Shoulder

Conditions We Treat

The shoulder is the most complex joint in the body, and shoulder pain may be related to conditions other than those within the shoulder itself, such as cervical radiculopathy (pinched nerve in the neck). Only through the usage of a detailed history of symptoms and careful physical examination can the proper course of diagnostic testing and treatment be determined, and the triggering factor(s) be identified. We provide comprehensive non-surgical care of shoulder disorders, including the follwing:

  • Myofascial pain syndrome
  • Acromioclavicular (AC) joint sprains and arthropathy
  • Rotator cuff sprains and strains
  • Subacromial and subdeltoid bursitis
  • Impingement syndromes
  • Osteoarthritis of the glenohumeral joint
  • Cervical radiculopathy and brachial plexus lesions
  • Suprascapular neuropathy

Diagnostic Tests

Because shoulder pain may be multifactorial, and not always directly related to the shoulder joint itself, the determination of which diagnostic study should be obtained should be based upon a careful and detailed history of symptoms and physical examination. Plain shoulder x-rays may be negative even in the presence of a frank rotator cuff tear, and MRI scan may be positive for limited pathology unless an arthrogram is obtained simultaneously to exclude such findings as a labral tear. For those reasons, Dr.Kahn prefers that those patients who have not yet undergone diagnostic testing wait until seen by him in consultation. Within our own office suite, we offer various diagnostic studies which produce a high yield in the evaluation of the causes of shouder pain and weakness, including:

  • Diagnostic musculoskeletal ultrasound (US-MSK) is an excellent modality for evaluating the AC joint, subacromial space, biceps tendon, and rotator cuff tendons, in addition to permitting limited evaluation of the humeral head and glenohumeral joint
  • Electrodiagnostic testing (EMG/NCS) can discriminate weakness of the shoulder girdle caused by pain vs. neurological causes, such as cervical radiculopathy, lesions of the brachial plexus, or entrapment of the suprascapular nerve

Procedures

All of our shoulder girdle related procedures, with the exception of certain trigger point injections, are performed under ultrasound guidance for increased accuracy and improved outcomes. These procedures include the following:

  • Myofascial trigger point injection
  • Injection of the acromioclavicular (AC) joint
  • Injection of the subacromial or subdeltoid bursae
  • Injections of the subacromial space and biceps tendon sheath
  • Suprascapular nerve block
  • Injection of the glenohumeral joint, including viscosupplementation (artificial joint fluid), when covered by insurance
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