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Shoulder injection beta
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By Old and Busted
From Centennial, CO
Aug 9, 2013
Stabby

My known issue is impingement due to a type III acromion spur. Have not done the MRI for tissue damage. Surgery is not an option at this point. Have had burning, achy pain for months since rolling over onto it in my sleep.
So, I can get an injection. Already know it may or may not work and that it needs to be targeted. What other useful info does this fine, really intelligent crowd have to offer me?


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By Chris Horton
From Tucson AZ
Aug 9, 2013
Awesomeness!

In my experience, the injection bought me a little bit of time. It dodn't help the instability, weakness and general discomfort caused by a torn labrum and rotator cuff. It did allow me to sleep better, stretch as needed, play baseball (I could not climb at all) and strengthen the surrounding muscles for a few months until I gave in and went under the knife.

My advice: get the injection, it should help with inflamation and allow you to reha/strengthen the parts of your shoulder that may not be totally detroyed already. Also, if the injection doesn't work, you'll know you should probably get the MRI. If you haven't already, look into a good rehab/pt/strengthening program.


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By jon weekley
From Denver, Co
Aug 9, 2013
avocado gully

Prolo-therapy. check it out. I had it done multiple times for ankle, thumb and shoulder soft tissue tears. Saved me some surgeries and got me back at it... Some spots I had substantial pain relief in 3 days.



www.berenbeimosteopathic.com.


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By Brent Apgar
From Out of the Loop
Aug 9, 2013
Me and Spearhead

Guys, Mike is talking about bony impingement on the supraspinatus and surrounding tissue. A labral tear or soft tissue damage causing glenohumeral instability is a totally different animal.

Cortisone injection would probably be your best bet in getting some relief. I wouldn't stay on NSAID's except for the really bad flare ups. Essentially your dealing with constant tissue irritation from that type 3 acromion.
Hate to say it, but the long term solution is to find the time and finances and just have the surgeon take care of it. If your Dx is right on then a sub acromial decompression will be the quickest and most effective fix. (And I'm not a surgeon.)

If you can get it under control with the injection, some manual therapy (dry needling, fascial release and a therapist that can run through a shoulder stability/motor control program) may also extend the shelf life prior to a surgical fix.
Good luck.


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By Edward Medina
Administrator
From Charlotte, NC
Aug 9, 2013
The FA of Full Scholarship

I've got the same issue (my acromion might be type 2) but I find that once inflammation sets in it is very hard to get rid of. The injection has worked really well for me, but this type of impingement needs pretty constant PT. After your shot get a power band and stay regular with your shoulder exercises.


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By mountainhick
From Black Hawk, CO
Aug 9, 2013

Why is surgery not an option? I know surgical results can be mixed, but if you have a true structural impingement, bone spurs etc, Cortisone isn't going to fix the underlying problem.

My own case involved some impingement, and I did have some acromion ground off, but that apparently was not the main problem.

The third ortho after close to a year of non effective PT (including cortisone treatment) was bummed I didn't find him first and said that he would have fixed it right off. And he did fix it. Surgery and recovery were a bitch, but no worse than what I already had been through with the disability of the shoulder problem.


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By Old and Busted
From Centennial, CO
Aug 9, 2013
Stabby

First off, great responses. Very helpful to me.
Surgery is not an option at the moment for me b/c of what I do for a living; which is swinging tools. Also, I am on anti-coagulants so that complicates surgery for me as well as eliminating NSAID's.
Again, thanks a ton for the advice!


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By Alex Shainman
From the best place right now!
Aug 9, 2013
Is there any good gear or solid holds up here???

From my personal experience...

NO NSAID's and NO cortisone!

You can try Prolo therapy (which is great for certain things) but I'd say don't waste your time and go straight for PRP (platelet rich plasma) injections. I had sub-acromial decompression surgery on my right shoulder in 2003 (went well). I had similar issues with my left shoulder with a similar MRI reading, but decided against surgery. Between last summer and this winter I received 1 Prolo and 2 PRP inter-articular and surrounding area injection sessions and my shoulder is awesome (also include a shitload of PT type stuff, yoga, no climbing for a couple months, etc)! I went to a Naturopathic Medical Doctor but there seems to be a lot of different practitioners out there... If you truly have a Type III, there may continue to be grating of the tendons BUT the PRP supposedly has been shown in studies to actually reduce the bone spur... Good Luck!


