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Shoulder pain conditions that limit movement are common, and are caused by problems with the shoulder joint and its surrounding structures. Your shoulder is more prone to injuries than other joints because of its wide range of movement and you need to know how to deal with the pain.

A few facts. About 13.7 million people went to the doctor's office in 2003 for a shoulder problem, including 3.7 million visits for shoulder and upper arm sprains and strains. (Source: National Center for Health

According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product

Statistics; Centers for Disease Control and Prevention 2003 National Ambulatory Medical Care Survey.)

One of the best ways you can avoid injury is to keep physically fit, through a balanced program of aerobic exercise, stretching and strengthening exercises for your whole body. There are a range of exercise programs available from local fitness centers, online services and even downloads for your MP3 or iPod players.

There are several conditions that generally cause pain and limit move

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

ment of your shoulder joint and you need to know what they are to effectively deal with your shoulder pain problem:

1. Rotator cuff disorders

Pain and Inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above shoulder level), heavy lifting, trauma, or poor posture. Serious injuries and untreated inflammation of the tendons can cause the rotator cuff to tear resulting in pain.

The p

lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

ain associated with rotator cuff problems is normally felt at the front or on the outside of your shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed. Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous pain.

2. Rotator cuff tears

It is usually the rotator cuff tendons (the thick bands of tissue that connect the muscles to the bones) that tear, but s

here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe

ometimes the tear occurs in the muscle. Severe injuries can cause several of the tendons and muscles to tear. There are special movement tests that your doctor can use to help determine which of the muscles or tendons has been torn.

3. Frozen shoulder

Frozen shoulder pain is characterized by progressive pain and stiffness in the shoulder. The pain is felt deep in the shoulder joint and may become worse at night due to inactivity.

The exact cause of this condition is not known, but

d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

Combination pro

it sometimes develops following other shoulder injuries. Resting a painful, injured shoulder for too long can cause the shoulder muscles and connective structures to stiffen up, so when a shoulder injury occurs make an effort to keep it loose without putting to much strain on it.

Frozen shoulder can develop spontaneously, particularly if you have thyroid problems or diabetes seem to be at increased risk. Most people with frozen shoulder tend to improve within 2 years, with or without treat

ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc

ment. In the interim, however it can be quite painful.

4. Dislocated shoulder and shoulder instability

A dislocated shoulder is visibly deformed or out of place, and there may be swelling or bruising around the joint. Your shoulder movement will be severely restricted. Your Doctor can usually put the shoulder bone back into place using gentle maneuvers.

If you suffer a dislocation, keep in mind that the shoulder joint sometimes becomes unstable and susceptible to repeated dislocat

easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi

ions. This causes pain and unsteadiness when you raise your arm or move it away from your body. Your shoulder may feel as if it is slipping out of place when you lift your arm over your head.

5. Arthritis

Arthritis causes progressive joint pain, tenderness, swelling and stiffness. Both rheumatoid arthritis and osteoarthritis will affect the shoulder joint. Sometimes shoulder pain can be due to problems in your neck or a mixture of several different problems. A visit to your doctor

nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically

is almost always necessary when it comes to a shoulder problem because in rare instances, shoulder pain may be caused by infection, problems with the nerves, or a tumor located somewhere else in your body.

As with any medical issue, a shoulder problem is generally diagnosed using a three-part process:

• Medical History – You tell your doctor about any injury or other condition that might be causing the pain.

• Physical Examination – Your doctor examines you by feeling for injury and

and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ

to discover the limits of movement, location of pain, and extent of joint instability.

• Tests – Your doctor may order one or more of the tests for you listed below to make a specific diagnosis.

What tests are needed to determine the cause of your shoulder pain?

Your doctor will determine the cause of your pain based on your symptoms and a physical examination. Where the pain is felt, both at rest and when moving the shoulder, is a clue to the cause of the shoulder pain. Your docto

ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi

r will also test your shoulder strength and the range of movement in your shoulder joint.

