| Shoulder Pain |
There are several reasons for shoulder pain. Age and whether there was an acute event prior to the onset of pain are the most relevant features.
Lets be clear common things are common.
The most common problem over the age of 35 with a gradual onset is impingement due to a problem with the rotator cuff . This cuff of muscle and tendons support the shoulder in its socket and can easily become painful with overhead activity.
We diagnose it based on clinical examination and diagnostic ultrasound scan of the shoulder
We can treat this condition quickly with an ultrasound guided injection into the painful target tissue followed by good physiotherapy.
Frozen Shoulder
Frozen Shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable. Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the shoulder. The condition goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take an awfully long time, sometimes as long as two or more years.
Frozen shoulder may be associated with diabetes and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture.
Risk Factors:
Trauma, surgery, diabetes and middle age.
A typical frozen shoulder develops slowly, and in three stages.:
Stage One: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.
Stage Two: Pain begins to diminish, however, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4 to 12 months.
Stage Three: The condition may begin to resolve. Most patients experience a gradual restoration of motion over the next 12 to 42 months
Treatment
The goal of treatment is to reduce pain and improve the range of movement. The fastest way to do this is via injecting the joint accurately followed by a good physiotherapy rehabilitation regime to restore the normal movement patterns. Injections reduce inflammation and provide pain relief.
If the injection therapy does not work Surgery may be indicated, it is more likely to be needed in Diabetics.
Surgery Surgery has been shown to be of benefit in both the early and later stages of a Frozen Shoulder. It is excellent for both pain relief and restoring movement, although intensive physiotherapy is essential after the surgery. This involves a manipulation of the shoulder under anaesthetic for most cases. Some people may require surgical release of the tight shoulder capsule done with keyhole (Arthroscopy)
Calcicific Tendinitis is an acutely painful condition affecting the shoulder. It comes on usually with no warning and presents with acute pain in the shoulder often referring down the arm. It is common in females and more common in the 30 - 45 age range.
Treatment
The goal is pain reduction this is rapidly achieved with an ultrasound guided injection into the affected tendons bursa shown below. This is followed with good structured physiotherapy.
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