Sore Shoulder

Have you heard about shock wave treatment for shoulder pain - or problems related to the shoulder tendons?

Extracorporeal shockwaves - waves of pressure delivered to the outside of the body - have been used in medicine for a number of years, but mostly in the context of treating kidney stones or gall stones. It's only in the last year or two that they've been used for joint and muscle problems.

Shoulder tendon problems seem to respond well to this kind of treatment - particularly when calcium deposits are present. The waves work internally to create new blood flow to the area and to help remove and restore injured or scarred tissue.

The treatment can be painful but the results seem very good from several published research studies.

Frozen shoulder or adhesive capsulitis is a common cause of a sore shoulder - and it causes severe problems with stiffness and loss of function.

If you're unlucky enough to experience it then the loss of sleep and inability to focus at work or at home can really lead to low mood and depression at times.

Doctor Gordon Cameron has created a unique support pack - check it out on the video above.

One of the most interesting treatments for shoulder pain at the moment is when warm salty water is injected into the joint in an attempt to improve the range of movement and decrease the pain of a frozen shoulder.

This is sometimes called hydrodistension treatment, sometimes hydrodilation or it can be described in some hospitals as a therapeutic arthrogram.

Many of those who struggle with sore shoulder and arm pain think that there might be two problems going on at the same time. Actually it's nearly always just the one source for the shoulder pain problem.

The body has a way of tricking the brain about where a pain is coming from. This is called referred pain. The brain misinterprets where the pain is coming from and "blames it" on the arm when in fact the actual injury or pain source lies insider or around the shoulder.

Shoulder conditions like frozen shoulder can send pain spreading all the way down to the hand - and even tendonitis or bursitis can cause a pain that seems to be coming from as far down the limb as the elbow.

I'm often asked if there's a  link between carpal tunnel syndrome and shoulder pain?

Strictly speaking the answer is no but in practice most doctors and physical therapists who specialise in joints and muscle pain will have seen several patients where the two conditions seem to exist at the same time.

Carpal tunnel syndrome is caused by compression or squeezing on the median nerve at the wrist. The nerve has to get through a narrow tunnel and pressure there causes pins and needles or tingling feelings in the hand. The thumb and index finger are usually worst affected.

Sometimes however you'll find that an identical pattern of symptoms can be triggered by irritation of the sixth cervical nerve in the neck. This is usually abbreviated to be called the C6 nerve. This nerve comes from the neck and runs down the arm to the hand - passing around the shoulder as it goes. Nerve pressure in the neck - or in the shoulder region - can cause pain around the shoulder and tingles in the hand.

There's another rarer condition called the Carpal Tunnel Double Crush syndrome. Research has shown that an injury to the median nerve at the wrist can also trigger problems with nerve function further up the nerve - causing pains at the elbow or at the shoulder.

The deltoid muscle is the large rounded muscle that lies over the top of the shoulder joint. It's main job is to move the arm outwards and upwards away from the body - although the many different directions that it's fibre strands take has led modern anatomists to suspect that it actually does much more than the old textbooks would have us believe.

Deltoid muscle pain is common - or, it's true to say that pain in the region of the deltoid muscle is common ... but actual injury to that muscle is rare. The structure of the muscle means that it's not likely to be injured by lifting or by a fall. The other smaller rotator cuff muscles that lie beneath it are much more vulnerable to injury. If these smaller muscles are damaged or become inflamed then the mechanism called referred pain often leads the brain to think that it's deltoid that's at fault.

It can be tricky sometimes to figure out the cause of a pain in the shoulder - particularly if the person also has symptoms in the hand such as pain or pins and needles.

Many cases of shoulder pain spreading down the arm have their origin in the muscles and tendons around the shoulder - or even in the joint itself. But sometimes you need to look elsewhere for the real root of the problem. The neck is often the guilty party ..... !

An inflamed nerve in the neck often triggers a pain that seems to come from the shoulder but doesn't really. The brain gets confused by the incoming pain signal and blames the shoulder, or the hand or both when the problem really lies in the neck itself or in the nerves that arise in the neck. This kind of pain is often accompanied by a sense of tingling or pins and needles in the hand.