ARM AND SHOULDER PAIN

WHAT IS IT?

ARM PAIN

Arm pain is typically the result of an injury or overexertion. Arm pain can refer to physical discomfort anywhere between the shoulder and the fingers. The arm is made up of two joints: the glenohumeral joint and the acromioclavicular joint. These joints are where most shoulder pain occurs. Acute arm and shoulder pain will typically settle spontaneously or resolve with modification of activities and instruction in appropriate exercising and self-management. However, arm pain that lasts three months or longer is considered chronic arm pain.

SHOULDER PAIN

The arm is made up of two joints, which is where most shoulder pain occurs.

  • Glenohumeral joint – where your upper arm bone (the humerus) connects with your shoulder blade (scapula)
  • Acromioclavicular joint – where the top of your shoulder blade meets your collarbone (clavicle)

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ARM & SHOULDER PAIN

WHAT CAUSES IT?

ARM PAIN

Common causes of arm and shoulder pain include:

  • Injury or sprain
  • Overexertion of a particular group of muscles or tendons (e.g. labral tear or teas to the rotator cuff tendons)
  • Osteoarthritis
  • Shoulder bursitis, which is caused by an inflammation of the small fluid-filled sacs known as the bursae between the bones in your shoulder joint
  • Inflammation of the shoulder capsule

SHOULDER PAIN

Causes of shoulder pain include:

  • Osteoarthritis
  • Inflammation of the shoulder capsules
    • Synovitis is when your synovial membrane becomes inflamed. It can occur as a result of another condition or may happen as a result of an injury
    • Frozen shoulder is a condition that occurs when your shoulder capsule thickens and becomes inflamed and tight
  • Inflamed bursa
    • A bursa is a small fluid-filled sac that reduces friction between two structures, such as bone, muscle and tendons. In your shoulder, the bursa that sits between the rotator cuff tendon and the bony tip of the shoulder can become inflamed
  • Injuries and sprains
    • Injured or sprained ligaments can cause short-term pain. This may be the result of the humerus coming partially out of the joint socket or if the humerus comes completely out
    • The flexible tissue that helps keep your shoulder joint in place (the labrum) can become torn. This is called a labral tear. This can occur as a result of an injury (e.g. falling onto your outstretched arm) or repetitive actions (e.g. throwing sports such as cricket)

Rotator cuff: this group of tendons and muscles keep your shoulder stable and positioned correctly for your shoulder and arm to move. Tears to rotator cuff tendons may occur as a result of an injury or happen over a period of time as you age

TREATMENT

OPTIONS

ARM PAIN

Initial treatments for acute arm or shoulder pain might include:

  • Medications, such as over-the-counter analgesics and anti-inflammatory drugs (Paracetamol or Ibuprofen)
  • Gentle stretching
  • Heat or ice packs
  • Physical therapy programs

A physiotherapist might recommend adjustments to your movement to avoid major flareups.
If you are not improving with over-the-counter or prescription medication, as well as physiotherapy, your healthcare professional might recommend:

  • Corticosteroid injection into the shoulder joint
  • Corticosteroid injection and hydrodilatation into the subacromial space
  • Radiofrequency (RF) therapy, which is a proven, low-risk treatment option. During the RF procedure, your doctor will place a thin needle at the site of your pain. This needle will deliver energy to those inflamed, pain-transmitting nerves to create a block, sometimes called a lesion. This disruption reduces the ability of the nerves to send pain signals to the brain.

More advanced care options include:

  • Neuromodulation or spinal cord stimulation (SCS), which works to reduce pain by altering the pain signals as they travel up the spinal cord to the brain. A generator, similar to a cardiac pacemaker sends electrical pulses to a thin wire called a lead. The lead is placed in the epidural space and delivers pulses to nerves along the spinal cord. The pulses modify the pain signals as they travel to different parts in the brain
  • Surgery

SHOULDER PAIN

There are a variety of treatments for shoulder pain. They include:

  • Physiotherapy is a common initial treatment, as well as modifying activities that make your pain worse
  • Medication such as paracetamol and low dose anti-inflammatories can be helpful in controlling pain
  • Head and cold packs to provide temporary relief of pain and stiffness
  • Verb? Hydrodilatation and CSI into the subacromial space
  • Verb? CSI into the shoulder joint
  • A high dose short course of prednisolone
  • Corticosteroid injection

Radiofrequency ablation of the pain generating nerves in the shoulder joint

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