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By mountainhick
From Black Hawk, CO
Aug 9, 2013

Mike Lane wrote:
First off, great responses. Very helpful to me. Surgery is not an option at the moment for me b/c of what I do for a living; which is swinging tools. Also, I am on anti-coagulants so that complicates surgery for me as well as eliminating NSAID's. Again, thanks a ton for the advice!


Gotcha on the blood thinners, likewise at this point, and likewise can't take ibu. Going for some PT for my back next week, I don't think needling is going to fly on Plavix and aspirin.


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By Old and Busted
From Centennial, CO
Aug 10, 2013
Stabby

Alex Shainman wrote:
From my personal experience... NO NSAID's and NO cortisone! You can try Prolo therapy (which is great for certain things) but I'd say don't waste your time and go straight for PRP (platelet rich plasma) injections. I had sub-acromial decompression surgery on my right shoulder in 2003 (went well). I had similar issues with my left shoulder with a similar MRI reading, but decided against surgery. Between last summer and this winter I received 1 Prolo and 2 PRP inter-articular and surrounding area injection sessions and my shoulder is awesome (also include a shitload of PT type stuff, yoga, no climbing for a couple months, etc)! I went to a Naturopathic Medical Doctor but there seems to be a lot of different practitioners out there... If you truly have a Type III, there may continue to be grating of the tendons BUT the PRP supposedly has been shown in studies to actually reduce the bone spur... Good Luck!

Hmmmmm. I am intrigued. My whole plan is to buy some time before I eventually submit to surgery. I think knocking the inflammation down (current episode result of rolling onto my shoulder badly while sleeping, almost 2 months ago) will greatly help; but still only a temp. fix. Surgery is not a simple decision for me either as I will have to stop the Plavix and thus be at greater risk to get a clot in one of my stents, and of course the surgery will also add some clot potential too. Ugh, hate getting old.


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By Tom-o Sapien
Aug 11, 2013
Conky and I confront Patrick Swayze

Mike Lane wrote:
Ugh, hate getting old.


+1

Keep us posted and good luck with your rehabilitation Mike.

-Off topic. Were you able to contact my liability insurance man?
Hopefully he can save you some coin next go around.

Tom


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By Old and Busted
From Centennial, CO
Aug 11, 2013
Stabby

Tom- thx for the reminder. We should look into combining forces for work.


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By Zirkel
From Bishop, CA
Aug 11, 2013
Owens Gorge.  Mt Tom in background.

Brent Apgar wrote:
Essentially your dealing with constant tissue irritation from that type 3 acromion. Hate to say it, but the long term solution is to find the time and finances and just have the surgeon take care of it. If your Dx is right on then a sub acromial decompression will be the quickest and most effective fix.


Agreed.

You have a diagnosed mechanical bone "defect" and engage in overhead types of activities/employment. This is a bad mix. I'm not really sure how simply reducing existing soft tissue/bursa inflammation is going to provide anything but a short-term band aid to the underlying problem.

I've had subacromial decompressions (SAD) in both shoulders for type III hooked acromion (along with rotator cuff and bicep tendon repairs). If the bony acromion is truly the extent of your shoulder disfunction then SAD is a relatively straight forward arthroscopic repair by any SHOULDER SPECIALIST orthopedist.

An MRI + arthrogram (dye injected into the shoulder joint capsule pre-MRI) is probably recommended to rule out any associated soft tissue injury. Keep in mind that MRI is not 100% diagnostic and often the ortho won't know the extent of the damage to the soft tissue until he is in there.

Yes, PRP is in excellent treatment option (I've had PRP for both elbow and hamstring tears) but, IMHO, best suited for connective tissue (ie. tendon) injuries/tears where adequate regenerative blood flow is lacking to the area, and not impingement issues such as yours. I would choose PRP over cortisone as a short-term solution but feel, from my own personal experience, to truly address the problem for the long-term warrants surgery.


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