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2 posts from April 2007

April 23, 2007

Shoulder Pain - How are shoulder problems diagnosed

As with any medical issue, a shoulder problem is generally diagnosed using a three-part process;

Medical history – the patient tells the doctor about any injury or other condition that might be causing the pain.  Time line of the shoulder pain.  Exacerbating and remitting factors...How does the pain get worse?  How does the pain get better?  This will give many clues to the physician about what might be causing this.

Keep in mind the differential diagnosis for shoulder pain is long.  Many different things can cause it.  The second part of the process is physical examination.  The doctor examines the patient to feel for injury and discover the limits of movement, location of pain, extent of joint instability.  Many times this will be enough and medical history and physical exams do a very accurate diagnosis about what exactly is going on with the shoulder. If the doctor still has more questions, the doctor may order more imaging tests to help make a specific diagnosis.

 

A standard x-ray in which low level radiation is passed through the body to produce a picture called a radiograph.  This type of x-ray is useful for diagnosing fractures or other problems with the bones.  Soft tissue such as muscles and tendons do not show up on x-rays.  Ultrasound is a different non-evasive technique in which ultrasound waves can be used to visualize some structures in the shoulder particularly the ones closer to the surface.  Many times the problems with the rotator cuff are due to some of the structures located close to the surface and therefore is very helpful in making this diagnosis.

Finally, a frequently used imaging technique is the magnetic residence imaging (MRI) which is another non-evasive procedure in which a machine with a strong magnet passes a force through the body to produce a series of cross-sectional images of the shoulder.  This allows the doctor to look at the soft tissues and help make a more definitive diagnosis.  Most certainly before a surgery is proposed, an MRI will likely be available for the doctor to review to plan surgery.

April 02, 2007

Shoulder Steroid Injection

Steroid injection represents a useful tool in the management of chronic shoulder pain. The doctor will typically use a lateral approach to inject the subchromial space, particularly with rotator cuff problems. At different times, the doctor may use an anterior approach or a posterior approach to actually put steroid in the shoulder joint. This would be less common. Ideally steroid should be thought of as providing temporary relief and when used appropriately, and when used in conjunction with physical therapy, shoulder steroid injections will almost act as a band-aid. They’ll give people a temporary period of time where the physical therapy can really start working. This is primarily because the steroid is a very effective anti-inflammatory, and for a short period of time will relieve pain.

Steroids have multiple actions. They act as anti-inflammatory, and therefore, frequently will reduce pain in an area with inflammation. Also and essentially a side effect is that they will cause destruction of protein. Certainly steroids do have a complication and you can get too many steroid injections into a shoulder. There has been research to suggest that if someone were to get more than 3 steroid injections into the shoulder that the subsequent repair of the rotator cuff that may need to happen is more difficult. Shoulder steroid injections are a beneficial tool when used appropriately. It is again recommended that it is used in conjunction with physical therapy. The doctor will perform the steroid injection under sterile conditions as to not introduce germs into the joint space. Steroids are actually produced by the body in small amounts.

The steroids injected into the joint are generally safe and do not have systemic side affects unlike steroid pills. Steroid injections typically will not rise up blood sugars to a significant degree. Possible side affects/adverse affects of shoulder steroid injection would include an infection, bleeding into the joint if the needle goes through a significant blood vessel, skin can ulcerate if too much steroid is injected closely underneath the skin. Also there can be fat trephine under the skin and essentially leaving a dent in the contour of where the steroid was injected. Additionally, there can be tendon rupture and overall weakening of the structure receiving the steroid.