Shoulder pain can be extremely severe, sometimes to the point where you can’t move your arm at all. In this blog, I’ll explain the three most common shoulder conditions responsible for this kind of limitation.
Why Does My Shoulder Hurt?
Shoulder pain is one of the most common orthopedic complaints. It can range from mild discomfort — like difficulty brushing your hair — to intense, stabbing pain that wakes you at night.
But what causes shoulder pain? And what’s really going on inside the joint?
Understanding the Shoulder Joint
The shoulder is a complex structure made of bones, tendons, ligaments, and bursae. Its main function is to allow a wide range of movement. So when movement becomes painful, what’s usually to blame?
The answer is often subacromial impingement.
What Is Subacromial Impingement?
Subacromial impingement happens when the rotator cuff tendons rub against the acromion (a bony projection of the scapula). This repeated friction causes inflammation of the tendons (tendinitis) and the nearby bursa (bursitis), resulting in pain, especially when lifting the arm.
Standard Treatment vs. Advanced Options
Traditional treatment includes NSAIDs and physiotherapy. While this helps some patients, others may not improve for weeks or even months.
In our practice, we offer a faster and more precise solution using ultrasound-guided infiltration.
What Is Ultrasound-Guided Infiltration?
Here’s how the procedure works:
- A topical anesthetic is applied to numb the skin.
- Under real-time ultrasound, we insert a needle directly into the inflamed bursa.
- A targeted injection — either corticosteroids or PRP (Platelet-Rich Plasma) — is delivered precisely where it’s needed.
This reduces pain and inflammation almost immediately, allowing faster return to movement and improved outcomes with physical therapy. Many patients feel better within a day.
Why Ultrasound Matters
Unlike blind injections, ultrasound ensures that medication reaches the exact area of inflammation. If you’ve had a cortisone shot that didn’t work, it may not have been placed correctly.
Precision matters. That’s why we use ultrasound for every injection we perform.
When Is Surgery Needed?
In more advanced cases, especially with persistent or recurrent symptoms, we may consider arthroscopic subacromial decompression. This minimally invasive surgery removes bone spurs and reduces pressure on the rotator cuff tendons, allowing proper movement to return.
Final Thoughts
Most cases of shoulder pain can be treated without surgery. The key is early diagnosis, precise imaging, and the right intervention.
Stay tuned for future posts where I’ll cover more causes and treatments for shoulder pain.
Why Your Shoulder Pain Keeps Coming Back
Shoulder pain that returns after every round of physical therapy or cortisone injections can be frustrating and concerning. Many patients come to our clinic saying, “I thought I was better, but the pain came back after a few weeks.”
So, why does this happen?
The Root Cause Was Never Fully Treated
Pain relief is only one part of healing. In many cases, the inflammation subsides, but the structural issue — like a tendon tear, calcium deposit, or impingement — was never fully resolved. This leads to repeated flare-ups.
Common culprits:
- Partial rotator cuff tears.
- Undiagnosed calcific tendinitis.
- Subacromial bursitis from ongoing impingement.
The Injection Missed the Target
Many cortisone or PRP injections are done “blind” — without imaging. If the medication doesn’t reach the exact area of inflammation, the relief is incomplete and short-lived.
In my clinic, every injection is performed under real-time ultrasound guidance to ensure precision. We don’t guess—we treat what we see.
You’re Stronger… But Not Stabilized
Pain might go away after rest or therapy, but if the rotator cuff and scapular muscles aren’t properly reconditioned, the shoulder remains vulnerable. A small movement or poor posture is enough to cause a setback.
That’s why we work closely with physical therapists to build strength and stability after pain relief.
What You Can Do About It
- Get a precise diagnosis using ultrasound or MRI.
- Treat inflammation and the underlying structural issue.
- Follow a personalized rehab plan that focuses on long-term function.
- Don’t settle for temporary relief — aim for complete recovery.
Shoulder pain doesn’t have to be part of your routine. We use a combination of modern diagnostics and targeted treatments to help patients heal smarter and stay pain-free.
When to Worry About Joint Pain That Wakes You Up at Night
We’ve all had the occasional ache after a long day, but when joint pain wakes you up in the middle of the night, it’s usually a sign that something more serious is going on.
