Shoulder Pain


 

SHOULDER PAIN


When you feel like the weight of the world rests on your shoulders it may very well be a physical injury. The shoulder, one of the most flexible joints in your body, allows you to reach up, down, and to the sides as well as to rotate fully.   It is comprised of a ball and socket joint, tendons, ligaments, muscles, bursae and cartilage, and they are all susceptible to damage and pain.


At the Center for Integrated Pain Management customized treatment plans target problem areas to give the patient optimal health and pain relief.  Below is a list of conditions the Center treats.


  • Shoulder Sprain, Strains and Tears Muscle Spasms
  • Shoulder Bursitis Shoulder Osteoarthritis
  • Frozen Shoulder/Adhesive Capsulitis
  • Nerve Entrapment/Radiculopathy
  • Biceps Tendonitis
  • Rotator Cuff Injuries
  • Shoulder Instability/Partial Dislocation



A diagnosis will be made once Dr. Kulick reviews your family history, completes a thorough physical examination and conducts an in-office ultrasound. If necessary,  Dr. Kulick may request that you obtain an MRI, a CT Scan or additional X-rays in order to determine the diagnosis and treatment plan.


To learn more about the treatment and relief of shoulder injuries please call us at 212-867-1777.



Shoulder Sprains, Strains and Tears


What is a Shoulder Sprain, Strain or Tear?


The shoulder is one of the least stable joints in the human body and is susceptible to injury, pain and stiffness from work, sports and daily wear and tear.  This may be caused by a sprain, strain or tear. Shoulder sprain occurs when the ligament that attaches the acromion, the bony protrusion of the shoulder blade, to the clavicle, also called the collarbone, is stretched or partially or completely torn as a result of a fall or injury. Shoulder strain occurs when a muscle or  a tendon in the shoulder is stretched or partially or completely torn. A tendon attaches muscle to bone while a ligament attaches bone to bone. Keeping the shoulder in one position for a long period can cause a strain as can carrying a heavy weight like a backpack, poor posture while working at a computer or sports that demand repetitive movements.  a sprain or tear can be caused by a fall or a trauma to the shoulder


Seek treatment for these symptoms:

  • Stiffness, pain or weakness in the shoulders or arms
  • Loss of full range of shoulder motion


Next Steps

Consult the Center for a diagnosis and for treatment possibilities.  If tendinosis is indicated then treatment options are ultrasound-guided tenotomy injections to destroy damaged tissue followed by ultrasound-guided injections of platelet rich plasma (PRP) to accelerate the growth of healthy replacement tissue. Additional options include a cervical collar, trigger point therapy, physical therapy and anti-inflammatory medication.


To learn more about the state-of–the-art treatment for the relief of shoulder sprains, strains or tears please call our office at 212-867-1777.



Shoulder Bursitis


What is Shoulder Bursitis?


Bursae are small fluid filled sacs that cushion the large joints and reduce friction. The shoulder has a large bursa called the subacromial bursa that is located below the acromion, the bony knob of the shoulder blade. Bursitis is an inflammation of the bursa caused by a shoulder injury or osteoarthritis.



Seek Treatment for these Symptoms:


  • Tenderness to the touch on the outer portion of the shoulder
  • Pain at the outer shoulder with or without movement


Next Steps


Consult the Center for a diagnosis and for treatment options. Ultrasound-guided corticosteroid injections, ultrasound-guided prolotherapy injections and anti-inflammatory medication may provide relief.


To learn more about the treatment and relief of Shoulder Bursitis please call 212-867-1777.



Frozen Shoulder/Adhesive Capsulitis


What is Frozen Shoulder/Adhesive Capsulitis?

Frozen Shoulder or Adhesive Capsulitis causes shoulder stiffness and pain.  The shoulder capsule, made up of connective tissue, surrounds the ball and socket joint of the shoulder. Synovial fluid lubricates this capsule. Frozen shoulder restricts the range of movement of the shoulder because adhesions or stiff bands of tissue develop in the capsule. The synovial fluid is also reduced.  An injury, arthritis or surgery may cause this to occur.


Seek Treatment for these Symptoms:

  • Shoulder stiffness or pain
  • Limited range of movement in the shoulder


Next Steps

Consult Dr. Kulick for a diagnosis and for treatment options. These may include ultrasound guided corticosteroid injections, anti-inflammatory medication for pain relief, ultrasound-guided prolotherapy injections and  physical therapy.


To learn more about the treatment of Frozen Shoulder/Adhesive Capsulitis please contact us at 212-867-1777.


Biceps Tendonitis/Tendinosis


What is Biceps Tendonitis/Tendinosis?


