Question: Hi - not sure if you can help me - I had 1 cc of 40mg Kenalog and 1cc of 0.5 marcaine without epinephrine in early March for a cortisone injection to my right knee. I had a terrible reaction and went to the ER 2.5 days later the worst symptoms were high blood pressure, stabbing/squeezing in my left side of neck and right shoulder. Although they subsided - the pain in my right shoulder and how arm and tingling in my right hand has not gone away. I am trying to understand why this happened and trying to get the insurance co to pay for treatment for my shoulder. I had no reaction 6 months earlier when I had 2 cc kenalog and 6cc of lidocaine. Any ideas why I may have reacted so violently to the kenalog and marcaine? Thanks so very much!

Hi Dr XXXXXXX XXXXXXX XXXXXXX
Thanks so much for your reply.
1)How long does the cortisone take to affect the whole body - as I got injected on the Thursday afternoon?
I felt giddy/strange by the evening, various side effects and a very red face on Friday eve, along with bloating of stomach, really nasty fat deposits in tummy/weight gain- that still don't seem to have left, feeling that I have drunk 20 cups of coffee.
By the Sunday morning I was emotionally tearful, didn't want to be left alone, shaking, high blood pressure on approx 138/88 compared to 96/72, then squeezing in left side of neck and squeezing/stabbing in right shoulder - at which point I went to the ER - I thought I was having a heart attack or stroke. I still have the pain in my shoulder which has got worse when moving it or at rest, now down my arm, muscle twitches and tingling/numbness in my right hand. I have never had shoulder/neck problems in the past and this came on within a couple of days from the cortisone injection.

I have had been to physiotherapy, acupuncture which has made no difference. However I had 2 sessions of chiropractor work and it felt that the nerve pain lessened however it has come back again.

I have never smoked. My blood sugar is within normal limits. I have had X-rays done on my shoulder but have not been told if there are any changes in the bone.

2)Because of what I had described and the symptoms have come on so quickly, in your opinion would it not be more likely that the marcaine is the more reasonable cause to all my symptoms, including stabbing/shoulder pains in right shoulder and left neck within 3 days of the cortisone injection to the knee as opposed to cervical spondylitis? I literally felt I was going to die. (At the time in March, I was not doing any heavy lifting or repetitive work, I was off work resting in order to see if rest would improve my knee pain without having surgery.)

I look forward to hearing from you and thank you very much in advance.

Hi Dr XXXXXXX XXXXXXX XXXXXXX
Thanks so much for your reply.
1)How long does the cortisone take to affect the whole body - as I got injected on the Thursday afternoon?
I felt giddy/strange by the evening, various side effects and a very red face on Friday eve, along with bloating of stomach, really nasty fat deposits in tummy/weight gain- that still don't seem to have left, feeling that I have drunk 20 cups of coffee.
By the Sunday morning I was emotionally tearful, didn't want to be left alone, shaking, high blood pressure on approx 138/88 compared to 96/72, then squeezing in left side of neck and squeezing/stabbing in right shoulder - at which point I went to the ER - I thought I was having a heart attack or stroke. I still have the pain in my shoulder which has got worse when moving it or at rest, now down my arm, muscle twitches and tingling/numbness in my right hand. I have never had shoulder/neck problems in the past and this came on within a couple of days from the cortisone injection.

I have had been to physiotherapy, acupuncture which has made no difference. However I had 2 sessions of chiropractor work and it felt that the nerve pain lessened however it has come back again.

I have never smoked. My blood sugar is within normal limits. I have had X-rays done on my shoulder but have not been told if there are any changes in the bone.

2)Because of what I had described and the symptoms have come on so quickly, in your opinion would it not be more likely that the marcaine is the more reasonable cause to all my symptoms, including stabbing/shoulder pains in right shoulder and left neck within 3 days of the cortisone injection to the knee as opposed to cervical spondylitis? I literally felt I was going to die. (At the time in March, I was not doing any heavy lifting or repetitive work, I was off work resting in order to see if rest would improve my knee pain without having surgery.)

I look forward to hearing from you and thank you very much in advance.

Hi!
Thanks so much for emailing me again, I am so sorry I have so many questions.

Just to clarify I did not have the shoulder pain a long time after the initial injection into my knee. I had the squeezing in my shoulder and arm at the ER within 3 days of being injected with cortisone in my right knee.

With my blood pressure going up dangerously high at the ER related from the marcaine and cortisone - would it be fair to say that if I had nerve damage at that time, (squeezing and stabbing)is it a possibility that the nerve compression or the impingement, with my body in fight or flight mode be caused by the marcaine and cortisone? And the nerve damage that happened at that time could stay in the body until it is released?

Thank you very kindly.
XXXX