Nighttime pain is serious because it often points to inflammation, irritation, or structural damage inside the joint.
Here’s what you need to know.
Shoulder Pain at Night? Think Bursitis or Tendinitis
If you find it painful to lie on your side or wake up with a deep ache in the shoulder, the most common causes are:
- Subacromial bursitis (inflammation of the fluid-filled cushion in your shoulder)
- Rotator cuff tendinitis (irritation of the shoulder tendons)
These conditions are often made worse by certain sleeping positions and may not fully settle down without precise, image-guided treatment.
Hip or Knee Pain That Disrupts Sleep? It May Be Inflammatory
Joints that throb or burn at night could be showing signs of:
- Osteoarthritis in an advanced stage.
- Inflammatory arthritis (such as rheumatoid arthritis).
- CAM-type impingement (especially in younger adults with hip pain).
Inflammatory joint conditions often flare up during rest, which is why night pain is such an important diagnostic clue.
Back Pain Worse at Night? Don’t Ignore It
Nighttime back pain — especially if it wakes you up or is not relieved by changing positions — should be evaluated. It can sometimes indicate:
- Sacroiliitis or ankylosing spondylitis.
- Disc issues pressing on nerves.
- Referred pain from the hip or pelvis.
When Is It Time to See a Specialist?
Here are the signs that your night pain needs medical attention:
- It’s happening more than twice a week.
- It interrupts your sleep consistently.
- You feel stiff in the morning, and it takes time to “warm up.”
- You’ve already tried rest, stretching, or painkillers — and it keeps coming back.
What We Do Differently
In our clinic, we start by identifying the exact structure causing pain using ultrasound or imaging. Then, we treat it directly, often with a targeted injection under ultrasound guidance, followed by a personalized rehabilitation plan.
This approach not only relieves pain, but it also helps restore function and prevent recurrences.
Final Thought
Pain that wakes you up at night should never be dismissed as “normal.”
It’s your body’s way of telling you something’s not right, and early treatment often means faster recovery.
PRP Injections: Natural Healing or Just Hype
You may have heard athletes, celebrities, or even friends talk about PRP injections as a natural way to heal joint or tendon pain. But what exactly is PRP, and does it really work?
This blog explains how PRP works, when it’s effective, and how we use it in our practice to help patients recover from orthopedic injuries without relying on long-term medication or invasive procedures.
What Is PRP?
PRP stands for Platelet-Rich Plasma. It’s a treatment made from your own blood:
- A small sample of your blood is drawn.
- It’s spun in a centrifuge to separate and concentrate the platelets.
- The platelets — rich in growth factors — are then injected into the area that needs healing (like a joint, tendon, or ligament).
These growth factors stimulate tissue repair, reduce inflammation, and support natural regeneration.
When Does PRP Work Best?
PRP is most effective in conditions where chronic inflammation or micro-injuries are involved. In our clinic, we use PRP to treat:
- Tendinitis (like tennis elbow, Achilles tendinitis, or patellar tendinitis).
- Mild to moderate osteoarthritis (especially in the knee or hip).
- Partial ligament or tendon tears.
- Post-injury recovery is when healing is slow.
It’s a great option when:
- You’ve tried rest, physical therapy, or medications without success.
- You want to avoid surgery.
- You prefer a natural, drug-free treatment.
How We Deliver PRP The Right Way?
The success of PRP depends on how and where it’s injected.
In our clinic:
- We always use real-time ultrasound guidance to ensure precision.
- The PRP is delivered directly into the inflamed or injured tissue.
- The injection is performed under sterile, controlled conditions.
- We follow up with a customized rehab plan to support healing.
This combination ensures better results, fewer complications, and faster return to activity.
What to Expect After a PRP Injection?
- Mild soreness is common for 1–2 days.
- Healing is gradual — most patients improve over 2 to 6 weeks.
- Results are longer-lasting than cortisone in many cases.
- No systemic side effects, since it’s 100% your own blood.
Is It Just Hype?
