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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
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Carpal tunnel syndrome and
frozen shoulder problems often seem to occur in the same patients - sometimes at the same time but sometimes many months apart.
Carpal tunnel syndrome is a problem with irritation of the median nerve - one of the main nerves that runs from the forearm into the hand.
The median nerve runs on the palm of the hand side of the forearm - entering the palm of the hand at almost exactly the mid point of your wrist crease. It supplies power to the muscles of the thumb and sensation to the skin of the thumb and the first three fingers - sometimes also to a bit of the fourth or ring finger too. To get into the hand the nerve has to pass through a tunnel of bones and gristle. This tunnel is called the carpal tunnel - so the problem of nerve entrapment there is called
Carpal Tunnel Syndrome.
The commonest reason for carpal tunnel syndrome to develop is when the median nerve is squeezed in the tunnel. This often happens during pregnancy or in diabetic patients or in those with an under active thyroid gland. Often no cause is found at all - it just seems to start from nowhere and this is called
Idiopathic carpal tunnel syndrome.
Sometimes however, carpal tunnel syndrome can arise as a later consequence of frozen shoulder. The median nerve arises from nerve roots that run in the armpit or axilla - just below the shoulder in other words. This group of nerve roots is called the brachial plexus and a good going frozen shoulder can affect the brachial plexus and thus eventually lead to carpal tunnel syndrome.
Labels: carpal tunnel syndrome, cause of frozen shoulder, diabetes joint pain, nerve pain shoulder, shoulder pain
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Does
manipulation for frozen shoulder work?
Manipulation as a treatment for shoulder pain has been around for a long time. The word manipulation can be applied in several different ways.
When we think of shoulder pain in general then physiotherapists will use mobilisation or hands on type manipulation of the shoulder as a means of improving movement range in the joint and thus reducing the symptoms. Osteopaths or chiropractors will do much the same thing - and you might often find that your neck or back is treated at the same time. Not a bad idea actually since shoulder pain and neck pain or upper back pain often go hand in hand.
Manipulation for frozen shoulder is a slightly different issue however. Historically this has been a technique used when the patient is deeply asleep under a general anesthetic and the procedure is performed in an operating theater.
We know that frozen shoulder creates sticky adhesions inside the joint and we think that its these sticky areas that lead to the loss of movement. Manipulation of the shoulder under general anesthetic is a way of trying to force these adhesions apart - thus releasing the stuck shoulder and improving both pain and movement. This type of
frozen shoulder manipulation seems to work but it's a very powerful - almost brutal technique - and there have been several reports in the past of arm bone fractures and other problems.
More modern (and more gentle) approaches include using keyhole surgery to break up the sticky adhesions.
Labels: cause of frozen shoulder, frozen shoulder manipulation, manipulation of the shoulder, shoulder injury, shoulder pain
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Shoulder nerve pain is not common but it can arise for a number of reasons. The shoulder joint and all the muscles that surround it get their nerve supply from the same part of the spinal cord that supplies the fifth segment of the neck. This is called the C5 segment of the neck.
Pain from the C5 segment of the neck (or from the shoulder joint and the tissues that surround it) is felt from the top of the arm, down over the outer part of the elbow and towards the hand. This type of shoulder nerve pain is called referred pain.
The shoulder nerve is also called the suprascapular nerve - it runs above the spine of the shoulder blade bone - passing through a little notch - to supply the joint and its muscles.
Some specialist doctors can inject this suprascapular shoulder nerve as a treatment for chronic shoulder pain.
Read more about your
shoulders by following the links on these pages
Labels: nerve pain shoulder, rotator cuff pain, shoulder nerve, shoulder pain
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Shoulder tendonitis is the name given to the condition where the tendons of the shoulder muscles become inflamed. The suffix "itis" means inflammation - think of tonsillitis, dermatitis, appendicitis and the likes. A tendon is the gristle that joins muscle flesh onto bone so "tendonitis" is inflammation in a tendon.
Shoulder tendonitis can be treated by physical therapy, by acupuncture, by exercises or stretches or sometimes by injection of a steroid.
Rarely
tendonitis at the shoulder can progress or deteriorate into a rotator cuff tear.
Read more about your
shoulders by following the links on this page
Labels: rotator cuff, rotator cuff pain, shoulder pain, shoulder tendonitis, shoulder tendons
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Shoulder Replacement
Shoulder replacement is the name given to the surgical technique of inserting a new artificial shoulder joint into the body.
Shoulder replacement surgery is becoming more and more common and the success rate is now very good. Even though fewer shoulder joints are replaced compared to hips and knees the procedure is rising in popularity for two reasons. Firstly, arthritis in the shoulder is less common than it is in the lower limb joints - and, secondly, fewer surgeons are trained in shoulder replacement techniques at present. New techiques are changing things fast however and
shoulder replacement operations are getting better and better all the time.
If you need help to deal with pain in your
shoulders then follow the links on these pages.
Labels: shoulder joint replacement surgery, shoulder pain, shoulder replacement, shoulder surgery
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Zocor and Shoulder Pain
Can treatment with the anti-cholesterol drug trigger
shoulder pain. Zocor or simvastatin as it is sometimes known is one of the most commonly used cholesterol medications in the world.
In general terms zocor is a fairly straightforward drug for most of those who take it but it can trigger joint and muscle pains in some people. The pain caused by zocor is usually quite diffuse in nature but I've had several email questions recently from people with
zocor related shoulder pain.
