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 facet arthropathy
Frozen Shoulder/Adhesive capsulitis
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.
Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.
In situations where the pain is disabling severe and not allowing you to do the day-to-day chores, medications have proven inadequate to reduce the pain; injections are targeted to be given either under x-ray guidance or ultrasound guidance at the presumed sources of pain. Injections mainly consist of local anaesthetic with or without steroid. This works as anti-inflammatory at the source of pain.
Injections are not a permanent cure. Injections help by reducing the intensity of pain. The aim is to reduce pain and break the cycle of pain, allow you to carry out rigourous physiotherapy and help and healing. We may have to repeat injections in order to achieve the goals.
There are other injections available when nerves can be ablated (burnt) or we can apply what is called a radio-frequency lesioning at lower temperatures. These treatments have intermediate to long-term benefits and also work to reduce inflammation. These can be offered if the initial injection does not last long enough to follow on with strengthening Physiotherapy. These injections are not operations or permanent treatments. They are used to improve your condition of pain in order for you to carry out rehabilitative strengthening physiotherapy and come out of the vicious cycle of pain.
We can offer you Non-injection interventions such as acupuncture. We can introduce you to other means of self management of pain such as using a TENS machine . We have a modalities to offer at our clinic for example Medical yoga therapy, deep electrical muscle stimulation, TENS treatment. If the pain is unbearable, not responding to medications, or you do not want to try the non-invasive modalities ; we could offer you injection therapies.
You will have a detailed consultation, examination and then be given information and advice about your condition. We may also organise investigations. We may be able to prescribe you medication and give you details about how to manage pain and other interventional options can be discussed.
You will be reviewed only by MACS clinic senior Pain Consultants for your condition.
If your pain is very severe, not responding to over-the-counter painkillers you should contact your GP and get an appointment for review. If you are in severe disabling pain, unable to carry out any routine tasks, you could book an emergency appointment with your GP or go to the local A&E for a review.
Shoulder and arm pain of new onset should be assessed by your GP and if indicated, you would be referred to an orthopaedic surgeon or specialist physiotherapist. Clinical assessment would enable them to give you a working diagnosis. You may require X-rays and scans and sometimes blood tests are indicated confirm the diagnosis.
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