Most shoulder pain comes from the rotator cuff tendons, the bursa above them, or the joint capsule — all clearly visible on ultrasound. Full-thickness tears in active people may need repair; almost everything else responds to precise, ultrasound-guided treatment and rehabilitation.
The shoulder trades stability for range: a shallow socket, a ball held in place by four tendons (the rotator cuff) and a capsule. Tendons pinch under the shoulder blade (impingement), fray with age (tendinopathy), tear, or accumulate calcium. The capsule can thicken and contract (frozen shoulder), particularly in diabetics.
Examination to separate cuff, bursa, joint and neck sources — some shoulder pain is referred from the neck. Dynamic ultrasound of the tendons and bursa in the same visit; MRI when a full-thickness tear or labral injury is suspected.
Conditions treated
The capsule inflames, thickens and contracts, passing through painful, stiff and thawing phases over one to three years. Ultrasound-guided intra-articular steroid injection shortens the painful phase; hydrodilatation (stretching the capsule with fluid) and a suprascapular nerve block help stiffness and allow physiotherapy to progress. Manipulation under anaesthesia or arthroscopic release is reserved for the few who do not improve.
Degeneration or partial tearing of the cuff tendons; pain on lifting and at night. Partial tears and tendinopathy are treated with ultrasound-guided PRP or, in selected cases, BMAC, alongside a loading programme. Full-thickness tears in younger or active patients are usually best repaired surgically, and Dr. Kiruthika refers these.
The bursa above the cuff inflames and pinches under the acromion when the arm is raised. An ultrasound-guided subacromial injection settles it; rehabilitation corrects the mechanics that caused it.
A calcium deposit forms in a cuff tendon and can be intensely painful. Ultrasound-guided barbotage — needling and washing out the deposit — followed by a bursal injection often resolves it in one or two sessions.
Wear of the small joint at the top of the shoulder; pain on reaching across the body. Ultrasound-guided injection into the joint.
Wear of the main ball-and-socket joint. Injection (steroid or hyaluronic acid) for flares; PRP in earlier stages; replacement is discussed when bone-on-bone change limits daily function.
Inflammation of the long head of biceps in its groove at the front of the shoulder. Ultrasound-guided injection into the tendon sheath, not the tendon.
Fifteen to thirty minutes under ultrasound guidance and local anaesthesia. Most patients drive home. PRP requires a short blood draw first.
Many tears seen on scans are partial or age-related and are not the cause of pain. Whether to repair depends on the tear, your age, your activity and the strength on examination.
Untreated, one to three years. Injection and guided physiotherapy shorten the painful phase and speed recovery of movement.
Yes, spaced out. Repeated steroid into a tendon is avoided; PRP is preferred for tendon problems.
No. Movement within comfort is encouraged from the same day.
Frozen shoulder is more common and slower in diabetics, and steroid can raise blood sugar for a few days. Both are accounted for in the plan.