Neurologist – Doctor Yaacoub

NeurologistAugust 29, 2023June 24, 2025byweb@digitalrevamp.comNo Comments

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.

Neurologist

NeurologistAugust 29, 2023July 16, 2025byweb@digitalrevamp.comNo Comments

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.