It may be that these people are making heavy use of their shoulder muscles and thus triggering discomfort which is aggravated by zocor. I'm really not sure of the true trigger for the situation.
You should be aware of this however:
Zocor triggers benign low grade joint and muscle pains in maybe around ten percent of those who take it. This includes zocor shoulder pain. These pains are usually transient and easy to cope with.
More rarely, zocor can cause a severe widespread muscle reaction that can lead quite quickly to serious ill health. Your doctor could pick up on this with a simple blood test. If you are concerned then please see your doctor at an early opportunity.
Labels: muscle injury, shoulder pain, zocor
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Frozen Shoulder - New Scientific Evidence
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
Are you struggling with shoulder pain?
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Shoulder Pain Talk
I'm always on the look out for new high quality
shoulder pain resources on the internet.
Dr Mike Carroll MD has created an extensive new blog site called
Shoulder Pain Talk - it covers a wide range of different aspects relating to shoulder pain - including
rotator cuff injury and
shoulder replacement surgery.
Many other topics are also covered with up to date research and information explained in clear and easy terms.
Take a look at Mike's site - it's a good complement to the frozen shoulder information available in the Joint Enterprise site.
Labels: rotator cuff pain, shoulder pain, surgery
Are you struggling with shoulder pain?
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A New Way To Treat Frozen Shoulder
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
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New Concerns About Frozen Shoulder
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
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Shoulder Blade Pain
Shoulder Blade PainWhat causes a pain in the Shoulder Blade area?Interestingly, but importantly, shoulder blade pain only rarely arises due to a problem with the shoulder blade.
The shoulder blade is also called the scapula. True problems in the region of the scapula are rare and include bone disease such as infection or bone tumour. These causes account for no more than a tiny percentage of shouder blade pain problems.
Nearly every case of shoulder blade pain is due to a problems in the lower part of the neck or in the upper part of the back. This pattern of pain is known as referred pain. Referred pain from the neck is usually felt along the inner side of the shoulder blade - the side nearest the spine in other words.
How to diagnose Shoulder Blade PainYour doctor or therapist will begin the diagnosis of shoulder blade pain with a simple examination. They will examine your shoulder joint, muscles and the nerves of the upper arm. Your cervical spine (or neck) will also be examined - along with your upper back or thoracic spine.
If your shoulder blade pain is arising in the cervical spine then neck movements will trigger it or make it worse.
Your doctor may organise an x-ray of the neck or an MRI scan to confirm the diagnosis of a neck problem although this is not always required.
If your doctor suspects another reason for your shoulder blade pain then you may need blood tests, a chest x-ray or an MRI scan of the chest or thoracic region.
Severe shoulder blade pain of sudden onset can be an indication of serious heart or blood vessel problems. You should seek medical attention immediately if this occurs
How to treat Shoulder Blade PainThe treatment of shoulder blade pain will in part depend on the cause that your doctor or therapist discovers. The commonest cause is related to the neck or cervical spine and treatment is usually best directed at this area.
Neck treatments for shoulder blade pain often result in a quick and full recovery.
Treatment options for shoulder blade pain include:
painkiller or anti-inflammation medication
physical therapy from a physiotherapist, chiropractor or osteopath
manipulation of the neck or thoracic spine
acupuncture
Labels: arthritis, joint pain, shoulder blade, shoulder pain
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Shoulder Pain - Treating Rotator Cuff Pain
The rotator cuff are the group of muscles that surround the shoulder and help to keep it stable and strong during movement.
These muscles can often become a source of pain - either due to inflammation or to tearing in the muscle fibres or in the muscle tendons that join the muscles to the bone.
Recovery from rotator cuff pain can be a long process - and you may receive a bewildering range of advice along the way.
Check out this great
Guide to Rotator Cuff Injury - written by tennis pro Brent Abel. It's a comprehensive overview of the nature of the problem and of the available treatments.
Labels: joint pain, muscle injury, shoulder pain
Are you struggling with shoulder pain?
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Check out Doctor Cameron's fantastic new
Shoulder Pain Survival Guide
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Shoulder Joint Surgery
Shoulder replacement surgery is not a new option for patients with severe pain due to shoulder arthritis - but there is an intriguing new approach available which seems to be yielding great results.
Surgeons are putting in the new shoulder joint "in reverse"
With the new reverse shoulder prosthesis, the classic ball-and-socket shape of the joint is basically reversed.
The shoulder is made up of a ball and socket joint and a rotator cuff. The ball connects to the arm, the socket connects to the shoulder blade. The rotator cuff is muscle that surrounds the joint and helps lift and rotate the arm. But in patients suffering from a torn rotator cuff or arthritis, this protection is gone and bone painfully scrapes against bone.
Now a new procedure can help.
Instead of the ball being on the arm side, now we see a socket on the arm side, and the ball is actually on the shoulder side, or the socket side. What the reverse prosthesis does it allows us to stabilize the shoulder, normalize the center of rotation, thus improving function and relieving pain.
The surgery takes about 90 minutes and usually leads to a full recovery in around four months.
Surgeons in Europe have been performing RSP, or reverse shoulder procedure surgery, for 15 years with excellent results. Now the FDA has approved the surgery, but it still will take a while for it to catch on across the country.
Read more about
Reverse Shoulder Surgery hereLabels: arthritis, pain control, shoulder pain, surgery
Are you struggling with shoulder pain?
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Frozen Shoulder - Taking Steroids by Mouth
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 shoulderIn 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 steroidsIn 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
