Shoulder Pain

Shoulder Pain

Shoulder Pain

  • Shoulder joint is a very complex joint and injuries and wear and tear changes could lead to disability secondary to shoulder pain especially in older age groups.


  • Pain could arise from shoulder joint because of mix of reasons such as tear in the muscles supporting shoulder joint called rotator cuff muscles, shoulder joint itself, or small joints around such as acromioclavicular joint or entrapment of a muscle tendon in tight space such as shoulder impingement syndrome.


  • Huge part of management lies in understanding the underlying pathology because some treatments that fit for one reason could be totally contraindicated in another hence careful history taking and examination is very important.


  • Conservative measures are usually the starting point using physiotherapy and simple pain killers.


  • If the pain is too severe then reassessment is done along with communication with our shoulder orthopaedic surgery colleagues to see if there is indication for surgical intervention.


  • In the interim we offer our patients a range of interventions to address their pain and improve their function.


  • Dr Alkholany offers his patients block of the nerves that supply shoulder joint namely suprascapular and axillary nerves with local anaesthetic and steroids guided by ultrasound as day case procedure and usually this, along with physiotherapy program is enough to reduce pain and regain function. Pulsed radiofrequency could be applied to those nerves as well to modulate how they function and give patients longer term pain relief.


  • Sometimes this could be coupled up with interventions such as glenohumeral hydro dilation if there is severe stiffness in shoulder joint usually known as frozen shoulder.


  • On other occasions Dr Alkholany could opt for conventional or cooled radiofrequency ablation of the nerves that supply the shoulder joint namely, Suprascapular, Axillary and Lateral pectoral nerves as day case guided by X ray. This needs to be preceded by diagnostic block of those nerves using plain local anaesthetic guided by X ray as day case procedure and if patients achieve good quality pain relief even for short period of time this is when a decision about conventional radiofrequency ablation is made.


  • Sometimes the shoulder problem is too complex that it needs surgical intervention and sometimes if patients are not fit for surgical interventions for various reasons, then optimising their medications, tailing a rehabilitative program to maintain reasonable margin of function around their shoulders and developing acceptance and coping to a degree of pain and limitation in function is the way forward with their management.
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