Shoulder pain treatment injections

Alvin Stein, MD, FACSAlvin Stein, MD, FACS

Shoulder pain is a common type of pain treatable by Prolotherapy. Much of the shoulder joint pain is associated with bursitis. This is an Inflammation of the tissue lying above the rotator cuff tendon. The bursa or potential fluid filled sac becomes inflamed from irritation associated with overuse or with rubbing of the tendon on the bone that is above the shoulder, the acromion process.

Shoulder pain treatment injections

The shoulder is a joint that has a great deal of mobility, it allows us to move our arms freely and in many different directions. This occurs because there is a relatively small bone to bone surface area as compared to the hip joint, but a large amount of ligament restraint to keep the bones in place. The bones I talk about are the humerus and the scapula with its glenoid (socket) and the acromion process.

The scapula or wing bone provide the socket. It is a relatively small and shallow dish like structure that allows the humeral head to articulate with it. The humeral head is held in place by the capsule of the shoulder joint, which has several specialized areas in its structure. These specialized areas are reinforced by ligaments, which stop the head of the humerus from sliding out of place. These ligaments are called the anterior and posterior glenohumeral ligaments.

In the anterior capsule there are three such ligaments, the superior, middle and inferior glenohumeral ligaments. The inferior is the most important and thickest one of the three. Its job is to prevent the humeral head from sliding forward and upward. If the head of the humerus slides forward and upward it interferes with the normal arc of movement. This allows the humeral head to come closer to the acromion process that is above the shoulder. The acromion acts as an attachment for the muscles that move the shoulder, especially the deltoid muscle and all of its specialized parts.

As the humeral head comes closer to the glenoid, the space allowed for the rotator cuff tendon is reduced and the tendon gets caught between the two bones and starts to get inflamed. This causes the bursitis in the shoulder. As the bursitis gets worse, the inflammation weakens the rotator cuff by rubbing away some of its fibers, if the process continues unchanged, the result is a rupture or tear of the rotator cuff and the need for reparative surgery to reestablish the continuity of the tendon. This condition is called IMPINGEMENT SYNDROME.

Conventional recommendations for the treatment of bursitis are the use of anti-inflammatory medication and cortisone injections into the shoulder. This will get rid of the pain and the patient will go on until the next episode. Here they are often referred to physical therapy for exercises to strengthen the rotator cuff in an effort to bring the head of the humerus into the proper place. This makes the assumption that the muscle is weak, and needs strengthening and that the inflammation is primary, or else secondary to muscle weakness. The conventional treatment does not consider ligaments being loose allowing the humeral head to move out of place causing the inflammation and or the weakness.

When the bursitis becomes chronic and the tendonitis becomes chronic, the patient often stops using the shoulder and the loss of function is called a frozen shoulder (which usually requires a lot of treatment leads to a prolonged morbidity associated with this condition). SURGERY is often recommended and at times, it is the only thing to do. This involves removal of the undersurface of the acromion and repair of the rotator cuff, if it can be accomplished. The postoperative treatment includes a lot of physical therapy and home exercise and often still leave the patient with weakness and pain BECAUSE THE UNDERLYING PROBLEM IS NOT SOLVED BY THESE SURGICAL PROCEDURES! The surgery treats the effect and not the cause. It treats the immediate cause of the pain, but not the cause of the condition. The surgery takes away a piece of bone as if that suddenly grew large and became the culprit. Although removing that piece of bone usually does no harm, (note I said usually) that is not always the case. Postoperatively, enough patients have more problems than they bargained for because the primary cause of their problem was not dealt with at all. The repaired rotator cuff can wear out again and rupture anew perhaps making it unrepairable.

Ie there an Alternative Treatment? YES, YES, YES!!!

This is where prolotherapy comes in and can help, preferably before all the damage has occurred, but even afterward. Using prolotherapy, we inject the glenohumeral ligaments in the anterior and posterior capsule of the shoulder. This causes the ligaments to tighten and pull the head of the humerus back into the normal position in relationship to the glenoid. It pulls the humeral head down away from the acromion. That allows the rotator cuff to have the room it needs to work without being impinged and without getting inflamed and without the bursitis and the pains that are present with and without activity.

The plan is for an examination and an x-ray of the shoulder. If there is any instability and/or tenderness in the area of the ligaments in the capsule, injections are given to the entire anterior capsule. The ligaments are injected with the proliferant solutions to force these tissues to return to their normal (healthy) size and length thereby restoring the proper anatomy and relieving the problem. Sometimes only one injection session is all that is needed. On other patients two or three sessions may be needed. The healing then begins. Results are usually seen in two to six weeks. The improvement is usually permanent. The injection can be repeated if needed without and adverse effects. This treatment does not do any damage to the shoulder.


More Prolotherapy research citations can be found on this page on our site Prolotherapy research. To learn more about Prolotherapy please read our article Prolotherapy information for patients

© Alvin Stein, M.D.

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