Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group tendon tear or enthesitis?

you might be ok. most of my doctors weren't familiar with this problem. though one PT did say (for the wrist) "if a brace helps its carpal tunnel and if a brace makes it worse, its tendonitis." don't know the truth in it, but i remember her saying that when i told her and showed her what the brace did to me: made a small problem into a huge one.

but not everyone reacts this way, so just play it by ear.

Just to confuse things Sue, I was reading recently that for tennis elbow (I think, though it might have been golfers elbow, and different tendon) that if you were going to rest it, you actually needed to rest the wrist rather than elbow, because it was use of the muscle from the wrist that stretched the tendon and caused problems at the elbow.

My thoracic spine is now also going out in sympathy, and I'm feeling things I shouldn't be around my shoulder as well. Am going to have to really not lift anything, and not stretch out that arm to pick up anything (stretching OK, stretching and picking up is instant pain).

Ouch. cemc - sounds like shoulder is giving problems - tendonitis. Could also be an osteophyte in the shoulder. Need an MRI or even a decent X-Ray of that shoulder, check out impingement. Might need a decompression (mine was most successful). ONLY with a good shoulder surgeon though. Arthroscopy. SAD/ACJ - see :-
http://www.shoulderdoc.co.uk/article.asp?article=1137&section=3

Also check out http://www.shoulderdoc.co.uk - home page.

Whatever you do, do NOT have a cortisone injection intyo shoiulders. The cortisone burns out the tendons and ligaments of the shoulder - and that is what yr shoulder relies on! The shoulder has the most movement of any joint in the body and is the most fragile as it only has ligaments and tendons to support and protect. http://www.shoulderdoc.co.uk/article.asp?article=1581&section=56
(snip...) "...there are problems with corticosteroids. They have been shown to be proteolytic and inhibit collagen formation in both cartilage and tendon. There is a high incidence of post-injection pain for approximately twenty four hours in many cases and the efficacy has been shown to be only of short term benefit. Corticosteroids are associated with tendon weakening and rupture, transient hypoglycaemia, lipoatrophy and fat necrosis. Our biggest concern in injecting around the rotator cuff is the risk of additional tendon rupture and tendon damage. (more...)

(NOTE: see Funk's proviso - only inject under guided needle!)

(snip...) "Essentially with any treatment our adage in medicine is to first do no harm. Therefore there are other substances that we could inject that would be safer to the rotator cuff tendons. One of the substances that has shown to have a kinder effect on the rotator cuff is Hyaluronans. Hyaluronans are a normal substance within synovial fluid making up the meshwork of the synovial fluid with viscoelastic properties. Hyaluronans act as a joint lubricant. However this is not the effect that is required for these injections. They have been shown to have an anti-inflammatory effect - both mechanical as well as biochemical in inhibiting phagocytosis, reducing levels of prostaglandins, interleukin 1, free radicals and cyclic AMP. They also tend to have a barrier affect coating the pain receptors on the synovial surfaces forming a protective barrier. They have also been shown to stimulate endogenous Hyaluronan production and therefore having a longer period of activity than corticosteroids.

Shibata et al. (JBJSA, 1999) performed a randomised control trial of steroids versus Hyaluronan in patients with rotator cuff tears prior to surgicalintervention. Cuff biopsies were then taken. They found the patients were treated with Hyaluronan, had denser collagen fibres compared to the corticosteroid group. They stated there was a link between the number of steroid injections and the outcome of surgery with a higher failure rate in rotator cuff repairs in those patients treated with a higher number of corticosteroid injections." (more...)

Strongly suggest exploring the site - it is considered the best bar none on shoulder conditions, treatment, surgical approach, rehab and physio. Prof Funk is a world leader in all things 'shoulder' (and yes, he is in England).

Continue to 'guard' that shoulder. Do not use arm above shoulder, and please be v. careful lifting.

Hope this helps - any questions, pm me. Take care cemc -

thanks Molly

maybe a PT could help get you patched up again. i've had times where i felt my body was falling apart, one thing after another. and always they've been able to put me back together.

huggs!

Has anyone had pain during ultrasound? When I went to PT his morning, she did some massaging and stretching of my wrist and arm, then she used the ultrasound, after about 3-4min, it started hurting a lot. She moved the ultrasound wand and it was ok.

I am noticing now that the tendon between my elbow and wrist is really sore and it hurts to use my keyboard. I guess I need to ice it again.

Many many years ago, Donna. I had what was described as on overuse injury (Repetitive strain injury), which I now think was an incredibly bad and longlasting enthesitis. The physio did try ultrasound and I couldn't stand it - made me ache so much more. I don't know if it was just the way the ultrasound head was pressed around the area or what, but I didn't go back for any more of that. I don't quite understand how ultrasound is expected to work for this kind of thing, so I wouldn't have a clue what caused the extra pain and how it managed to aggravate it for me.

was the PT moving it around constantly? if not, one can cook the muscle.

was the PT over bone? if so, one can cook the bone.

a chiro office tried the US on some other setting that was really painful.
what the PTs always used, what i use now doesn't hurt me.

my husband does mine for me.
he knows to move it constantly.
he knows not to ultrasound over the spine.

also very important to have plenty of gel or it can zap you and cook the tissue.

but if you follow all the rules, it should be ok.

not sure why it wasn't for you.

maybe they just needed to turn down the intensity?