Not infrequently people will wake up with an agonisingly painful shoulder for no particular reason at all: they hadn’t overdone it in the gym, they hadn’t fallen down stairs or painted all the ceilings. And yet there they are with an incredibly painful shoulder that they can barely move. Normal painkillers don’t touch it and it just won’t go away. Quite a lot of people actually end up in A&E because the pain is so overwhelming. And mothers will often say the pain is worse than having children.
One of the most painful conditions that exist.
There are only two conditions that cause a severe, acute, painful shoulder coming on out of the blue and these are Calcifying Tendonitis and Brachial Neuritis: a simple x-ray will tell me which it is and how to treat it.
Calcifying Tendonitis
Calcifying tendonitis is where the main tendon that lifts the arm up in the air has been rubbing (or impinging) away quietly, possibly for years, without you knowing anything about it. In simple terms, the tendon bleeds a little and the body changes the blood slowly into chalk. It’s more like toothpaste consistency than blackboard chalk and it can sit in the tendon for years without causing any issues. Until one day……
The dense white ‘cloud’ is the chalk deposit in the tendon.
And on that day the chalk starts to be squeezed or extruded out of the tendon into the sub-acromial space and sets off the horrific inflammatory reaction causing the severe pain that means you simply don’t dare move your shoulder.
But it is very treatable and a simple steroid and local anaesthetic injection into the sub-acromial space can get rid of it very quickly. That may not eliminate the pain completely but it is usually much, much better within a few hours and certainly manageable. Usually though you will need surgery a few weeks later to get rid of the residual discomfort where I do an arthroscopic subacromial decompression.
This is the chalk being removed arthroscopically.
Neuralgic Amyotrophy
If the x-ray doesn’t show any chalk deposits then you have a condition called Brachial Neuritis or Parsonage Turner Syndrome or Neuralgic Amyotrophy. These are all terms that cover the same condition in which (we think) a virus inflames the nerves and muscles around the shoulder causing pain, pain, pain. There really isn’t anything that can be done for this condition other than managing the symptoms until it sorts itself out. I will often refer you to a Pain Management Specialist as these guys have the skills to organise an excellent regime of medication that can help control the pain without making you dopey or sleepy.
This acute and severely painful is NOT a frozen shoulder – they just don’t come on like this. It is the pain that means that you can’t move the shoulder not a freeze.
Both of these are horrible, horrible conditions and make life unbearable.
Come and see me and hopefully I can help.
