Multidisciplinary Approach to
Shoulder Pain

In the medical community, the principal approaches for shoulder pain are corticosteroid injections and referral to physical therapy.¹ However, when the shoulder pain relates to disorders of the spine or the adjoining ribs, research has shown manipulation to be more efficacious than injections or physical therapy (even in the short term).² The same research showed steroid injection to be more effective over 11 weeks when the shoulder complaints originated from the glenohumeral joint, the subacromial space, or the acromioclavicular joint.

Henry West, DC, past president of the ACA, has been known to argue that corticosteroid injections are treatments of symptoms and that a chiropractor usually should be concerned with causation or etiology.³ While this makes sense to practitioners of physical medicine, patients who are in pain or who feel that more rapid relief may be available often seek additional care without consulting the primary physician.^4,5 When patients find rapid relief under the treatment of a medical practitioner, it is important that the medical practitioner stress to the patient that shoulder problems are notorious for recurrence, and that continued treatment for causation is justified.

Chiropractors should tell patients upfront that they can help make referrals to medical pain specialists who can provide rapid symptom relief if necessary. This will help ensure that your patient is forthright when seeking other medical care. Refer to Dr. Neal Taub, ABPM&R not only to ensure that your patients receive excellent pain management but also to ensure that the medical practitioner providing analgesic care is knowledgeable about and supportive of chiropractic treatments.

One of the major advantages available at the private practice of Dr. Taub is ultrasound guidance for injections. While the majority of patients respond dramatically well to subacromial injection, others respond poorly or not at all. This may have a lot to do with the fact that 30% of palpation guided subacromial injections miss their targets, even in expert hands.^6-8 Research has shown that using ultrasound to guide subacromial injections, an enhancement available at Dr. Taub’s practice, improves accuracy and effectiveness of injection therapy.⁹

Ultrasound guidance can also improve outcomes when you refer for injections of the knee, sacroiliac, piriformis, wrist, or plantar fascia. The private, physiatry practice of Dr. Neal S. Taub is referral based. Dr. Taub treats for specific complaints falling under the physiatry realm of expertise and returns your patient to you for ongoing care.

Please tell your patients about
Dr. Neal S. Taub, Physiatrist.

References:

1. van der Windt DA, et al. “Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful, stiff shoulder in primary care: randomised trial.” BMJ November 7, 1998; 317: 1292-6.
   
2. Winters JC, Sobel JS, Groenier KH, et al. “Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study.” BMJ 1997; 314: 1320-5.
   
3. “The Chiropractic Take on Tendonitis.” Journal of the American Chiropractic Association; March 2002.
   
4. McCarbert B, Dachs R. Managing Pain: Dispelling the Myths. CME Program. Leawood, Kan: American Academy of Family Physicians, Jan 2003; p 2.
   
5. Wright A, Lloyd-Davies A, Williams S, et al. Individual Active Treatment Combined with Group Exercise for Acute and Subacute Low Back Pain. Spine. 2005; 30 (11): 1235-1241.
   
6. Eustace J, Brophy D, Gibney R. “Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms.” Ann Rheum Dis. 1997 Jan; 56(1) 59-63.
   
7. Yamakado K. “The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation.” Arthroscopy. 2002 Oct; 18 (8): 887-91.
   
8. Sethi P, El Attrache N, “Accuracy of intra-articular injection of the glenohumeral joint: a cadaveric study.” Orthopedics. 2006 Feb; 29 (2): 149-52.
   
9. Naredo E, Cabero F, Beneyto P, et al. “A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder.” J Rheumatol. 2004 Feb; 31(2): 308-14.