PRP isn’t a miracle, but it’s a powerful tool when used correctly and for the right conditions. It won’t repair a completely torn tendon or replace a worn-out joint, but it can stimulate healing, reduce inflammation, and delay the need for surgery.
Final Thought
PRP is one of the most exciting natural therapies in modern orthopedics—but like any treatment, it needs to be done right.
If you’re looking for a way to recover without pills or surgery, PRP might be the right step for you.
Arthroscopy vs. Open Surgery: What’s the Difference and Why It Matters
When patients hear the word “surgery,” many imagine long hospital stays, large scars, and weeks in bed. But orthopedic surgery has changed—dramatically.
Thanks to arthroscopy, many joint problems can now be treated through small incisions with minimal tissue damage and faster recovery. But how does arthroscopy differ from traditional “open” surgery, and when is each approach appropriate?
Let’s break it down.
What Is Arthroscopy?
Arthroscopy is a minimally invasive surgical technique used to diagnose and treat joint problems.
It involves:
- A tiny camera (arthroscope) inserted into the joint through a small incision.
- Specialized instruments passed through additional small incisions.
- Real-time visualization on a screen for precise repairs.
It’s commonly used in:
- Shoulder (e.g. rotator cuff repair, instability).
- Knee (e.g. meniscal repair, ACL reconstruction).
Benefits of Arthroscopy
Compared to open surgery, arthroscopy offers:
- Smaller incisions.
- Less bleeding and soft tissue damage.
- Lower risk of infection.
- Faster recovery time.
- Reduced postoperative pain.
- Minimal scarring.
This means patients are often back on their feet quicker and can begin rehabilitation much earlier.
What Is Open Surgery?
Open surgery requires a larger incision to fully expose the joint and surrounding tissues. While it may sound outdated, it’s still necessary for:
- Joint replacements (e.g. total hip or knee arthroplasty).
- Complex fractures or deformities.
- Severe arthritis where arthroscopy wouldn’t be sufficient.
We still aim to use minimally invasive techniques even in open surgery — like muscle-sparing approaches in hip replacements — to reduce trauma and speed up healing.
When Do We Recommend Arthroscopy?
We always aim for the least invasive, most effective treatment. We recommend arthroscopy when:
- The joint problem can be fully treated through a camera-based approach.
- The benefits of a faster recovery outweigh the need for extensive exposure.
- You’re motivated to engage in post-op rehab and return to activity quickly.
Common procedures I perform arthroscopically include:
- Rotator cuff repair.
- Labrum reattachment (Bankart repair).
- Meniscal suture.
- Subacromial decompression.
Final Thought
Surgery doesn’t have to mean long recovery and big scars.
Arthroscopy allows us to diagnose and treat joint problems with precision and minimal disruption—helping you heal faster and get back to what you love. If you’re facing surgery, let’s talk about the best approach for your condition and your goals.
Cortisone Injections: Safe, Effective … But Not for Everyone
Cortisone injections have been used for decades to treat joint inflammation and pain, and for good reason. When used properly, they can provide rapid relief and help patients move and function better. But they’re not a cure-all. In fact, repeated or poorly placed cortisone injections can sometimes do more harm than good.
Here’s what you should know before saying “yes” to another shot.
What Is a Cortisone Injection?
Cortisone (a type of corticosteroid) is a powerful anti-inflammatory medication.
When injected directly into a painful or swollen joint or tendon sheath, it can:
- Reduce inflammation.
- Decrease pain.
- Improve range of motion.
This makes cortisone a useful tool for conditions like:
- Shoulder bursitis.
- Tendinitis.
- Knee or hip osteoarthritis.
- Trigger finger or plantar fasciitis.
Why Some Injections Work and Others Don’t
Many patients tell me, “I had a cortisone shot but it didn’t help.”
The truth is, it’s not just about the medication—it’s about the precision. If the injection is done “blind” (without imaging), there’s a chance the medication doesn’t reach the inflamed area. That’s why we perform every injection under ultrasound guidance, ensuring the medication goes exactly where it’s needed.
This simple step makes a huge difference in how well the injection works — and how long the relief lasts.
The Limits of Cortisone
While cortisone is helpful, it’s not without risks:
- It doesn’t fix structural damage, like torn tendons or cartilage.
