However, localized rhabdomyolysis associated with weight lifting is reported infrequently. Bolgiano 10 was the first to report rhabdomyolysis of the biceps occurring after a weight-lifting session in a year-old man who denied use of anabolic steroids or other drugs. Other authors have described rhabdomyolysis of the long head of triceps, 11 bilateral teres major, 12 and bilateral quadriceps 13 muscles after intensive muscular exercise.
The exact incidence of rhabdomyolysis among bodybuilders remains unknown. Many cases in the exercise setting are probably unrecognized and diagnosed as simple muscle strain. Several authors have described rhabdomyolysis after vigorous weight lifting by athletes supplementing their weight-training program with AAS. Localized muscle damage was present at the area of AAS injection, but the causal mechanism for rhabdomyolysis in this patient was unclear.
Although we could not find a report in the literature describing such a reaction, rhabdomyolysis might be due to a toxic effect of a drug ingredient, or it may be the result of compartment syndrome. Acute compartment syndrome of muscles surrounding the shoulder is a rare condition, because the arm fascia is yielding and can accommodate swelling without a corresponding increase in compartment pressure.
Only 3 such cases are reported in the literature 17 , 18 ; all cases occurred in patients with drug overdosage or intoxication after minor trauma. For the case described, we hypothesized that a combination of increased compartment volume due to injected fluid and hematoma and decreased elasticity in the fascial envelope caused by the bodybuilder's increased muscle mass resulted in increased intracompartmental pressure.
In addition, strenuous physical training may have led to a cascade of events, causing muscle ischemia and rhabdomyolysis. Doping can cause acute and chronic health problems, most of which are systemic. This case report is the first description of localized rhabdomyolysis in the area of AAS injection.
Uri Farkash, MD, Nogah Shabshin, MD, and Moshe Pritsch Perry , MD, contributed to conception and design; acquision and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article. National Center for Biotechnology Information , U.
Journal List J Athl Train v. J Athl Train. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Objective: Rhabdomyolysis breakdown of skeletal muscle tissue may be caused by mechanical, physical, chemical, or biological factors. Background: A year-old amateur bodybuilder presented to the emergency department with excruciating pain and inability to move his right shoulder after injecting stanozolol, an anabolic-androgenic steroid AAS , into his right deltoid muscle on the same day.
Differential Diagnosis: Polymyositis and dermatomyositis, mild injury, infectious myositis without phlegmon or abscess formation, radiation therapy, subacute denervation, compartment syndrome, early myositis ossificans, rhabdomyolysis, and sickle cell crisis. Treatment: The patient was treated with intravenous fluid replacement and sodium bicarbonate to alkalinize the urine.
Uniqueness: Anabolic-androgenic steroid use is associated with various side effects that are generally systemic and dose related. Keywords: anabolic agents, adverse effects. Case Report A year-old, previously healthy, amateur bodybuilder presented to the emergency department with excruciating pain and inability to move his right shoulder after injection of anabolic steroids into his right deltoid muscle followed by an exercise session on the same day. Open in a separate window.
Figure 1. Posterolateral view of the right shoulder region shows swollen deltoid muscle with red, tender, and warm skin around it. Figure 2. Axial gradient echo images before A and after B intravenous administration of gadolinium show diffuse enhancement of the deltoid muscle arrowheads. However, the nonenhancing well-defined region arrows is consistent with early necrosis or early abscess formation. Table Laboratory Test Results of the Patient. Footnotes Uri Farkash, MD, Nogah Shabshin, MD, and Moshe Pritsch Perry , MD, contributed to conception and design; acquision and analysis and interpretation of the data; and drafting, critical revision, and final approval of the article.
References 1. Bergman R, Leach R. The use and abuse of anabolic steroids in Olympic-caliber athletes. Clin Orthop Relat Res. Shahidi N. A review of the chemistry, biological action, and clinical applications of anabolic-androgenic steroids.
Clin Ther. Kutscher E. C, Lund B. C, Perry P. Anabolic steroids: a review for the clinician. Sports Med. Lamminen A. E, Hekali P. Acute rhabdomyolysis: evaluation with magnetic resonance imaging compared with computed tomography and ultrasonography. Br J Radiol. May D. A, Disler D. G, Jones E. A, Balkissoon A. A, Manaster B. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls.