Biceps Tendonitis or tendinosis is an inflammation of the biceps tendon that connects the upper head of the biceps muscle, located in the front of the upper arm, to the bones in the shoulder.  It becomes swollen and thickens. Wear and tear and repetitive overhead movements may cause this painful condition. Symptoms include pain and tenderness near the front of the shoulder that can radiate down the arm. It may be the result of shoulder wear and tear or repetitive motions used in sports such as baseball and tennis.


Seek Treatment for these Symptoms:

  • Pain in the front of the shoulder
  • Pain radiates down arm
  • Pain worsens with activity
  • A snapping sound in the shoulder that accompanies movement


Next Steps

Consult Dr. Kulick for a diagnosis and for treatment options. These may include ultrasound guided corticosteroid injections, anti-inflammatory medication for pain relief, ultrasound-guided prolotherapy injections and  physical therapy. If tendinosis is indicated, ultrasound-guided tenotomy injections to remove damaged tissue followed by ultrasound-guided injections of platelet rich plasma (PRP) to accelerate the growth of healthy replacement tissue may be recommended.


To learn more about the treatment of Biceps Tendonitis/Tendinosis please contact us at 212-867-1777.



Rotator Cuff Injuries


What is a Rotator Cuff Injury?

Rotator cuff injuries may range from a minor inflammation to a complete rotator cuff tear. The rotator cuff is a group of muscles and tendons that provide strength and stability to the shoulder and hold the upper arm in place in the shoulder socket. These allow the shoulder and arm to rotate. Bone structure issues, a bad fall, lifting a weight improperly or repetitive arm movements, particularly overhead motions, may lead to a rotator cuff injury. Ongoing stress on the bones and tendons of the rotator cuff can eventually lead to a complete tear.  The risk of a rotator cuff injury increases with age.


A rotator cuff tear occurs when one or more rotator tendons have either partial or complete tears. The rotator cuff tendons attach the humerus or upper arm bone to the shoulder blade and help to lift and move the arm.  Tears can be acute and occur because of a trauma like a fall, or, degenerative, a gradual erosion of the tendon. Shoulder instability, repetitive stress and age contribute to the risk of a tear.


Seek Treatment for these Symptoms:

  • Shoulder pain or tenderness
  • Pain when lifting an arm
  • Grinding or popping sound when moving arm
  • Arm weakness
  • Inability to lift arm
  • Increased pain when sleeping on the affected side


Next Steps

Consult the Center for a diagnosis and for treatment options. A customized treatment plan may include ultrasound-guided corticosteroid injections for pain relief, anti-inflammatory medication, physical therapy, trigger point therapy, ultrasound guided prolotherapy injections, ultrasound-guided tenotomy injections to destroy damaged tissue, followed by ultrasound-guided injections of platelet rich plasma platelet rich plasma (PRP) to accelerate growth of the muscles or tendon, stem cell injections, or possibly surgery. If nerve entrapment is indicated then a hydrodissection to release the nerve from compression or ultrasound-guided nerve block injections will be advised.


To learn more about the treatment and relief of rotator cuff injuries please contact our office at  212-867-1777.


Shoulder Instability/Partial Dislocation


What is Shoulder Instability?

Shoulder Instability, a rotator cuff condition, occurs when the ball of the ball and socket joint of the shoulder is not held stable by the surrounding ligaments, tendons and muscles. Repetitive overhead motions, such as those used in such sports as baseball and tennis, may exacerbate shoulder instability.  The joint may become so loose that the head of the upper arm - the ball- slips slightly out of the shoulder blade’s socket. This is called a partial dislocation and can happen repeatedly if the soft tissue holding the ball joint in place suffers tears or remains loose.


Seek Treatment for these Symptoms:

  • Shoulder pain from a trauma to the area
  • Shoulder repeatedly gives out
  • Recurrent shoulder dislocations


Next Steps

Consult the Center for a diagnosis and for treatment options.???????


These may include ultrasound-guided corticosteroid injections, prolotherapy injections and physical therapy.


To learn more about the treatment and relief of Shoulder Instability or Partial Dislocation please call 212-867-1777.


Muscle Spasms

 

What Are Muscle Spasms?

Muscle spasms are very common and can happen without warning. Perhaps you reach for an item, turn to face a friend or even sleep in an awkward position. This suddenly triggers a muscle spasm in your shoulder and you cannot turn or move it without pain. Muscle spasms are the involuntary contraction or tensing of one or more muscles. They may in the neck, wrist, forearm, shoulder, hand, upper or lower back, and legs.  Muscle spasms may be caused by turning suddenly, heavy lifting, muscle overuse, weak muscles, nerve compression, spinal conditions such as degenerative disc disease or a herniated disc, and many sports injuries. Spasms may seem to appear out of nowhere, however, typically small tears in the muscle may have developed over time. These tears may lead to swelling that compresses the nerves surrounding the muscle. This in turn sparks a muscle spasm that can cause pain, cramping or twitching.

