Are You Tired of Living With Shoulder Pain?

BY FRED G. ARNOLD, DC, NMD

The Shoulder
What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm, from scratching your back to throwing the perfect pitch. However, mobility has its price and it may lead to increasing problems with instability or impingement of soft tissue resulting in pain. You may feel pain only when the shoulder is moved, or all of the time. The pain may be temporary and disappear in a short time, or it may continue and require medical diagnosis and treatment.

Most shoulder problems involve the soft tissues that includes the muscles, ligaments, and tendons, rather than bones. And most of these problems fall into three major categories:

• tendinitis/bursitis
• injury/instability
• arthritis

Rotator cuff injuries is a non-specific phrase to imply injury to four specific muscles and their associated tendons. Pain secondary to partial tears of the rotator cuff tendons responds well to prolotherapy. It is recognized that a complete tear of a tendon should be repaired surgically. However, persistent pain following surgical repair may oftentimes be relieved through prolotherapy. Patients with recurrent shoulder dislocation particularly find prolotherapy beneficial due to the “stabilization” of the joint capsule, ligaments and tendons. Patients with a “frozen shoulder” implies capsular tightening or capsular adhesions that may be relieved with a combination of stretching exercises and intra-articular specialized injections to restore normal movement and reduce pain.

Other much more rare causes of shoulder pain are tumors, infection and nerve-related problems.

Prolotherapy, A Proven Treatment Alternative
Prolotherapy has been used with great success for over 60 years. Prolotherapy (aka Regenerative Injection Therapy – RIT), is also known as ligament reconstructive therapy or sclerotherapy and is a recognized orthopedic procedure that stimulates the body's natural healing processes to strengthen joints weakened by trauma or arthritis. Joints weakened when ligaments and tendons are stretched, torn, or fragmented, become hypermobile and painful.  Traditional approaches with anti-inflammatory drugs and surgery often fail to stabilize the joint and relieve pain permanently.  Steroid injections are commonly given to patients who experience shoulder pain and actually weakens the associated ligaments and tendons. Prolotherapy has the unique ability to directly address the cause of instability and repair the weakened sites, resulting in permanent stabilization of the joint.

OUR UNIQUE APPROACH
Prolotherapy treatment is a very effective treatment for shoulder conditions.  Dr. Arnold evaluates each patient thoroughly with a personal history that includes the neck and upper back as a possible source of referred pain to the shoulder. An orthopedic physical exam, including neurologic assessment and careful palpation of the affected shoulder is performed. Palpation of a tendon or ligament that produces pain is usually associated with weakened tissues and can at times be more beneficial in identifying the problem areas than diagnostic testing. On an individual basis further evaluation may include ultrasound evaluation, X-rays and/or MRI before receiving prolotherapy.  In cases involving chronic pain, Dr. Arnold will use his expertise to provide a comprehensive treatment approach that includes rehabilitative exercises, nutrition, and specific supplements to maximize your health and ability to heal.

Following the initial injection treatment, the patient is reassessed in 2 weeks and the injections are repeated at decreasing intervals as the patient’s condition is improved and resolved. It is not possible to always predict the exact number of sessions required, since each patient’s condition is unique in terms of his or her ability to repair and re-grow new tissue. Most patients require 4-6 treatments for a mild-moderate condition and some patients require only 1-2 treatments for resolution of their symptoms. Dependent upon each patients individual pain level, prescription pain medication may be provided. Most patients do well with no pain medication or use over the counter Tylenol.

Always a common question is “What are you going to inject me with ?” Our standard shoulder prolotherapy solution includes a mixture of an anesthetic called lidocaine that is given many times when you go to the dentist and dextrose, a sugar solution. A small amount of Vitamin B12 may also be included to promote healing. When precise injections of dextrose are given into the site of pain or injury, this creates a mild, controlled inflammation which stimulates the body to lay down new tendon or ligament fibers, resulting in a strengthening of the weakened structure.  When the joint becomes strong, pain will be relieved.

So what are the benefits of prolotherapy?

• You are spared invasive surgery.
• When relief comes it is sudden, total and seems miraculous.
• The results are usually long lasting unless the injury is caused by repetitive strain.

Prolotherapy is not a cure-all for all pain; however, the founders of prolotherapy, Dr.Gustave Hemwall and Dr. George Hackett, who pioneered the treatment in the forties, say that it can result in a 30-40% strengthening of the attachment points in the joints that were weakened by injuries.

Other conditions responsive to prolotherapy include neck pain, back pain, hip pain, elbow problems, wrist and hand conditions, knee pain, ankle and foot problems.

References:
Hackett, George Stuart, M.D., Hemwall, Gustav A., M.D., Montgomery, Gerald A., M.D., Ligament and Tendon Relaxation Treated by Prolotherpay, Beulah Land Press, Oak Park, Il, 2002.
Hauser, Ross A., M.D. and Hauser, Marion A., M.S., R.D., Prolo Your PAIN AWAY, Beulah Land Press, Ill, 2004

With over 20 years of clinical experience, Dr. Fred G. Arnold D.C., N.M.D specializes in Prolotherapy/Pain Rehabilitation services. He is a Diplomate of the American Academy Health Care Providers, member of American Academy of Pain Management and he is one of the few physicians in the nation with both a naturopathic medical degree and chiropractic degree.