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corticosteroid injections?? 5-May-2005 At 11:16:09 AM Julian

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Hi there. How are going? I am not sure of your name- "mclard". How about Lardy for short!

Have a read of my article in Rock regarding elbow tendinopathy; it was a couple of issues ago. If you have had elbow pain more than a few weeks it is likely not all tendinitis, but rather tendinosis. This is not an inflammatory condition and as such will not respond to cortisone. Tendinitis is inflammatory and is very sensitive to cortisone, as it is a strong anti-inflammatory. That said, it would go away in a short while if you stop pissing it off; this would negate the need for an injection. The longer you have had it the more likely it is to be tendinosis. Either way there are things you can do regarding your climbing habits; stop crimping for instance. Crimping requires a muscle called flexor carpi ulnaris much more so than open handing, and is usually the main offender in either of the aforementioned conditions.

I would be curious to know what you have tried regarding treatment. I have treated well over 100 climbers with this condition and never had a failure. I agree with the advice that it will go away, though it usually requires you to stop the aggravating activity. There is minimal risk involved but an injection will mean a rest period.

Not climbing is a rather unsatisfying step. I do not normally recommend this as it is not necessary, and normally sees my patients progress to more advanced states of disrepair! Strengthening the tendon using very specific exercises, depending on the muscles involved, is very effective (ulnaris is the most common, but there are others).

Many GP’s will now not inject cortisone (a catabolic steroid- opposite to anabolic) for elbow tendinopathy, as it is more likely to be tendinosis, for which the injection will be ineffective treatment. The underlying pathology for this condition is a strength differential between the muscle and its tendon insertion.

If you stop the aggravating activity, muscle strength will reduce, thereby reducing the strength disparity, and the problem will resolve. Conversely, you can increase the tendon strength. Both steps will address the pathology, rather than applying a bandaid. A combination of the two (the first by altering your climbing style rather than stopping) will fix the problem- guaranteed.

Kind regards.

Julian