Shoulder pain

Shoulder pain is commonly caused by injury and usually resolves with rest, simple pain medications and conservative treatments. When pain has been present for a longer period of time (usually greater than 3-6 months) it can be more difficult to manage and support from the pain service would be appropriate.

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Common causes for shoulder pain

• Rotator cuff injury

• Osteoarthritis of the glenohumeral or acromioclavicular joint

• Instability of the glenohumeral joint

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Diagnosis of shoulder pain

This is usually determined by the timing of the pain, location and whether there was an injury to the shoulder/arm prior to the pain starting.

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Investigations:

 

The history would be informative however imaging would clearly help and aid treatment. A Shoulder Xray +/- MRI  would be performed to 

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Treatment of shoulder pain

 

Conservative therapies: It is advisable to try simple techniques or medications at home to manage pain initially. These include:

 

Medications:

            Simple painkillers – (Paracetamol, ibuprofen, naproxen)

            Opioids – codeine, tramadol and morphine

            Anti-neuropathic medications – pregabalin, gabapentin and amitriptyline

 

Complementary treatments:

            Acupuncture

            Physiotherapy

            TENs machine

            Topical treatments –   Anti-inflammatory gels

                                                Hot / cold packs

 

Interventional therapies

 

Shoulder joint injection

This involves a needle, injecting directly into the shoulder joint under ultrasound guidance. Local anaesthetic and steroids are injected which aims to provide pain relieve and an anti-inflammatory effect to the joint.  

 

Suprascapular nerve and Axillary nerve injection

There are a number of nerves that supply the shoulder joint and rotator cuff muscles. Injecting these with Local anaesthetic and steroid under Ultrasound guidance can provide long lasting relief. This can also aim to reduce / delay the requirement for surgery.

 

Suprascapular nerve and axillary nerve radiofrequency denervation

After a successful injection, if pain returned, radiofrequency (using heat) can improve the duration of the block.

 

Surgery

Various surgical procedures could be considered dependant on the underlying injury. This would require further discussion with a specialist surgeon.

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