effectiveness of cortisone injection - nerve root

[salsaqueen99]

Hi there,
I'm interested if anyone can send me some literature on the effectiveness of cortisone injections into the nerve root. I have a compressed ulnar nerve which has improved a lot but my physio thinks that the other shoulder problems (muscle spasms, weakness in right shoulder) could be due to some dysfunction in C5. He thinks that if there is some inflammation around the c5 nerve root that cortisone could be very beneficial. I am not keen about this idea because 1) an injection around the nerve root does not sound very safe (even though it would be guided by an MRI) and 2) I've already had a cortisone injection before into the biceps tendon and I understand that there is a limit with the number of cortisone injections you can have. I am also concerned about potential damage cortisone injections can have on the body such as kidney and liver failure.

Current treatment is dry needling into c5 along with soft tissue work. I'm currently seeing the physio on a weekly basis and have seen a great deal of improvement. So I guess I'm not sure if there is a point in getting the cortisone injection if the dry needling is settling things down.

Help greatly appreciated.

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[roycar]

hi there.

i dont have literature to send you but anecdotally i've found steroid injections around the nerve root to be helpful in the recent past.

its important to note that while you may have had an injection "into" a muscle or tendon. they would be injecting steroid "around" the nerve to calm the inflammation, not into it.

a colleague of mine recently had a client who had fallen from a horse onto her shoulder. Lots of pain around neck and shoulder who resolved about 60% with physio but he just couldnt get that last 40%. C5 seemed to at the root of a lot of her trouble so we had a pain specialist inject around her c5 nerve root area. she had instant relief and two months on its seems to be lasting. (my colleague also continued to mobilise the cx spine etc for a couple weeks)

we thought that maybe it was a traction type injury to the c5 root which had then become quite inflamed and sensitised the nerve leading to pain in its distribution. the steroid knocked out some of the inflammation allowing the nerve to get used to being moved again thus being desensitised?

this is just anecdotal but it does show a good outcome. talk it over with a pain specialist. if you are of good health with no pre existing kidney/liver trouble steroid injections shouldnt really lead to any problems but everyone is different.

all the best. let us know how things go.

[salsaqueen99]

Hi there,

Thanks for your reply. I have read up that it can go either way. Sometimes cortisone is very effective other times not so much. Is there a way to determine if there is inflammation around the nerve root before getting an injection? I'm keen to wait and see to let it resolve. My physio does a lot of dry needling work which helps a lot and plus most of the referred pain has been reduced quite a bit. I'm almost pain free which is a good thing. I guess with my first injection, we went down the diagnostic route. If the injection worked, then it was obvious that there was inflammation around the biceps sheath even though it didn't show up on the ultrasound.

Also do you think that a cortisone injection would be the next step before considering taking drugs like endep or lyrica? I'm not keen about taking either one of the drugs because of the side effects and really I'm not up for feeling like a zombie all day long and I know that it is very hard to come off them once you start. If you have any insights about patient's experience with these drugs I'd be interested in hearing about them too. Even if I got to the stage where I had to consider taking them, I still don't think that it would change my treatment plan. I'd still need physio as per usual to mobilise the thoracic and work on the neck and shoulder.

Cheers.

[salsaqueen99]

This is a potentially silly question too. Any thoughts on iontopherisis for treating the area around the inflammed nerve root? I'm assuming it won't be as effective or longer lasting as the cortisone injection but if it gives me some relief then I can go and spend my money on getting a MRI and the cortisone injection.

[roycar]

not sure about the iontopheresis. re lyrica etc, some of my clients have had some really bad experiences on it. the particular girl i mentioned earlier tried lyrica prior to being injected and she told me she felt like she was losing her mind completely. but then i've encountered others who've had no issues. everyones different.