1) How do you diagnose whether the pain I have is coming from the shoulder or the neck?
We use a continuous x-ray machine and place an anesthetic inside the shoulder joint. We then assess the patient to see if the pain is gone. If the pain is not significantly better, we know there is another reason for the shoulder pain. We will then place an anesthetic and steroid on the nerve that goes from the neck to the shoulder. If the pain is gone within ten to fifteen minutes after this procedure, we have a diagnosis of a cervical nerve that is creating “referred” pain to the shoulder.
2) Who is a good candidate for these procedures?
Persons who have experienced any of the following are good candidates for our procedures:
a) If you have had constant shoulder pain that has not responded to conservative care, including rest, medications, physical therapy, and/or chiropractic care over a four week period
b) If you have had surgery on your shoulder and still have shoulder pain
c) If your shoulder pain limits your normal functions and keeps you from enjoying a full active lifestyle
3) Why do the procedures give long-term relief if the steroid is gone in a week?
Long-term relief from the injection can be achieved just because we are able to eliminate the inflammation. Remember, a lot of people have degenerated shoulder joints and cervical discs, but they only have pain when a structure in their shoulder or neck becomes inflamed. Most of our patients report relief that lasts from months to years. One of the most important ways to get long-term relief after the pain is to work on body mechanics and posture, which will keep the structure that was creating your pain from becoming inflamed again.
4) What can I do to keep the pain from reoccurring?
Using proper body mechanics and posture are the most important things to remember. The cervical discs are located in the front of the spine right behind your voice box. That means every time you bend your head down to look at your phone, look at your computer, or read a book, you put a lot of pressure on the discs, which in turn can lead to degeneration of the discs in the neck over a period of time. Look at the section on “tips for a healthy neck” in this newsletter for specific things you can do to avoid putting stress on your spine.
5) You do not perform pain management techniques, such as series of epidural steroid injections, Botox injections, and trigger point injections in the neck. Is there a reason why you avoid doing these types of procedures?
These procedures are based on chronic pain management techniques where the main goal is to have ongoing long term care of the patient. There is absolutely no diagnostic information gained by these procedures, and they really just mask the problem. Our main goal is to either eradicate the pain long-term or locate the exact issue creating the pain and have it fixed.