Shoulder Pain Treatment

As a doctor with a special interest in shoulder pain I get asked a lot of questions about steroid injections.

"Will a steroid injection help my shoulder?"

"Is a cortisone shot dangerous?"

"Are steroid injections for the shoulder painful"

I must have answered a thousand emails on the subject over the years, I've given lectures about it and written articles for books and journals. And so .... at last you might say .... I've pulled all that I know together for your benefit. I've been busy crafting a detailed series of expert reports on topics related to neck and shoulder symptoms. One of the most popular is the one about Steroid Injections for Shoulder Pain.

Take a look - I hope you like it.

Labels: cortisone injection, cortisone shot in shoulder, frozen shoulder, pain after shoulder injection, shoulder injection treatment, steroid injection, steroid injection into the shoulder, steroid shot

Shoulder and back pain can be closely related - sometimes one leads to another and sometimes the two share a common source related to nerve entrapment.

The shoulder joint and all of its muscles and soft tissues are derived from the same part of the embryo as the fifth vertebra and nerve of the neck. This means that lower neck pain and shoulder area pain can be directly related.

Sometimes shoulder pain and back pain between the shoulder blades can also occur. Irritation of the lower segments of the neck will typically send pain down into the area between the shoulder blades - this pain is called referred pain. It is often dull and aching in quality and made worse by movements of the neck. This type of shoulder related back pain often causes trigger points to form in the muscles and these can be felt as acutely tender spots.

Labels: back pain, frozen shoulder, pain control, shoulder and back pain, shoulder blade, shoulder nerve, shoulder pain

The science behind frozen shoulder has always been somewhat mysterious.

Frozen shoulder experts often disagree on whether the problem is truly due to inflammation or not - some say that an auto immune reaction happens in the gristle around the shoulder.

Fibroblasts are cells that control wound healing and tissue repair. Some previous research has blamed overactive fibroblasts in the trigger of frozen shoulder.

A new study has looked at this in more detail. The aim of the study was to take fluid from the shoulder joint of patients with frozen shoulder and to see if this fluid affected fibroblast cells in a laboratory test tube. They also took fluid from patients without frozen shoulder for comparison.

The fluid from frozen shoulders caused a marked increase in the test tube fibroblast activity.

These findings demonstrate that fluid from shoulders with frozen shoulder contains chemicals or growth factors that influence fibroblast activity - and this may well be the basic trigger for the frozen shoulder process.

Labels: cause of frozen shoulder, frozen shoulder, shoulder pain

Doctors are using synovial fluid replacement products to treat frozen shoulder pain and shoulder arthritis. Several synovial fluid replacement products exist but the commonest one used for shoulder pain is Hyalgan.

Hyalgan is mostly used for knee arthritis in patients who have not responded to simple treatment options.

However, a recent study presented at the American College of Rheumatology Annual Scientific Meeting suggested that Hyalgan may be beneficial for patients with arthritis pain in the shoulder.

More than 600 patients were studied. They suffered from moderate to severe shoulder pain due to arthritis, rotator cuff muscle pain and adhesive capsulitis or frozen shoulder.

The study showed that patients who received three or five weekly injections of Hyalgan over a six-month period had a statistically significant reduction in pain.

The results seem to show that Hyalgan relieves shoulder pain in most patients with osteoarthritis of the shoulder.

Other doctors recently have used hyalgan and other synovial fluid replacement products to treat chronic shoulder pain that has not responded to intraarticular steroid injections.

The synovial fluid replacement products seem to work best for people who have an osteoarthritis element to their shoulder problem,

No one knows how hyalgan actually works inside the joint but recent research suggests that Hyalgan works inside the cartilage cells to block inflammation pathways.

Labels: arthritis, frozen shoulder, shoulder pain, steroid treatment

There is now serious concern amongst experts that cases of frozen shoulder are on the increase.

Doctors have different possible explanations for this but surgeons at the Mayo Clinic say that they think frozen shoulder is becoming more common because of the increase in obesity, diabetes, and an aging population.

Frozen shoulder is a condition in which the shoulder capsule contracts or becomes inflamed, causing adhesions and scarring that "freeze" the shoulder. Inactivity after even a minor injury can bring it on, though it usually begins spontaneously.

Symptoms include pain in the shoulder, especially when attempting to raise the arm. When raising an arm straight up, normal range of motion allows the arm to be raised as high as top of the head. A person with severe frozen shoulder can move a straight arm only waist high or lower. Orthopedists say that if patients and doctors understood the risks and symptoms, the disorder could be successfully treated by physical therapy.

Early diagnosis when the condition is still "freezing" is the key. Early therapy lessens the severity and lifespan of the disease.

Currently, about six million people in the U.S. suffer from the condition. About 10 percent to 20 percent of diabetics will have it at one time or another. And women are affected somewhat more often than men.

Shoulder ligaments are normally elastic and tighten when you reach up high. In a frozen shoulder, the joint gets smaller. Ligaments adhere to the shoulder or tighten at its resting position. Movement becomes painful and difficult, or even impossible.

Doctors have also found that a shot of cortisone into the shoulder may prevent a full-blown case of the disease. For severe cases, surgery is required. But for many with advanced frozen shoulder, full range of motion will not be achieved.

Labels: arthritis, frozen shoulder, shoulder pain, steroid treatment

A new review of the evidence has been undertaken to assess whether those with frozen shoulder or adhesive capsulitis might benefit from a short course of oral steroid tablets.

The studies tested people who had adhesive capsulitis for about 6 months.

They were given no treatment, fake treatments, steroid injections or oral steroids.

Oral steroids, such as prednisolone or cortisone were given for about 3 to 4 weeks, and sometimes again for another 3 to 4 weeks if people still had pain and stiffness. All people had physiotherapy or an exercise programme while taking the steroids.


Benefits of oral steroids for adhesive capsulitis or frozen shoulder

In people with adhesive capsulitis, at 3 weeks, oral steroids may work more than fake pills:

• 48 out of 100 people who took fake pills said they were better
  
  ­96 out of 100 people who took steroids said they were better

Oral Steroids may decrease pain and disability more than fake pills ­- the studies show that pain may decrease by 2.7 more points on a scale of 0 to 10 with steroids

­Researchers also found that disability may decrease by 18 more points on a scale of 0 to 100 with steroids and that oral steroid tablets may increase the ability to move the shoulder more than fake pills - ­shoulder movement increased by 23 degrees

But these benefits did not last as long as 6 weeks so there is not enough evidence to be certain of the results beyond 3 weeks.

Oral steroids may also improve pain earlier and quicker than no treatment at all. But after 5 months there were no benefits of oral steroids over no treatment. There is also not enough evidence to be certain of the results.

Harms of oral steroids
In people with adhesive capsulitis who have no serious other problems, taking oral steroids for a short time may not cause serious side effects. But there is not enough evidence to be certain. Other research about steroids taken over longer periods of time shows that harms could include high cholesterol and high blood pressure.

Read more about frozen shoulder treatment

Labels: frozen shoulder, shoulder pain, steroid treatment