Neural Prolotherapy for Shoulder Pain
Shoulder pain can arise from joints, muscles, tendons, and bursa in and around the shoulder region as well as from more distant locations like the neck, upper back, or even referred pain from the gall bladder. The onset of shoulder pain is highly variable as it can occur without an obvious cause, or it can be related to a specific mechanism of injury such as a work or sports injury. Shoulder pain can also occur as a result of repetitive trauma over time, such as a job requiring overhead reaching. Neurological injuries such as stroke or a pinched nerve in the neck can cause shoulder pain as well. Experts estimate that as much as half of the population experiences shoulder pain each year, though many people often decide to “just live with it” and therefore, don’t seek treatment. However, shoulder and neck disorders do account for 18% of disability payments for MSK pain.
Factors that contribute to shoulder pain:
• Inflammatory conditions: Tendonitis, bursitis (the bursa are the fluid-filled sacs that lubricate the surrounding tissues), osteoarthritis (the “wearing out” kind), and rheumatoid arthritis (the autoimmune kind). Inflammatory conditions are a common cause of shoulder impingement (see below).
• Excessive Motion: Instability can arise from tearing of the joint capsule, tendons, and/or ligaments that become lax after healing. The terms “strain” and “sprain” refer to tears of muscles and/or tendons (strains) vs. ligaments (sprains). Trauma typically results in instability in one direction vs. congenital (or “born with”) problems where instability can be multi-directional. This can result in a subluxation and/or a dislocation of the shoulder.
• Limited Motion: This occurs when the joint capsule and ligaments are tight and restrict freedom of movement. This can happen after prolonged immobilization (use of a sling) and can result in impingement and/or “frozen shoulder” (adhesive capsulitis).
• Muscle Weakness/Imbalance: The muscles in front, on top, behind, and those that connect from below must be in proper balance for the ball and socket joint of the shoulder to function properly. Weakness in any of these muscles can alter the normal balance and result in shoulder pain due to poor, inefficient shoulder motion. A common example of this is forward head posture with shoulder protraction (forward, rounded shoulders) that many of us “suffer” from as a result of using electronics (smartphones, computers, television). Overtraining of any of these muscles (like the chest muscles), stroke, or pinched nerves can also alter muscle balance.
Impingement is a common cause of shoulder pain that arises from swelling or inflammation from the tendons and/or bursae. Here, the ability to raise the arm is limited.
Repair Nerves and Heal Pain:
Regenerative Medicine techniques like Neural Prolotherapy (NPT) are used to treat neuropathic pain in a variety of musculoskeletal injuries and various pain conditions. Neural Prolotherapy restores unhealthy nerves into healthy nerves by targeting a specific type of nerve called peptidergic sensocrine nerves.
When they are healthy, these nerves release anti-inflammatory and healing molecules to help heal the nearby muscles, joints, and other nerves. However, if these nerves become injured or irritated, healing is halted, and instead they release hormones that stimulate pain and inflammation. Neural Prolotherapy switches the nerves out of ‘inflammatory mode’ and back into ‘healing mode’ by inhibiting a receptor on the nerve surface.