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Shoulder Pain

Pain in the shoulder is always difficult to diagnose based solely on examination. Since many people have tears in the cartilage or tendons of their shoulders because of natural degeneration or aging, even an MRI cannot reliably tell you what hurts. Often, shoulder pain is actually caused by problems in your neck - even if you do not have significant neck pain. Through special diagnostic procedures, it is possible to isolate the source of your discomfort so treatment is directed to the actual cause of your pain.

Osteoarthritis of the Shoulder

Cervical Radiculopathy

This page offers the answers to some of the most common questions related to pain occurring within the shoulder area, as well as the procedures used to diagnose and treat it effectively. Click on the questions to reveal the answers. Additional questions and answers about spine-related pain and our procedures are featured in the Ask the Doctors section.

How do you diagnose whether the pain that I have is coming from the shoulder or my cervical spine?

We use a continuous x-ray machine and we place an anesthetic inside the shoulder joint. We will then assess the patient to see if the pain is gone. If the pain is not relieved then we know that there is another reason that the shoulder hurts. We will then place an anesthetic on the nerve that goes from the cervical spine to the shoulder. If the pain is gone within ten to fifteen minutes after the procedure we then have a diagnosis of a cervical nerve that is creating “referred” pain to the shoulder.

Who is a good candidate for these procedures?

Persons who have experienced any of the following are good candidates for our procedures:

  • If you have had constant shoulder pain that has not responded to conservative care, including rest, medications, physical therapy and/or chiropractics over a 4-week period.
  • If you have had surgery on your shoulder and did not improve.
  • If your shoulder pain limits your normal functions and keeps you from enjoying a full, active lifestyle.

How long do most patients experience relief from the pain in their shoulder after having these procedures?

Most of our patients report relief that lasts from weeks to years from these procedures. Of course, the length of time that you will experience relief will depend upon several factors, including the cause of your problem and your general health. Our physician will advise you of special steps that you can take after the procedure, including exercises, to decrease the likelihood of further pain.

Will this procedure cure the pain in my shoulder?

To date we know of no “cure” for shoulder problems. The purpose of our treatments is to decrease or eliminate your pain, but it will not necessarily “cure” the problem for everyone. Unfortunately, all of our bodies undergo a natural degenerative process and we all strive to get the most out of our bodies with the least amount of symptoms. It is important that you take care of your shoulder by using proper body mechanics, exercise and avoid doing things that can trigger shoulder pain. Over time, everyday “wear and tear” takes its toll on all of us and our goal is to give you the highest quality of life possible with your given set of circumstances.

Can this treatment be repeated and, if so, how many times?

Yes, if needed, the treatment can be repeated up to 2 to 3 times each year for as long as significant gains in your quality of life occur with the treatments.

If my MRI is negative, is it still possible that I can have an irritated nerve in my shoulder that is causing the pain?

Yes. An MRI is an indirect image of the spine and does not always show everything. In addition, an MRI usually is taken while you are laying down. Nerves can shift when you change positions, especially if your pain is worse with when you stand or sit. The disk can leak part of its “jelly” center—or nucleus—around the nerves, which can cause significant chemical inflammation and pain. Our procedures can dramatically reduce the pain and inflammation resulting in increased circulation and healing.

I only hurt in my shoulder and arm. So how could I have a problem in my cervical spine?

All sensation in your shoulders and arms are carried by nerves coming out of your cervical spine. If you irritate or injure the nerve in your shoulder that goes to your thumb, for example, you will feel the pain in your thumb and not at the actual site where the injury is located. It is like having a “nick” in the telephone line outside your house, but you only hear the static inside at the telephone headset.

I was told that my problem is caused by a muscle strain. Can you do anything for this problem?

If your problem really is a strained muscle in your shoulder it should heal spontaneously over several weeks. If your “ muscle strain” continues it may be due to a cervical spine disorder. When the nerve in the cervical spine is inflamed due to a herniated disc it can create muscle spasm into your shoulder, as your body is trying to slow you down until the inflammation heals.

If your pain has lasted over three to four weeks you may want to consider your cervical spine as a source of your shoulder pain. If you wish to get better, you have to get to the real source of pain and not just treat the symptoms.

My doctor suggested trigger point muscle injections to treat my pain. Will this help?

Generally speaking, trigger point injections are not effective for treating spine disorders. These types of injections usually only mask the symptoms for a short period of time. If you want longer-term relief, you must get to the source of the problem, which rests in a disorder of the spine itself.

My doctor suggested Botox injections for my problems. Can Botox be beneficial for my condition?

We do not recommend Botox for treating back or shoulder pain. Botox paralyzes the very muscles that are trying to support your spine when an underlying disk or joint creates a problem. We have seen people treated this way who might have recovered from an initial minor disorder only to need surgical fusion because of the instability that developed after the supporting muscles were taken away by Botox.

  • Texas Orthopedic Hospital
  • Fondern orthopedic group LLP
  • Spine Interventional Society