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Category Archives: shoulder
If you take cases of cervical radiculitis – if imaging shows possible reason for it, they give a history of having had shingles at about 18.4%. In cases with normal imaging, the prior incidence jumps to 81.6% (p<0.01) – most of … Continue reading
June 2017 Pain News: I put them up as short snaps because not going to blog note them – hope you like. You will probably not find many in news elsewhere.
Subdeltoid hyaluronic acid injections 2 ml x 2 weekly associated with mild improvement in pain
116 patients Forty-one (35.3%) patients experienced post-injection pain. The mean duration of symptoms was 3.9 days. At 6 months, 81 (69.8%) patients were discharged successfully and, at a mean of 23.2 months, did not require re-referral; 29 (25%) had surgery; … Continue reading
It has always been vague on the fine points of this techique. A beautiful account for this procedure is available in this newsletter: http://www.asra.com/content/documents/nov-13_asra_news.pdf on pages 14-17 I have included a summary for those who can’t reach it.
Study found 20 mg Kenalog worked as well as 40 mg and another found you don’t even need to hit the joint. I supplement suprascapular and quadrilateral space blocks as well as subscapularis working out.
I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.
A drop of 1.5/10 does not seem like much though they do say 71.4% got rid of night pain
50% reduction of pain was reported in about 1/2 of post shoulder and knee arthroplasty pain cases with Botox injections. This was sustained by repeated injections.
Recently, had an elderly but otherwise in good condition patient with tears of two of his shoulder rotator cuff tendons that he wished repaired. Was told by specialist – too far gone – and just learn to live with it. … Continue reading
Bolulinum Works as Well as Steroid in Frozen Shoulder – Isn’t it About Time We Think About Combining The Two?
A recent article shows that botulinum and steroid have similar durations of action in adhesive capsulitis – ie Frozen Shoulder. I have given both triamcinolone and botulinum (at separate times) into knee joints and noticed the combination can cause a profound … Continue reading
At Last – Treatments For Supraspinatus Tendonitis – Platelet Rich Plasma (PPP) or Dry Needling or Deep Frictions
Because (noncalcific)supraspinatus tendons can tear, I tend to avoid steroid injection. This leaves deep frictions that may work 1/2 time but are painful and labor intensive – Though Platelet Rich Plasma needling/injection worked well, dry needling by self did not work … Continue reading
Does Neuropathy Form a Part of Chronic Shoulder Pain? And Nerve Irritation the Basis to Some Chronic Knee and Tennis Elbow Pains
One dumbed down rhizotomy – 42 degrees centigrade pulse treatment to the suprascapular nerve going to the shoulder can give long term 50% relief of various forms of chronic shoulder pain. The ease of this effect (only one treatment) makes one wonder … Continue reading
I have previously written: Does Pain “Grow” at Tendon injury sites? -and Treatment tennis elbow Now for shoulder tendonopathy, “increases of newly grown nerve fibers and blood vessels ” inside tendons has been found
In 70 year olds, incidence of major asymptomatic supraspinatus tears is 7.8% in elderly controls, and 15.8 in elderly diabetics
When partial tear became full, or when full tears spread by >5 mm – it was more likely to become symptomatic. It was suggested that “Further research is warranted to investigate the role of prophylactic treatment of asymptomatic shoulders to … Continue reading
Post Stroke Hemiplegic Shoulder Pain – Plain Local Suprascapular Block as Good as Steroid Injection in Shoulder
Beefing up my contention that suprascapular nerve blocks have therapeutic shoulder effects, is a new article finding it works as well as steroid injections into shoulder – without having to use steroids.
Various measures have been used for trapezius tip pains but they keep coming back. Now it’s confirmed the neck is a player.
Torn shoulder tendons gimp shoulder mechanics and can lead to “chronic and often unbearable pain, muscular fatigue, and severe functional disability”. A reverse prothesis and latissimus dorsi tendon transfers are a treatment but are extreme measures. A simple and effective … Continue reading
Study of Scapulothoracic Bursitis – Though 78.6% presented with the breast/chest pain, a tender area was found posteriorly on the medial aspect of the shoulder blade(scapula). Injection of steroid to area relieved the breast/chest pain as well in 83.5% of … Continue reading
I am used to doing an arm raised adduction test (bringing arm over chest) to see if it elicits pain. Alarmingly , this crossed arm adduction test may only be positive 67% of the time. More sensitive tests have been … Continue reading
Rotator cuff tendon repairs give good results even with fatty degeneration and muscle atrophy best under 4 months. Single tendon tears – commonly supraspinatus, are sneaky – only 43% can relate any trauma to onset and 90° active abduction is … Continue reading
Just got back from a course showing how to give ultrasound guided injections so you can hit the right spot. Now it appears you don’t need to be close at least for shoulders…
Both Hyaluronate Injection and physiotherapy work for isolated simple supraspinatus tendonitis though the former would be easier – but more expensive…
A recent study showed diffuse muscle trigger knots about the shoulder in impingement syndrome, highlighting the fact there is considerable peripheral and central sensitization. Measures dealing with this disease must deal with these issues.