- Too many injections in the same area may weaken tendons or cartilage over time.
- Temporary relief — the effects often last weeks to months, but may wear off.
- May delay proper treatment if used without proper diagnosis.
For these reasons, use cortisone strategically — and only when I’m confident it will benefit the patient as part of a larger plan.
Who Should Avoid It?
Avoid cortisone injections in:
- Young, active patients with tendinitis (we use PRP instead).
- Patients with poorly controlled diabetes (cortisone can raise blood sugar).
- Those who’ve already had several injections in the same area.
What Are the Alternatives?
If you’re looking for a longer-term or more natural approach, we may recommend:
- Platelet-Rich Plasma (PRP) — to stimulate healing.
- Ultrasound-guided needling for calcific tendinitis.
- Minimally invasive surgery — when structural damage is confirmed.
- Rehabilitation with my expert physio team — to restore strength and function.
Final Thought
Cortisone is a valuable tool, but it’s not always the right one.
The key is not just the injection—it’s the diagnosis, technique, and overall plan behind it.
If you’ve tried cortisone without lasting results, it might be time to explore other solutions.
Hyaluronic Acid Injections: A Natural Cushion for Painful Joints
If you’ve been dealing with knee or hip pain from osteoarthritis, you may have heard of hyaluronic acid (HA) injections—also known as “viscosupplementation.” These injections offer an alternative to cortisone and medications by restoring lubrication and cushioning inside the joint, helping many patients move with less pain and more confidence.
In this blog, I’ll explain what HA injections do, how we use them in our clinic, and when they may be a better choice than other treatments.
What Is Hyaluronic Acid?
Hyaluronic acid is a naturally occurring substance found in your joints. It acts like a thick gel — lubricating, cushioning, and helping absorb shock during movement. But in joints affected by osteoarthritis, the quality and amount of hyaluronic acid decrease over time.
As a result:
- Movement becomes stiff and painful.
- Cartilage wears down faster.
- The joint loses its ability to absorb impact.
That’s where injection therapy comes in.
What Do HA Injections Do?
When injected directly into the joint, hyaluronic acid helps:
- Restore lubrication.
- Reduce friction.
- Relieve pain.
- Improve joint mobility.
It’s especially helpful for:
- Knee osteoarthritis (most common use).
- Early to moderate hip arthritis.
- Shoulders and ankles in select cases.
HA vs. Cortisone: What’s the Difference?
| Hyaluronic Acid | Cortisone | |
| Main Action | Lubricates, cushions | Reduces inflammation |
| Onset | Slower (1–3 weeks) | Fast (24–72 hours) |
| Duration | Long-lasting (months) | Short-term (weeks to months) |
| Joint Protection | May delay cartilage loss | Does not protect cartilage |
| Repeat Use | Safe for repeat cycles | Limited due to tissue thinning |
For patients with mild to moderate osteoarthritis, hyaluronic acid can be a safer and more sustainable option, especially if inflammation isn’t the main issue.
What to Expect During and After the Procedure?
In our clinic, we perform HA injections under ultrasound guidance to ensure accuracy and comfort.
Here’s what the process looks like:
- 5-minute procedure.
- Minimal pain, no anesthesia required.
- You may feel pressure or mild discomfort.
- Most patients return to normal activity within 24–48 hours.
- Results build up gradually over 1–3 weeks.
The full benefit may last anywhere from 4 to 9 months, depending on your activity level and joint condition.
Is It Right for You?
Hyaluronic acid injections may be a good option if:
- You have early to moderate osteoarthritis.
- You want to delay or avoid surgery.
- You prefer a non-cortisone approach.
- You’re not ready for joint replacement, but daily activities are becoming harder.
It may be less effective in patients with:
- Severe “bone-on-bone” arthritis.
- Ongoing joint inflammation or swelling (where cortisone may be preferred initially).
Final Thought
Hyaluronic acid injections aren’t a miracle, but they can be a valuable bridge between conservative care and surgery. They provide cushioning, reduce pain, and help you move more freely without altering the structure of your joint.
If you’re not ready for surgery—but not comfortable living with pain—HA injections might be your next step.