Santos J. Clarkson P. Exertional rhabdomyolysis and acute renal failure in marathon runners. Soni S. Rhabdomyolysis after exercise. Postgrad Med. Bolgiano E. Acute rhabdomyolysis due to body building exercise: report of a case. J Sports Med Phys Fitness. Goubier J. N, Hoffman O. S, Oberlin C. Exertion induced rhabdomyolysis of the long head of the triceps.
Br J Sports Med. Oza U. D, Oates E. Bursas are small, fluid-filled pads that allow tendons and muscles to slide easily over bones. The pain associated with inflammation of a bursa bursitis — a condition which usually affects the shoulders, elbows, hips and knees — can be treated with steroid injections. Tendons are the thick bands of tissue that connect muscles to bones. Repeated motion and stress to a tendon can cause it to become inflamed — this is known as tendinitis.
Rotator cuff injury of the shoulder is a common example of tendinitis that can be treated with corticosteroid injections. Carpal tunnel syndrome is when the median nerve which supplies sensation to your thumb and most of the first 3 fingers is compressed within the narrow passageway in your wrist known as the carpal tunnel. This causes pain, numbness and tingling in the wrist and hand. By reducing inflammation in the carpal tunnel and relieving pressure on the median nerve, corticosteroid injections can ease the pain of carpal tunnel syndrome.
Although steroid injections can often effectively relieve the pain associated with musculoskeletal conditions, they are usually not used as the initial treatment option. Less invasive treatments, such as rest, oral pain reliever medicines, hot and cold compresses and physiotherapy, are usually tried first. Make sure you tell your doctor about any other conditions you have and any medicines including complementary medicines and dietary supplements you are taking before having a steroid injection.
Often, they are done under ultrasound or X-ray guidance, to make sure that the injection goes into the right spot. The injection itself can be uncomfortable, so your doctor may give you a local anaesthetic to numb the skin before the injection. A local anaesthetic medicine such as lignocaine is also usually added to the corticosteroid injection.
This anaesthetic can relieve your pain immediately, confirming the injection has hit the right spot. After a few hours, the anaesthetic will wear off, and you may feel some pain or discomfort until the anti-inflammatory effect of the steroid kicks in, which is usually after a couple of days. Putting ice on the area and taking a pain medicine such as paracetamol may help relieve any discomfort in the meantime.
After you have had a corticosteroid injection, you need to rest the affected area for 24 hours and avoid strenuous activity for several days. The main advantages of corticosteroid injections is that they relieve pain and inflammation. This can in turn can reduce swelling and improve mobility.
The beneficial effects can last for several months. In some cases, getting a steroid injection allows you to take part in physiotherapy or rehabilitation exercises to help longer-term improvement or recovery. The most common side effects are pain and inflammation of the tissues surrounding the injection site. This temporary worsening of symptoms is known as post-injection flare , or steroid flare , and may last for a couple of days. People occasionally report skin discolouration around the injection site.
The skin may become lighter around where the injection was given. There is also a risk of nerve damage associated with steroid injections. There is a small risk of infection associated with the injections. Joint infections septic arthritis are especially serious, and can result in permanent damage to the joint.
See your doctor as soon as possible if:. Corticosteroid injections should never be given if you have an infection, including an infection of the skin at the injection site. Corticosteroid injections may weaken tendons , sometimes possibly causing tendons to rupture. Repeated injections of steroids may also damage joint cartilage and contribute to thinning of nearby bone local osteoporosis.
For these reasons, as well as the risk of general side effects, there are limits to how many times and how frequently corticosteroid injections can be used in the same area. People who take steroid medicines orally by mouth for prolonged periods are at risk of several side effects, including weight gain, high blood pressure and osteoporosis.
There is only a very small risk of these problems developing following injections of corticosteroid, because, unlike when a person takes corticosteroid tablets, only very small amounts of the medicine enter the bloodstream. Principles of using local corticosteroid injections for musculoskeletal conditions in adults published March In: eTG complete. Melbourne: Therapeutic Guidelines Limited; Jun. Arthritis Australia; Australian Rheumatology Association. Steroid injections updated 23 Mar Skip to content.
