Q&A Mailbox

Q: Hi, I met a young man who recently had tommy john surgery and claimed he was prescribed steroids as part of the rehab process. I'm not sure if there is more than one kind of steroid, but we're talking about the kind that promotes muscle growth. Is this customary?
– Tim, March 32, 2011

A: Thank you for your question. Tommy John Surgery is a common procedure that I perform in overhand throwing athletes. It refers to a reconstruction of the ulnar collateral ligament of the elbow. The ligament serves as a stabilizer of the elbow and is put through a tremendous amount of stress during the overhead throwing motion. Ligaments can be stressed to the point of partially or completely tearing.

As part of a non-operative treatment protocol, physicians can prescribe a corticosteroid, which is an anti-inflammatory to help decrease pain and help with rehab. A full tear in an athlete who wants to continue to pitch or throw will likely undergo a reconstruction utilizing a tendon donated from their own body. In my practice, steroids that "promote growth" are not part of a typical post operative protocol. If the patient is post operative and experiences an increase in pain or symptoms while in rehab, a short course of corticosteroids may be used to decrease inflammation, however this is rare. Reconstructed ligaments go through a process of ligamentization and revascularization. In other words, your body has to make the tendon into a new ligament. Biologically this takes a period of 3-6 months to occur regardless of rehab or supplemental medication. I hope this answers your question and feel free to contact me with any other concerns. 
– Kevin Michael Kaplan, MD
Sports Medicine, Joint Replacement
San Marco

 

Q: I have chronic shoulder tendonitis. Do you provide extracorporeal shockwave therapy? 
Using Sonocur or Dornier or other equipment?
– Miguel, March 4, 2011

A: No, there is no convincing evidence that it is effective.
– Philip Hardy, MD
Sports Medicine, Joint Replacement
San Marco

 

Q: I have been diagnosed with a herniated disk in my neck (between 6& 5) and have radiating pain in my left arm. Is there any non-evasive treatment for that other than surgery? My back doesn’t hurt; it’s just the pins and needles symptoms in my left arm. 
– Lorett, April 26, 2011

A: With a history of pain radiating down your left arm and evidence of a disc herniation at the C5/6 level, it sounds like you have a pinched nerve. It is not necessary to have concomitant neck pain, but usually there is pain with extension-rotation of the neck. An electrodiagnostic study can be performed to confirm this diagnosis since other entrapment neuropathies can cause numbness and tingling in the arm. However, assuming that your symptoms are coming from your neck and that you have failed to improve with anti-inflammatory medications such as NSAIDs or Medrol Dosepak or that the pain is poorly controlled even on narcotic medications; you should consider having an epidural steroid injection. Epidural steroid injections are image-guided injections which target the irritated nerve, wiping out the inflammation and breaking the pain cycle. This is a minimally invasive procedure which can be done in a series to eliminate your pain and discomfort while your body slowly heals. The weakest links in the cervical spine are the C5/6 and C6/7 levels, so it is not surprising that you have a disc herniation here. Disc herniations can be either contained or uncontained. Contained disc herniations are less symptomatic, but also less exposed to the body’s immune system and hence are less reabsorbed by the body. Larger, uncontained disc herniations tend to be more symptomatic, but are exposed to the body’s immune system and hence are better reabsorbed. Once your pain is under control, you should be enrolled in a formal physical therapy program for traction, stretches and strengthening exercises. If your symptoms persist despite these image-guided injections in conjunction with physical therapy, then surgery should be considered. Thank you for your question and I hope this is helpful.

Sincerely, 

– David A. Doward, MD
Physical Medicine & Rehabilitation – Spine Team; Sports Medicine
San Marco
                    

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