it dramatically increases the chances of the shot working. it feels really good when the shot is over, though!!

having had four elbow shots (two on each side), and one elbow surgery, here is my advice: ice frequently, complete rest till no pain, self massage the sore spot several times a day, and use one of those air casts that takes the pressure off the tendon attachment point.

I had to borrow my sons mountain bike to ride around because riding on the drops or even the hoods hurt my elbow too much.

good luck.

ps, the surgery, should you need it, usually works, but you'll be out of the game for 5 full months.

actually, for a cortizone shot to be effective, it should hurt like, well, heck. it is true that there is a little lidocaine in there or it would be unbearable. two things are going to make it hurt: first, the target area is inflamed, so when that needle gets to the right spot its in the heart of the very area that's causing all the pain to begin with. second, a good doctor will use the needle to "stir up", (for lack of a better word) the part of the tendoncthat is inflamed. this promotes blood flow and healing. although it will make you feel like Braveheart just poked a spear into you, it dramatically increases the chances of the shot working. it feels really good when the shot is over, though!!

having had four elbow shots (two on each side), and one elbow surgery, here is my advice: ice frequently, complete rest till no pain, self massage the sore spot several times a day, and use one of those air casts that takes the pressure off the tendon attachment point.

I had to borrow my sons mountain bike to ride around because riding on the drops or even the hoods hurt my elbow too much.

good luck.

ps, the surgery, should you need it, usually works, but you'll be out of the game for 5 full months.

Oh good, I can hardly wait... :eek: :eek:

cyclinfool - 2 years?!:eek::eek::eek: How long did it take the pain to subside so you could start working on strength?



I stayed off of it for about 8 months. I tried the straps, ice & Ibuprofen, etc. Nothing helped me except a "reset". I needed to be really careful, even lifting a gallon of milk out of the fridge caused pain.

I think the problem with the shot was that it just treated the symptoms and caused me to think everything was OK again.

I had tendinitis in both elbows, and what I thought was bursitis in my shoulders. Did PT, for years, multiple cortison shots, which helped and hurt, but eventually their effectiveness diminished.
I have had Lateral Epichondrial release ops on both elbows. The ops have both helped, but it varies person to person, and recovery from each was about 6-7 weeks. Everyone is different, and finding a good Dr. is vital. My present ortho discovered that some of my arm (shoulder) pain was not caused by the shoulder, but resulted from herniated discs in my cervical spine. I had 4 epidurals, and that helped immensely. I found this Dr. when we moved, and am glad I did, or may have never discoverd the spinal issue. Like I said, everyone is different, and I feel lucky to have gotten some relief, it has been a long journey though.

I stayed off of it for about 8 months. I tried the straps, ice & Ibuprofen, etc. Nothing helped me except a "reset". I needed to be really careful, even lifting a gallon of milk out of the fridge caused pain.

I think the problem with the shot was that it just treated the symptoms and caused me to think everything was OK again.

By "stayed off it", do you mean you didn't use it at all? Did you use your other arm for everything? It would be hard to get ready for work using only arm... how do I style my hair with one arm? By the time I'm on the vanpool @ 5:30, my elbow is a wreck. And that's just the start of the day.

I had tendinitis in both elbows, and what I thought was bursitis in my shoulders. Did PT, for years, multiple cortison shots, which helped and hurt, but eventually their effectiveness diminished.
I have had Lateral Epichondrial release ops on both elbows. The ops have both helped, but it varies person to person, and recovery from each was about 6-7 weeks. Everyone is different, and finding a good Dr. is vital. My present ortho discovered that some of my arm (shoulder) pain was not caused by the shoulder, but resulted from herniated discs in my cervical spine. I had 4 epidurals, and that helped immensely. I found this Dr. when we moved, and am glad I did, or may have never discoverd the spinal issue. Like I said, everyone is different, and I feel lucky to have gotten some relief, it has been a long journey though.

Wow, you really went through a lot.

I'm ambivalent about the cortisone shot because it's not considered a cure --- yet, some people have told me they had one shot and they were all set, and years later their pain and other symptoms are still gone. Others (like you) say they had multiple shots. As you said, everyone is different. It's like a crapshoot --- find the right doctor, choose the right option, and hope you're one of the lucky ones it fixes.

Think of this as a chance to polish your "no hands" skills. I used to ride most of the way to school no hands, and I think I could do it again if i had to. Kind of the opposite of riding standing the whole way like I did for a week when I had a saddle sore.

Think of this as a chance to polish your "no hands" skills. I used to ride most of the way to school no hands, and I think I could do it again if i had to. Kind of the opposite of riding standing the whole way like I did for a week when I had a saddle sore.