You may need an X-ray, or other scans, such as an ultrasound scan or MRI. Sometimes, an arthroscopy is needed. In this test, your doctor can look inside the shoulder joint using a small telescopic instrument that has a camera on the end. This is not as painful as it sounds.

How your shoulder pain will be treated

In addition to relieving pain, treatment is aimed at restoring mobility in your sh

ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a

oulder joint. The choice of treatment depends on the extent of your shoulder problem and the level of pain.

Pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) are often used as an initial treatment for shoulder pain. Ibuprofen is the best and Aspirin should be avoided.

Another simple way of easing shoulder pain is by applying a cold pack to your shoulder for 10 minutes at a time three or four times a day. Cold packs will reduce inflammation, and are most helpful when app

dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod

lied for the first few days following a shoulder injury. After that, you can switch to using a heat pack; intermittent applications of heat can help relax the shoulder muscles.

A heat pad used at night when sleeping will keep the shoulder from stiffing up. You should rest your shoulder for a couple of days after an injury, and if you have dislocated your shoulder, you may need to rest your arm in a sling or splint for several weeks after the joint has been manipulated back into place.

How

cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin

ever, with most shoulder problems it isn’t a good idea to rest for too long. While you should avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint. By returning to your normal activities as soon as possible (within the limits of disability and pain), you can help prevent the shoulder joint from stiffening up.

Physiotherapy can help treat you shoulder pain.

Physiotherapy can help improve your

tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen

shoulder strength and flexibility as well as relieve the pain associated with most shoulder problems. Physiotherapists use a variety of different therapies, including massage, ultrasound therapy, laser therapy and electrical nerve stimulation (TENS) — a therapy that uses mild electrical currents to treat pain.

Taping the shoulder joint can also help stabilize it and reduce pain during activities. Your doctor will refer you to a good Physiotherapist is he feels the extent of your injury war

t?

As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel

rants Physiotherapy.

Physiotherapists can also teach you special rehabilitation exercises to stretch and strengthen the rotator cuff muscles of the shoulder. Exercises that improve your shoulder’s range of movement help reduce the pain and stiffness that occurs after a period of immobility. Range of motion exercises may be followed by resistance exercises and weight training to strengthen the muscles.

Steroid injections can be effective but proceed with caution.

Depending on the c

ping new procedures for reviewing their safety, efficacy and quality.

Professional from academic institutions, pharmaceutical industries, health care indust

ause of your shoulder problem, corticosteroid injections may be given to relieve the pain in the short term. The corticosteroid, which is often mixed with a local anesthetic, reduces inflammation and allows you to move the shoulder more comfortably. Make sure you understand what is involved in this kind of treatment to include the long term effect on your body. The jury is still out on the impact of this type of treatment.

Surgery may be necessary to treat your shoulder problem.

Bec

y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products

ause most people improve with the above treatments, only about 10 per cent of people with shoulder problems will need to be treated with surgery. People with shoulder instability or rotator cuff problems that are not responding to less invasive treatments may benefit from an operation, and shoulder joint replacement may be considered for people with degenerative arthritis.

There are also some conditions that need to be treated initially with an operation, including some rotator cuff tears a

.

As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de

nd dislocated shoulders that cannot be reduced (put back in) with simple manual maneuvers. Sometimes frozen shoulder is treated with what’s known as manipulation under anesthesia. In this therapy, your shoulder is gently moved while you are under a general anesthetic to help improve its range of motion and of course avoid the treatment pain.

So make sure you do not self-diagnosis your shoulder problem, see your doctor. Keep in mind that it isn’t a good idea to rest it for too long or it wil

elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

Companies that provide selfless information through particip

l stiffen up. Use Cold and Heat intermittingly to speed up the healing process. Avoid strenuous activities and lifting heavy objects, but remember to move your shoulder to help make sure that you regain full use of the joint by returning to your normal activities as soon as possible and you will regain full use of your shoulder in a reasonable period of time.

But, if you are still experiencing pain, listen to it, it is a signal trying to tell you something is still wrong with your shoulder.

tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

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