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Cortisol shots for carpal tunnel - any affects on kidney?

Jojo61's picture
Jojo61
Posts: 1310
Joined: Oct 2013

Today I went to a rheumatologist due to some pain in my hands.He diagnosed it as carpal tunnel and tendonitis. He suggested I get cortisol shots. I made him aware of my nephrectomy and asked it would be harmful to my kidney. He said no. So I said go ahead and he gave me a shot in each wrist and has me returning next month.

When I got home tonight I googled a bit and noticed some info on adrenal glands and that artificial cortisol can cause kidney infections.

Does anyone have any advice on this?

Thanks!

 

Jan4you's picture
Jan4you
Posts: 1310
Joined: Oct 2013

Sorry you are going through such pain. My question is did this Rheumy test for this or just make an educated guess? Usually it takes an EMG test of the arms/hands to identify and accurately diagnose Carpal tunnel.

Just wondering.. tired of docs who make these absolutes without proper testing.

Hope you get relief without any ramifications.

Let us know how you are doing hon!

Jan

NanoSecond's picture
NanoSecond
Posts: 653
Joined: Oct 2012

Hi Jojo.  Cortisol is a steroid.  Here's what Wikipedia says about it:

"Cortisol is a steroid hormone, more specifically a glucorticoid, produced by the zona fasciculata of the adrenal cortex. It is released in response to stress and a low level of blood glucocorticoid. Its primary functions are to increase blood sugar through gluconeogenesis, suppress the immune system, and aid with fat, protein, and carbohydrate metabolisms. It also decreases bone formation."

In other words - your fasting blood glucose levels wil go up and your immune system will be weakened.  These are far more serious issues than the low potential for kidney infections.

My advice is to avoid steriods when/if at all possible. And, if it is not possible, use them sparingly.

foxhd's picture
foxhd
Posts: 3183
Joined: Oct 2011

Carpal tunnel or any tendonitis, bursitis, or acute soft tissue inflammation is a response to injury, stress, strain or overuse syndrome. The ensueing inflammation acts to provide the process of healing and immobilization. Sometimes the swelling and inflammation is excessive and can become chronic with considerable pain and dysfunction. It is a normal response. In severe or acute cases, having a shot of cortisone resolves inflammation rapidly. Cortisone is a steroid. Not the type an athlete uses to build muscle. It is a strong anti-inflammatory. The quicker the swelling resolves, the less the permanent risk for long term damage to the affected tissue. It is not systemic. It is local. It is effective and safe when used on occaision.  Don't be concerned with any adverse effects in kidney function. Without treatment, the damage to musculoskeletal tissue will be of greater concern to kidney function. Things need to be kept in perspective. It is a well accepted standard of care. I hope it works for you. So much depends on the accuracy of the injection.

NanoSecond's picture
NanoSecond
Posts: 653
Joined: Oct 2012

Thanks for that clarification Fox. It makes good sense to me.  I was only concerned about any long-term use.

todd121's picture
todd121
Posts: 1422
Joined: Dec 2012

Hi. I was having an issue with this in my right hand. I started paying attention to how I was using my hand and noticed I was putting a lot of stress by the way I held my phone when texting. I changed the way I hold my phone and started using both hands (and relax and don't over-extend) when texting, and after a few weeks of being careful things improved.

Carpal tunnel is one syndrome that is related to one nerve, but the kind I was having was another nerve more towards the outside. The neurolgist I saw did mention he might have to do the test Djinnie mentioned to diagnose the nerve damage.

I only mention what happened to me thinking you might pay attention to the way you're using your hands. Maybe typing? Or in your job? It did help for me.

Also, I was leaning on my elbow on the arm rest in my car while driving, and that also might have been causing damage to that ulnar nerve that runs through my elbow. I stopped doing that too. I'm pretty sure one or the other helped me resolve my problem with time. I didn't get a cortisone shot, but I have had them before for plantars fascitis in my fot (and it helped resolve that) and for a problem with my shoulder (I think it helped with that too).

I remember hearing that you should have only a limited number of these shots in a certain area (I don't recall how many), because it can cause a different problem. You might want to research that if he wants to give you another shot.

Best to you.