:D I'd need to do a bit of braking while relearning that skill... no can do, too painful.

After wearing straps/bands, taking Ibuprofen and such I couldn't stand it anymore. I could barely lift my arm when I rolled over sleeping at night. Went to the Dr. and he gave me a cortisone shot. I too thought it was going to be painful as my Dad gets shots deep into his shoulder. This shot was not painful. It did take a day or two to feel the effects. I'm now about 2 months pain free. I wish I hadn't waited so long.

By "stayed off it", do you mean you didn't use it at all? Did you use your other arm for everything? It would be hard to get ready for work using only arm... how do I style my hair with one arm? By the time I'm on the vanpool @ 5:30, my elbow is a wreck. And that's just the start of the day.

What I mean is that I did not lift thinks over about 5 lbs with it until it felt better, then I treated it normally but did not lift anything heavy. Sure - there was strength loss, but when ever I tried the PT route, it just flared up again. I waited until I just didn't notice it anymore.

If the cortisone doesn't work, look into this: http://www.platelettherapy.com/indication.html
According to the doc was seeing for my tendonitis, this is the next big thing.

I asked my doctor about this today. He does the treatment (he's a sports doc) but doesn't suggest it because it has not been proven and still controversial --- he doesn't want to encourage his patients into a scientifically unproven treatment that insurance may not cover. Since I asked, he discussed it with me and said he's willing to do it for me, but only after an MRI of my elbow which I will schedule next week. He mentions cortisone shots but doesn't encourage them because of their risk of long-term weakening of the tendon. If I do either of those treatments and they fail, then the next option is surgery.

So, MRI next week to see what's going on in my elbow; meanwhile I will think about the options.

my doc offered me to try platelet therapy instead of surgery. after some research I decided not to, because a. insurance doesn't cover it and it costs about $800 per treatment. b. it may take up to three treatments to work, but it may not work at all.

I would pay $2400 out of pocket if it was high liklihood of success, but I'd rather get a new bike that I know would make me feel a lot better with that money!

so I'll have the surgery this upcoming winter.

my doc offered me to try platelet therapy instead of surgery. after some research I decided not to, because a. insurance doesn't cover it and it costs about $800 per treatment. b. it may take up to three treatments to work, but it may not work at all.

I would pay $2400 out of pocket if it was high liklihood of success, but I'd rather get a new bike that I know would make me feel a lot better with that money!

so I'll have the surgery this upcoming winter.

Having to wait for the MRI appointment buys me some time to think about my options. Based on the MRI results, I may not quality anyway, but I am doing the research and preparing my questions for the doctor. If the insurance company won't pay, then I probably won't go that route. Surgery is starting to seem like the most likely long-term cure, but I want to be 100% certain that's my only remaining choice.


In a post above you said:


having had four elbow shots (two on each side), and one elbow surgery, here is my advice: ice frequently, complete rest till no pain, self massage the sore spot several times a day, and use one of those air casts that takes the pressure off the tendon attachment point.


Unfortunately, since I am still working full-time I can't give it "complete rest". My morning routine getting ready for work leaves it feeling like I hit the bone HARD several times with a hammer; it's still sore when I get to work and takes a while to settle down. I am considering wearing a sling around the house, just to remind me to not use the arm when it isn't hurting, but that's not really practical at work where I use a computer keyboard all day.

My morning routine getting ready for work leaves it feeling like I hit the bone HARD several times with a hammer; it's still sore when I get to work and takes a while to settle down. I am considering wearing a sling around the house, just to remind me to not use the arm when it isn't hurting, but that's not really practical at work where I use a computer keyboard all day.

Wow! - You have it worse than I did. At the peak lifting a gallon of milk out of the fridge would set it off, but it never hurt to lift a 12oz beer

Wow! - You have it worse than I did. At the peak lifting a gallon of milk out of the fridge would set it off, but it never hurt to lift a 12oz beer

And I'll bet the pain would subside after lifting *several* 12oz beers.:D

Wow! - You have it worse than I did. At the peak lifting a gallon of milk out of the fridge would set it off, but it never hurt to lift a 12oz beer

Well, to really know who is worse, we'd have to do a side-by-side comparison using the same objects of the same weight, using the same shoulder mechanics, etc. That said... it usually hurts to lift my coffee cup. It hurts to fitness walk because that requires swinging my arms, and the harder they swing (i.e. the faster I walk) the more it hurts. For some reason, it REALLY hurts during the night when I roll over... I don't know why --- does it get stiff in one position for long?