Shoulder pain is common and the incidence increases with age.  Arm and shoulder can get injured or strained easily and pain is a common symptom even the original injury has healed.  This can interfere with daily activities and quality of life.  The shoulder joint is ball and socket joint with the socket providing only a narrow area making it prone to dislocation and strain; the muscles around the rotator cuff supports and stabilises the joint, hence are important to pain management.  Shoulder pain could be referred from the neck or even the diaphragm and internal organs.

Common Conditions treated at Pain Clinics:

Cervical spondylosis

Cervical stenosis

Cervical facet arthropathy

Disc prolapse

Frozen Shoulder/Adhesive capsulitis

Subacromial impingement

Tennis/Golfer’s elbow

Carpal Tunnel syndrome

Arthritis- shoulder, acromio-clavicular

Post mastectomy pain

Sudden onset pain is usually due to trauma resulting in fracture or dislocation.  Spontaneous shoulder dislocation can occur in some people.  It is usually associated with muscle spasm and stiffness.  Exquisite tenderness could be elicited at the site of injury.  Shoulder joint is a common site for osteoarthritis and can cause pain and stiffness.  Pain radiating from the neck could be radiated to the shoulder; this could be accompanied by tingling, numbness and neuropathic pain.  Referred pain from angina or from a diaphragmatic or pleural pathology can be experienced in the shoulder as diffuse pain.

The treatment of the acute problem is mainly treating the cause; it could be pain-killers and resting the joint for the inflammation to settle down.  It could also be managed pro-actively by treating the anatomical cause of the pain.  In the absence of a specific pathology, simple analgesics and topical treatment with hot packs and mobilisation exercises would improve the situation.

Chronic pain is usually managed by Pain Consultant and is usually when there is persistent pain even after the suspected pathology has been addressed.  After a comprehensive assessment, several treatment options would be discussed.  The aim would be to have functional restoration through various physiotherapy and psychological treatments and for this to be successful, good pain relief is essential.  The following options are available.

• Medications – This could range from simple over the counter medications to strong opioids or neuropathic pain medications. Topical NSAIDs and Capsaicin creams have been used to provide symptomatic relief.
• Pain interventions
• • Injection therapies with or without steroids are used to target the cause of pain in and around the area of pain. This can include nerve blocks (suprascapular nerve block), targeting the neck or even sympathetic system to achieve pain relief.
  • Radiofrequency (pulsed and thermal) is used to achieve long term pain relief.
  • Neuromodulation techniques include spinal cord, dorsal root ganglion and peripheral nerve stimulations.
• Surgery – Most cases are referred to the Pain Consultants after a surgical opinion. However, there are situations where we may have refer for surgical options if it is deemed appropriate.
• Rehabilitation
  • Most of the musculoskeletal pains are best managed in a multimodal fashion with regular input from specialist physiotherapists. The Pain Consultants would work closely with the therapists to enable the best outcomes.