 

 

Seek Treatment for these Symptoms:

  • Muscle pain that does not dissipate on its own
  • Constant muscle cramps
  • Difficulty moving
  • Muscle appears hard or distorted

 

Next Steps

If the muscle spasm does not resolve by itself after a few days of rest, icing the area for short periods of 10 to 20 minutes every two hours or using a heated pad, and taking non-steroidal anti-inflammatory medication, then seek treatment. Consult the Center for a diagnosis and for options.  The spasm may be the result of an underlying condition that can be treated. Once identified, treatment options may include ultrasound-guided corticosteroid injections, trigger point therapy, ultrasound guided prolotherapy injections or anti-inflammatory or muscle relaxant medication. Ultrasound guided injections of platelet rich plasma (PRP), or stem cell therapy may be advised. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.

To learn more about the treatment and relief of Muscle Spasms please call our office at 212-867-1777.



Shoulder Osteoarthritis


What is Shoulder Osteoarthritis?


Shoulder Osteoarthritis afflicts many people. The cartilage in the shoulder gradually degenerates leading to bone on bone friction and inflammation.  Cartilage, the tough connective tissue covering the ends of the bones, allows the bones to glide smoothly. When it erodes, due to the wear and tear of aging or a traumatic injury, joint stiffness, pain, and loss of movement can occur. This condition is more common in older women and people with a genetic predisposition or a bone deformity. Repetitive motions or an untreated shoulder injury may speed the deterioration. The formation of painful bone spurs, bony bumps, exacerbates the discomfort.  


Seek Treatment for these Symptoms:

  • Shoulder stiffness
  • Shoulder pain
  • Limited range of motion


Next Steps

Consult the Center for a diagnosis and for treatment options. These may include rest, ultrasound-guided corticosteroid injections, anti-inflammatory medication and physical therapy.  Other pioneering treatments may include trigger point therapy, ultrasound-guided prolotherapy injections, and stem cell therapy. If tendinosis is indicated then ultrasound-guided tenotomy injections to remove damaged tissue followed by ultrasound-guided injections of platelet rich plasma (PRP) to accelerate healthy replacement tissue growth will be advised.


To learn more about the treatment and relief of Shoulder Osteoarthritis please contact our office at  212-867-1777.


????Shoulder Impingement may also lead to a rotator cuff tear. This occurs when the acromion, a bony protrusion of the shoulder blade, pinches a rotator cuff tendon when the arm is raised. The tendon is trapped in the narrow space between the acromion and the humerus or upper arm bone. This can be the result of a poorly shaped acromion or because of a bone spur, a bumpy bone overgrowth.



Nerve Entrapment/Radculopathy


What Is Radiculopathy?

Radiculopathy is a group of conditions affecting one or more nerves in the spine. These nerves may become pinched or compressed, causing pain, numbness or tingling in the arms or legs. The sciatic nerve, the large nerve that runs down the lower back, hip, buttocks, and back of leg to the foot may be compressed in the lower back as a result of a herniated disc or other spinal damage.

Radiculopathy commonly occurs in the cervical spine (neck), the thoracic spine (mid back)or the lumbar spine (lower back).

Cervical, thoracic, and lumbar radiculopathy are often caused by herniated discs in the vertebrae (bones of the spine) and spinal stenosis, a narrowing of the hole in the vertebrae through which spinal nerves exit.  This places pressure on the nerves as they branch out from the spine. The compression may also be caused by an injury, overuse of muscles and tendons, poor posture, bone spurs, and arthritis.

 

Seek Treatment for these Symptoms:

  • Pain that radiates outward from the injured nerve
  • Numbness, tingling, burning sensation
  • Muscle weakness
  • Cervical radiculopathy affects the neck, upper back, shoulder, chest, arm,or hand.
  • Thoracic radiculopathy affects the chest, ribs, shoulders, mid back or stomach area
  • Lumbar radiculopathy causes sciatica which is an irritation of the large sciatic nerve located in the lower back.  This causes pain to radiate down the back of the leg to the calf or foot called sciatica
  • Pain may be aggravated by activities such as walking, climbing stairs or sitting

 

Next Steps

Consult the Center for a diagnosis and for treatment choices.  Depending on the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, ultrasound -guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve and ultrasound-guided nerve block injections will be recommended.


To learn more about cervical radiculopathy and its treatment please call our office at 212-867-1777.



Location
Alexander Kulick, MD
112 East 61st Street
Upper East Side

New York, NY 10065
Phone: 917-810-4139
Fax: (646) 585-0042
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917-810-4139