Todd

Jojo61's picture
Jojo61
Posts: 1310
Joined: Oct 2013

Thanks for the input. Still not sure what to do. I went to the rheumatologist because my hands and feet have been very sore and stiff and my wrists have given me very sharp pain when I lean my wrist on a surface, or when I am leaning using my hands - such as yoga. The backs of my hands have developed large lumps at the joint between index and middle fingers - on both sides. My family doctor (who is in his first year of practice) looked at them and said "you have arthritis and by the look of your hands, you have had arthritis for a while". I asked if he wasn't sure it is carpal tunnel. He said no, but, he said, this "Joint doctor" (don't get excited, Fox ;) was really good at diagnosing. This joint doctor looked at the lumps on the backs of my hands and said they were my tendons (xrays showed nothing) and both hands had carpal tunnel. Diagnosis by eyeballing, Jan! When he suggested the shot I felt I may as well give it a try -  the shots hurt!! He gave the shot on underside of each of my wrists. One hand went completely numb about 5 minutes after but by the end of the day it was back to normal. However they feel worse than they did before!! Even though I have an appointment to go back for another shot in a month, I think I am going to ask for a referral to a neurologist. I do believe that I need to watch what I am doing...I work in an office setting, which doesn't help, I am sure, and also I know when I sleep, my hands always end up being flexed down....time for support splints, I think! Thank you for your input!!

Hugs

Jojo

Jan4you's picture
Jan4you
Posts: 1310
Joined: Oct 2013

Oh boy, JoJo.. don't get me started!  I too as diagnosed with carpal tunnel after an EMG test (needles/electrodes) which said both arms has positive results. I had this dime size pain in upper arm of ONE arm for months and months. How can that be carpal tunnel when i have no wrist/hand pain? Turns out its all part of my MS.

Now, did this Rheumy do any labs to substantiate or rule out arthritis? Or any other diseases? AND why call it carpal tunnel when your pain/stiffness is in both hands and feet?

Eventually I was referred by my life-saving chiropractor to this specialized nutrtionist. They use NRT/ART which is Nutrtional response testing or Autonomic response testing. If you ever had someone push against your limbs and you push counter to these pressing down THAT is what ART is like only its more specific.

Another suggestion besides seeing a provider of NRT/ART is an ant-inflammatory diet. You'd be surprised at how reducing inflammation improves how you feel, give you much more energy and reduce or eliminate many symptoms.

BUT you still need to see if you have any form of arthritis. Even if you do, and those "lumps" are a part of it, you need a wholistic approach. If you are open to that approach. Are you?

Even my MS doctor was amazed at my improvement after seeing this specific and highly trained Nutritionist helped me reduce inflammation which in turn improved my balance issues, cog fog and overall fatigue/pain issues.

Maybe a 2nd opinion from another Rhuemy? Or one who runs tests to rule in/out other diseases?

Gentle hugs, Jan

foxhd's picture
foxhd
Posts: 3183
Joined: Oct 2011

What a can of worms. Not enough space and time to cover it all. Yes, carpal tunnel can be diagnosed by ones verbal complaints and history. Sort of like explaining about that large thing that is over on the wall. Moves easily but can be easily immobilized. Rectangular in shape with metal parts. Oh, you mean a door? Often the "rule out" process is used. Elimination of what it can't be. It has to be whats left. From here it sounds like it can also be a tenosynovitis. It can be treated the same way. Yes injections will hurt for up to 24 hours then subside if the proper spot is hit. Usually no more than 3 injections will be given because it weakens the integrity of the tissue. Some doctors don't even inject the problem spot but inject trigger points in the area. I don't care for that approach. Having pain when leaning on the hand leads me away from carpal tunnel as the primary problem. Although it can certainly be there. Anatomically, the wrist consists of the radius,ulna, carpal bones, ligaments, tendons, nerves and blood vessels. They are wrapped in a fascia which holds it all together like electrical tape around an exposed lamp cord. When things swell, there is not any extra space to accommodate this. Therefore pressure, pain and numbness developes. The median nerve is usually the nerve involved. Typically, during the day it can be annoying. But due to daily activity and motion, the swelling is pushed out reducing some pressure. But the inflammation remains. When sleeping, the fluid returns and increases the pressure on the nerve. You wake up with your hand or portions thereof asleep. With that history the confirming tests do include an EMG. Electromyelogram or nerve conduction study. Nerves transmit impulses at predictable rates. Sending a current along a nerve will provide a read out. It can be interpreted as normal, repairative or degenerative. Surgically a small incision is made cutting the fascia to allow more room for the impinged tissue relieving pressure. It is not unheard of for some people to have surgery again in the future, although not common. Night splints are often suggested first. They hold the wrists in a proper alignment at night.

 I had both done at the same time about 10 years ago. Never a problem since. As a therapist, I've seen scores of these. Conservative treatment is only effective in acute cases brought on by positional or overuse syndromes.

Jans issues have complications which may require a different approach.

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