Shoulder pain can result from any one of the following typical problems.
1) Shoulder arthritis, also called Degenerative Joint Disease (DJD)
2) Rotator cuff problem, such as rotator cuff tear
3) Subacromial impingement, called Impingement Syndrome
4) Cervical Spinal Stenosis
5) Cervical Disc Herniation
6) There are quite a few others, these are the usual culprits
So how do you know what the generator of the pain is? How does one tell if the pain is coming from a shoulder problem, a neck problem (cervical spine), or a combination of the two? From a combination of patient history, physical examination, and imaging studies, the answer usually becomes apparent.
If there is still a quandary after the above is performed, an injection into the shoulder may serve both a diagnostic and therapeutic purpose. If the pain is coming from Impingement Syndrome, an injection of pain medication (numbing plus/minus steroid) into the space called the Subacromial Space may substantially or completely decrease the pain within a few minutes. If the pain is completely alleviated, one can be fairly certain the subacromial space pathology is causing the pain.
If the patient's x-rays show considerable degenerative joint disease of the shoulder itself, an injection into the glenohumeral joint should be considered. Technically it's a more difficult injection, but if accomplished correctly and the pain diminishes substantially then voila, mission accomplished.
If the patient has a disc herniation in the neck, called a cervical disc herniation, it can result in shoulder pain. Also, if a patient has spinal stenosis in the neck, one or multiple nerve roots may be compressed from arthritis. The cervical spinal stenosis resulting in pinched nerve(s) may cause considerable shoulder pain and may be seen as a result of a shoulder problem when in fact it is not.
Keep in mind that even if a person's shoulder pain is being generated from a cervical spine problem, the patient may not have any neck pain at all. So this means it is not a prerequisite for determining whether the neck is the culprit.
So if the shoulder injection(s) either do not help or only partially relieve the person's pain, and the patient has a neck problem, injection(s) can be performed in the neck. These are usually epidural injections around the nerve root being pinched from the herniated disc or the nerve roots being pinched with spinal stenosis.
Defining how much pain is relieved by either the shoulder injection or the cervical injections can define where the pain is being generated. In conjunction with the information from the history and physical examination and imaging studies, physicians should be able to fairly accurately classify the source of the pain.
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