Shoulder Pain Management

It can be very troublesome because they impede many movements essential for daily activities of life and interfere with sleep.

The shoulder is an unstable joint in that the socket is very shallow and the head is almost the same size as the socket. As a result, nature has devised ligaments and heavy muscle cover to provide stability. So, it is a contradictory responsibility for muscles in that they provide mobility as well as stability. As a result, muscles are vulnerable to injuries.

Types Of Shoulder Pain:

Frozen Shoulder

Usually occurs because of adhesive capsulitis or rotator cuff tears. Adhesive capsulitis refers to a condition where the cover of the shoulder joint called the capsule becomes inflamed and as a result causes severe stiffness of all the muscles of the shoulder. This stiffness ‘freezes’ the shoulder making most movements difficult or impossible. Frozen shoulder is common in diabetics, women, after shoulder injuries or dislocations, pacemaker insertions and chest and cardiac surgery. it causes severe continuous pain that does not allow them to rest at night because it causes pain in most sleeping positions and just does not let up.

Rotator Cuff Tears

Also cause similar pains and restrictions but the cause is a tear in the rotator cuff which surround the head at the upper end of the arm bone humerus. There are 4 muscles that insert into the cuff to move the humerus in various directions. Any tear in this cuff will restrict these movements and make them very painful. Microtears are common and may not heal well particularly with deficiencies of vitamin D3 and B12.

Osteoarthritis of shoulder joint is not a very common occurence
Neck problems like compression of nerve by cervical disc
Entrapment of nerve root by deep cervical muscles, part of shoulder hand syndrome,
A type of neuropathic pain and rarely because of brachial plexus injuries.

Signs and Symptoms :

Shoulder issues can present with pain at the shoulder, gradual loss of range of movements at shoulder joint. Patients cannot do activities like combing their hair, removing a T shirt etc. Extreme movements aggravate the pain at the joint.

Prevention:

Regular exercise to keep the muscles and ligaments supple and the joints mobile. Corrections of deficiencies helps heal microtears as they form. Adequate sleep is essential for maintaining muscle health.

Treatments:

Lifestyle Changes: Medications/pharmacotherapy; is the most user friendly treatment from simple paracetamol (which has a surprisingly good anti-inflammatory effect), non steroidal anti-inflammatory drugs, tramadol etc. Addition of a neuromodulator medication helps tremendously in improving patient comfort.

Physiotherapy: Hot and cold packs, Electrical modalities like TENS, Interferential current along with stretching exercises help tremendously in helping patients.

Injections: steroid injection into the joint, trigger injections into the muscles, followed by physiotherapy. At AIPMR, we have found that there is not just one structure but several which cause the shoulder pains and we systematically inject into all these areas.

Platelet Rich Plasma : (PRP) treatment uses the patient’s own blood which is drawn just before the procedure and centrifuged till the PRP is separated from the blood. PRP is injected into the joint to heal and regenerate cartilage, and into tears to heal tendons. These injections are with ultrasound guidance so that we look at the tendons as we inject.

Pulsed Radiofrequency Treatment : We address all the nerves that supply not just the shoulder joint but also all the muscles that move the shoulder so that there is a global relief of pain . This is followed by our specialty treatment called ultrasound guided dry needling (USGDN ) of all the muscles responsible for shoulder movements to relax them. This double pronged treatment of nerves and muscles ensures that our patients not only get pain relief but also regain their painless movements.

In severe cases, we use botox to relax muscles quickly and to reduce the pain of USGDN. One session of botox achieves as much relaxation as about 5-6 sessions of USGDN.

Shoulder Pain Management

Types Of Shoulder Pain:

Frozen Shoulder

Frozen Shoulder

Rotator Cuff Tears

Rotator Cuff Tears

Signs and Symptoms :

Prevention:

Treatments:

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