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Shoulder pain procedures

Persistent shoulder pain can be treated by targeting the nerves that supply the joint, or by injecting the joint or bursa directly. Which is appropriate depends on what is generating the pain, established by examination and, where needed, diagnostic block.

The shoulder joint receives most of its sensory supply from the suprascapular nerve, with a contribution from the axillary nerve. This makes both accessible targets for people with persistent shoulder pain — particularly where surgery is not an option, has already been done, or is not wanted.

Nerve blocks and radiofrequency. A diagnostic block of the suprascapular nerve, with or without the axillary nerve, indicates how much of your pain is carried by these nerves. Where the response is good but short-lived, radiofrequency treatment of the same targets can extend the effect for months. This approach is particularly useful in frozen shoulder, advanced arthritis, and rotator cuff tears not suitable for repair. It reduces pain; it does not restore a torn tendon or reverse arthritis.

Bursa and joint injections. Where inflammation of the subacromial bursa or the joint itself is the main driver, direct injection under ultrasound guidance can help. Ultrasound matters — landmark-guided shoulder injections miss the intended target more often than most people expect.

Platelet-rich plasma and hyaluronic acid. Both are available here in selected cases, and both warrant honesty about the evidence. Platelet-rich plasma involves concentrating a component of your own blood and injecting it. Results across trials are inconsistent, and high-quality placebo-controlled studies — including Australian research in knee osteoarthritis — have found no benefit over placebo in some settings. Evidence in shoulder conditions is likewise mixed. Hyaluronic acid injection has a similarly contested evidence base and major guidelines vary in whether they recommend it.

Neither is rebated by Medicare, and both are an out-of-pocket cost. Dr Martin will tell you plainly where he thinks the evidence sits for your specific problem, including when he thinks it is not worth your money.

On the day. Most shoulder procedures are ultrasound-guided, take 15–30 minutes, and do not require sedation. Radiofrequency treatment takes longer and light sedation is available.

Risks. Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

What else matters. Shoulder pain responds substantially to targeted rehabilitation. Injection is most valuable when it makes that rehabilitation possible.