A 63-year-old female having dull aching pain in the shoulder area, around the back of the neck and hand region. She has diabetes, thyroid, and high blood pressure. She was diagnosed with frozen shoulder six months back and took Nurokind LC and Myotop). She had physiotherapy sessions for a month. The pain reduced a bit, but now instead of sharp shooting pain, she is having dull aching pain while working and unable to sleep during night time. Any suggestions on what to do next and the preferred medications will be appreciated.
Ok. then the pain is coming from cervical spine. you should examine her reflexes especially Hoffman reflex and plantars. check Romberg. if she can afford get a MRI done. best is to refer her to orthopedic spine surgeon as you won't be able to diagnose her.
Does the patient have any neurological symptoms? tingling numbness, altered sensation? if not then MRI won't add much input and it will also be expensive. Instead try dry needling, musculoskeletal release massage, TENs therapy, This therapy gives alot of relief in nonspecific pain. Also chiropractic manipulation may benefit. Please consult if you need more help!!
Does she have trigger points? Myofascial pain syndrome can cause referred pain to the shoulder area especially if the upper trapezius and the paracervical muscles are affected. In this case, I recommend HMP, TENS, US, cervical and bilateral shoulder range of motion exercises followed by gentle passive stretching (GPS), scapular clock exercises, ischemic compression therapy followed by GPS, myofascial release, PNF and calliet exercises. You may also consider trigger point injection using steroid or prolotherapy. I hope these helps.
Hello Dr Shakti
The type of pain that you have explained here may also be a result of unbalanced occlusion. please check out patient's oral health. Long term unbalanced occlusion results in pain of head and neck region that is commonly missed out.
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