Friday, October 10, 2008

Frozen Shoulder - Cortisone injection

In China they make you pay for the bullet.... in BC if you need a Cortisone injection you have to buy the Cortinsone yourself :-)

After the MRI (the radiologist suggested an impingement and possibly a laberal tear) my GP got me referred to a an ortho-surg via the cast clinic at the local hospital (it is reasonably easy to get in appointments for these, but you get about 2-3 minutes of his time typically.) 

He looked at the MRI, said it was inconclusive at best... that he didn't do "elective shoulder surgery" and said he would refer me to another ortho-surg who specializes in shoulders. That took almost a month... (the GP said it could have taken HIM almost a year to get me in to this guy..)

That new ortho-surg's (who is highly recommended by my wife the physio and her physio friends and my GP) first diagnosis was a possible frozen shoulder. (I think this link is good overview.) His first suggestion was that we try a cortisone injection.

I had that done yesterday. A fairly complicated procedure done by a radiologist. They light freeze the skin over the shoulder (lydicaine I think she said). Then using the X-ray machine they place a needle into the general area of the joint capsule. Next they inject a dye that allows them to see the capsule better and replace the needle to get it into the capsule.

Next they shoot in saline solution to distend the joint. Then the cortisone. Two vials of 40mg. Along with a bunch of saline solution. The instructions from the ortho-surg where to "rupture" the capsule. Presumbaly so that the cortisone would get into a wider area. The effect felt much like a small balloon in there.. unconfortable but not painful (like eating too much turkey dinner at Thanksgiving.)

All in all, took longer than I thought it would, about 30-35 minutes. And not was painful or traumatic as you might think. Fun if you like watching the TV monitor of the X-ray to see what is happening. Kind of like an episode of House (but without blood squirting all over the place, although at one point there was a nice spray of saline..)

The effect overall seems fairly effective 24 hours in. The shoulder is still very weak in the areas where the impingement was. But certainly at this point a lot less pain. Only time will tell if this is just a temporary or permanent change. 

The plan is to continue the shoulder and physio exercises. Which with less pain may get me into better condition. Which may keep the situation under control. They will repeat once if the situation warrants. 

Longer term if a second injection doesn't do the trick either then he (ortho-surg) will look at surgery. The problem being his waiting list is about two years... But at least at this point I'm (hopefully) on the list.

Anyway I'm back to the orth-surg in January time frame. Which gives me three months to see what this does for us.

The good news all along is that for the most part this has not impacted training. I only have problems on the bike if I go out for longer than 3-4 hours.  

What has been a problem is sleeping. The shoulder pain tends to be noticable and recurrent mostly at night (when in-active). And typically will wake me up in the middle of the night. So I end up taking ibuprofen about 2-3 nights a week to get back to sleep.

[Soapbox mode on]
I still have no explanation from anyone why you have to buy and bring your own Cortisone. Not particularily expensive at $26Cdn... Given what the procedure cost overall (a half hour plus of X-Ray room in Vancouvers 2nd or 3rd largest hospital, radioligist and assistant, x-ray dye, saline, disposable needles and syringes etc) I can't believe that $26 (or probably half that if the hospital was paying for it wholesale) would be more than a few percent of the total. Go figure.


Mark said...

My guess is the rules under the MSP. I think it is a similar situation when you have to buy the flu vaccine for a flu shot.