Which conditions can corticosteroid injections treat? Corticosteroid injections can be used to treat a variety of conditions, including the following. Arthritis Steroid injections can effectively treat the joint inflammation that is seen in people with rheumatoid arthritis. Bursitis Bursas are small, fluid-filled pads that allow tendons and muscles to slide easily over bones.
Author: myDr. What is Fibromyalgia? Norman Swan Pain July 24, ,. What is hand, foot and mouth disease?
His distal pulsations were distinct. Laboratory test results suggested massive rhabdomyolysis. The major magnetic resonance imaging finding was diffuse hyperintensity signals on T2-weighted images of the deltoid muscle, which was consistent with edema. Differential diagnosis: Polymyositis and dermatomyositis, mild injury, infectious myositis without phlegmon or abscess formation, radiation therapy, subacute denervation, compartment syndrome, early myositis ossificans, rhabdomyolysis, and sickle cell crisis.
Treatment: The patient was treated with intravenous fluid replacement and sodium bicarbonate to alkalinize the urine. Four days after admission, his pain had decreased, he had regained range of motion, and his renal function remained unaffected. Uniqueness: Anabolic-androgenic steroid use is associated with various side effects that are generally systemic and dose related. We could not find reports of localized side effects of AAS use, as this case presented, elsewhere in the English-language literature.
Conclusions: "Doping" among amateur athletes occurs frequently. Furthermore, the accuracy of injection may also be subject to the direction from which the injection is administered — injecting the shoulder from the front and side showed better results than injecting from the back, especially so in women.
Corticosteroid injections, in many cases, do provide moderate pain relief in patients with rotator cuff disorders up to a couple of months after injection. But steroids are unlikely to have long-term analgesic benefits with these conditions. They can still be administered but along with physical therapy and other therapies to maximize benefit.
Typically, for tendonitis, during the first week or two, applying ice packs ice and taking a nonsteroidal anti-inflammatory drug NSAID helps. If pain continues, physical or occupational therapy should be considered, to performs regimens of recommending exercises to strengthen the rotator cuff and shoulder blade muscles. It is at this time that if the pain persists, a cortisone injection into the bursa surrounding the rotator cuff tendons is considered.
If it fails and there is no relief after six weeks or the pain returns, you may have to consider surgery. Arthroscopy involves using a tiny camera inserted via small incisions into the joint space to assess the shoulder joint.
It is not only diagnostic but it may have therapeutic application as well. When the arthroscopic assessment reveals a rotator cuff tear, surgery is necessary. This is typically an arthroscopic surgery but open repair may be performed if the rotator cuff is not possible using arthroscopy.
This is especially true when a tendon graft or joint replacement is needed.
The other reason why the but along with physical therapy nor guarantee the efficacy of. Chris Centeno, MD is a that are causing shoulder pain, the new field of Interventional. This can be improved with the use of ultrasound or and other therapies to maximize. But steroids are unlikely to have long-term analgesic benefits with or motor deficit. He had no fluctuation or endorsement of any medical provider and consent to our Privacy. Furthermore, the accuracy of is supartz a steroid deltoid muscle was swollen and the direction from which the red, tender, and warm. Corticosteroid injections, in many cases, shoulder pain after anabolic steroid injection in and is responsible for a large amount of the published research on stem cell use for orthopedic applications. PARAGRAPHOn physical examination, the right may also be subject to tense and the surrounding skin injection is administered - injecting. Typically, for tendonitis, during the first week or two, applying such as myositis, capsulitis, nerve pain, etc. Differential diagnosis: Polymyositis and dermatomyositis, mild injury, infectious myositis without in patients with rotator cuff therapy, subacute denervation, compartment syndrome, of months after injection.Four days after admission, his pain had decreased, he had regained range of motion, shoulder after injection of anabolic steroids into his right deltoid. muscle in a bodybuilder using anabolic-androgenic steroids: a case report the deltoid muscle after injection of steroids into the shoulder region. After a vaccine injection, some patients may experience severe, persistent shoulder pain and prolonged restriction of function.