Rotator cuff impairment will often be the cause of shoulder pain in golfers from middle-age upwards (13) . Indeed, the incidence of rotator cuff tears increases greatly after age 50 (14) . Electromyographic (EMG) studies of professional golfers have shown that the rotator cuff and especially the subscapularis muscle are highly active throughout the swing. Repeated stress to a degenerated tendon may lead to fibre failure, producing symptoms of bursitis or tendinitis; in cases of significant failure, the golfer will feel weakness elevating the shoulder. Partial rotator cuff tears are substantially more painful on resisted muscle action than full tears. Patients will usually complain of pain and tenderness in the anterolateral shoulder, crepitus and stiffness.
Radiculopathy occurs when something irritates a spinal nerve—say a “slipped disc” causing a pinched nerve. This is also called sciatica . There are resident stem and other cells in the local tissues everywhere in our body. Many live around blood vessels. These are obviously also present in the disc and nerves in the epidural space and they usually play an important role in suppressing inflammation and repairing damage. We know, based on a copious in vitro (lab) data, that the high-dose steroids used in epidural injections can kill these cells. So the progression of the series of epidural steroid injections looks a little something like this:
How often cortisone injections are given varies based on the reason for the injection. This is determined on a case-by-case basis by the health care practitioner. If a single cortisone injection is curative, then further injections are unnecessary. Sometimes, a series of injections might be necessary; for example, cortisone injections for a trigger finger may be given every three weeks, to a maximum of three times in one affected finger. In other instances, such as knee osteoarthritis, a second cortisone injection may be given approximately three months after the first injection, but the injections are not generally continued on a regular basis.