Chronic Shoulder Pain: Is Rehabilitation Enough for Lasting Relief?

Shoulder problems

For over 30 years, I have experienced chronic pain, accompanied by a hunchback since childhood.
In addition to cervical spine deformity and bilateral shoulder pain, I have recently developed sharp pain in my right elbow over the past year, which prompted me to seek medical attention.
After undergoing rehabilitation, my condition improved, but I then started experiencing sharp pain in my right upper arm.
I can lift my arm upward, but I am unable to raise it to the right or at a 45-degree angle to the right front.
(When sitting at my desk, reaching for a cup placed at a 45-degree angle in front of me causes pain in my arm.) I began rehabilitation in May 2016, which included ultrasound and interferential current therapy.
Is this treatment merely symptomatic? If I want to address the root cause, should I focus on treating the cervical spine deformity?

Ms. Li, 50~59 year old female. Ask Date: 2016/09/19

Dr. Yin Xinbei reply Rehabilitation

If there is compression of the cervical nerves, it can indeed lead to discomfort or chronic inflammation in the muscles and fascia of the shoulders, neck, and upper arms.
Although the symptoms described do not closely resemble those caused by cervical nerve compression, since there is already an issue with the cervical spine, it can still be addressed during rehabilitation.

Reply Date: 2016/09/19

More Info

Chronic shoulder pain, especially when it has persisted for 30 years, can be a complex issue that often requires a multifaceted approach to treatment. Your history of postural issues, such as kyphosis, along with cervical spine deformities, suggests that the source of your pain may not solely be localized to the shoulder but could also involve the cervical spine and its relationship to shoulder function.

Rehabilitation, including physical therapy, is a critical component of managing chronic shoulder pain. It can help improve strength, flexibility, and range of motion, which are essential for functional recovery. However, as you have experienced, rehabilitation may sometimes only provide temporary relief, particularly if the underlying causes of pain are not addressed.
In your case, the pain radiating from the elbow and the inability to lift your arm at certain angles could indicate that there are neurological components involved, potentially related to the cervical spine. The cervical spine houses nerves that innervate the shoulder and arm, and any compression or irritation of these nerves can lead to referred pain and functional limitations in the shoulder.

Given your symptoms, it is essential to consider a comprehensive evaluation of your cervical spine. Imaging studies, such as an MRI of the cervical spine, can help identify any degenerative changes, disc herniations, or nerve root compressions that may be contributing to your shoulder pain. If significant issues are found, addressing these through appropriate medical or surgical interventions may be necessary to achieve lasting relief.

In addition to physical therapy, other treatment modalities may include:
1. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain. If the pain is severe, your doctor may consider corticosteroid injections to provide more immediate relief.

2. Alternative Therapies: Acupuncture, chiropractic care, or massage therapy may provide additional relief for some individuals.

3. Surgical Options: If conservative treatments fail and significant structural issues are identified, surgical intervention may be warranted. This could involve decompression of the cervical spine or repair of any rotator cuff tears if present.

4. Posture Correction: Since you mentioned a history of kyphosis, working with a physical therapist to improve your posture can also be beneficial. Proper alignment can alleviate some of the strain on your shoulders and neck.

5. Ergonomic Adjustments: Making changes to your workspace, such as adjusting the height of your desk or chair, can help reduce strain on your shoulders and neck during daily activities.

In conclusion, while rehabilitation is a vital part of managing chronic shoulder pain, it may not be sufficient on its own if there are underlying issues related to the cervical spine or other structural problems. A thorough evaluation by a healthcare professional, potentially including a neurologist or orthopedic specialist, is recommended to determine the best course of action for your specific situation. Addressing both the symptoms and the root causes will be key to achieving lasting relief from your chronic pain.

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