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MACS PAIN CLINIC

Tel: 07868118976
Arm & Shoulder Pain

Arm and shoulder pain

ARM PAIN & SHOULDER PAIN

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

SYMPTOMS & SIGNS

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.

  • CAUSES OF SHOULDER & ARM PAIN
  • Pain from the joint itself: The shoulder joint complex comprises of the glenohumeral, acromioclavicular and coracoclavicular joint connecting the upper limb to the shoulder blade.  The former is a common site for osteoarthritis as well as adhesive capsulitis commonly known as a frozen shoulder.  Dislocation or sprain of the shoulder joint are not uncommon.  The shoulder joint could be affected by metastatic cancer causing severe boone pain.
  • Pain from the Rotator cuff
    • The muscles of the rotator cuff can become weak and be a source of pain; it can also cause severe muscle spasm and related pain.
    • Impingement of the muscles or tendon can cause severe pain and restriction of movement
    • Inflammation of the bursa (bursitis) is another common cause of pain.
    • Biceps tendonitis is when there is inflammation and restriction of movement.
    • Myofascial pain arises from the surrounding muscles, tendons and ligaments around the shoulder. Trigger points that could be very tender could be identified in some cases.
    • Nerve pain
      • The commonest cause of nerve pain in the shoulder is cervical brachialgia where the nerve roots in the neck are feeling “pinched” due to a variety of causes.
      • Infiltration of the brachial plexus due to cancer of the lung or breast can radiate to the shoulder and arm.  Thoracic outlet syndrome is when the nerves are compromised between the collar bone and first rib.  This could be due to pregnancy, injury or presence of a cervical rib.
      • Central Neurological conditons like Multiple Sclerosis or post-stroke pain can cause shoulder pain.  Shingles and post-herpetic neuralgia can affect the shoulder and arm
      • Post-surgical nerve pain can occur around the shoulder or arm especially after joint replacement or decompression surgery.
  • Complex Regional Pain Syndrome is a serious condition associated with pain and swelling with debilitating pain and loss of function.  It is important that diagnosis is made early and prompt treatment initiated.
  • Referred pain – Pain can be referred to the shoulder and arm from the neck, but also from abdominal problems like cholecystitis and diaphragmatic pathology.  Chest pain due to angina can classically radiate to the left shoulder.  These pains should be investigated and managed without any delay
  • Specific Causes of Upper Limb pain –
    • Tennis elbow and golfers elbow are common conditions affecting the elbow and radio-ulnar joint.
    • Carpal tunnel syndrome and Dupyutren’s contracture are causes of wrist pain.
    • Hand and finger pains are associated with osteoarthritis, rheumatoid arthritis and tenosynovitis (inflammation of the tendon sheath)

TREATMENT

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.

Frequently Asked Questions

Q: What are the side-effects of injections?

A:

Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.

Q: How can injections help in pain management?

A:

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.

Q: What can I do if I do not want medications for my pain control or medications have not helped, or I get too many side-effects from medications?

A:

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.

Q: What will happen then ?

A:

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.

Q: Who will be seeing me?

A:

You will be reviewed only by MACS clinic senior Pain Consultants for your condition.

Q: If I am unable to get a GP appointment or don’t want to wait for any appointments how can I get in touch with you?

A:

You could phone us On (020) 7078 4378 or 07868118976; from 9 am to 6 pm; to book an appointment. You could also email us on info@macsclinic.co.uk or you could also get in touch with us on our website www.macsclinic.co.uk

Q: I am concerned about my pain. What should I do?

A:

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.

HOW DO I GET A DIAGNOSIS?

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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