Dr. Tewani has broad experience, both NHS and private, diagnosing and treating these problems. In her role at University Hospitals Birmingham, she works across both Primary and Secondary Care where she treats limb and joint pain.
She approaches pain issues in a holistic manner, using medications, injections and referring to other specialists if needed, but also supporting lifestyle and health changes that help with pain.
Types of pain
Shoulder & arms
Several factors and conditions can contribute to shoulder pain. One reason is due to inflammation of the tendons that join the muscles to the shoulder joint bone called the rotator cuff. Another cause is impingement syndrome where the rotator cuff gets caught between the bones in the shoulder joint, because of injury to another location in your body, usually the neck or the muscle in your forearm called the biceps.
Arthritis of the shoulder joint or injury or swelling of the cartilages and bursal sacs in the shoulder joint can cause pain. Also, pain can arise due to a pinched nerve in the neck or shoulder, due to a dislocation or fracture of the shoulder joint and injury due to repetitive use. Frozen shoulder can cause pain, and so can serious conditions like spinal cord injury. Pain from a heart attack can be perceived as shoulder pain.
Pain in in the arm can come from the neck or may originate from the arm itself. It can be due to the involvement of muscles, tendons, ligaments nerves or bones. It can be due to osteoarthritis or fractures. Complex regional pain syndrome can occur in the aftermath of an injury, medical procedure, or following a more serious neurological injury. It typically begins at the site of the injury and spreads from there.
Legs & buttocks
Pain in the lower limbs can be due to various causes, including arthritis in different joints, muscular pain, radiation of pain from the back, tendinitis, varicose veins, Raynaud’s disease, and nerve entrapments or peripheral neuropathies.
Pain in the buttocks can arise from minor muscle strains to infections. Most of these conditions are not serious. We can help you if the pain doesn’t go away. The conditions that we can help you with are :
- Sciatica – if you get a sharp or shooting pain in your buttock or leg, with muscle strain or spasm of a muscle called the piriformis muscle causing nerve entrapments in the buttocks.
- Ischial tuberosity bursitis – the ischial tuberosity bursae are tiny sacs of fluid on the bones that you sit on which gets inflamed by sitting for long or from injuries.
- Sacroiliac joint pain – the sacrum is a triangular bone at the base of your spine, and it connects to your pelvic bone by the sacroiliac joint. When this joint becomes inflamed, it can cause pain in your lower back that may radiate down your buttock to your upper leg. Activities like walking, running, or climbing stairs can aggravate the pain from the sacroiliac joints.
- Arthritis in the hip joint can cause pain that radiates to the buttocks.
Hips, knees & ankles
Hip pain can be due to arthritis, fractures, bursitis, tendinitis, labral tears, cancers, or due to avascular necrosis of the hip joint.
Knee pain can be caused by injuries, mechanical problems, types of arthritis, or other problems such as tumours and infections.
Pain can also develop after surgery in the lower limb. Pain can persist after hip and knee surgery. The ankle joint can develop arthritis, there can be tendonitis, flat feet, nerve entrapment, peripheral neuropathies, and vascular deficiency. Any of this can cause pain.
Treatment
Your symptoms will help Dr. Tewani discern the cause of your pain. You may have to undergo clinical examination, which will help her reach a diagnosis to provide the appropriate treatment. Sometimes, investigations or diagnostic injections may be needed to aid the diagnosis.
To reduce your pain, you may be prescribed medications or be given suitable lifestyle advice. If the treatment for your underlying condition is outside the remit of the clinic, she will refer you to an appropriate specialist, including physiotherapists, spine surgeons, orthopaedic surgeons, rheumatologists or others.
Afterwards, if necessary Dr. Tewani will follow up to ensure the correct diagnosis was made and that you have progressed with your treatment.
We do not treat: Pain arising due to blockages of blood vessels resulting in leg pain. The aorta is the main blood vessel from the heart. It splits into two smaller vessels called the iliac arteries that then continue to get smaller and brings blood to the legs. A blockage in these blood vessels can cause buttock pain.
If you have symptoms such as a fever of 104°F (40°C) or higher, pain that only happens when you are walking and limits your movement, like numbness or weakness in your leg, or if you develop trouble controlling your bowels or bladder, you must consider this an emergency and report this to your GP or the A&E.
Injections offered for
Shoulder & arm pain
- Acromioclavicular joint injection
- Shoulder joint injection
- Subacromial bursa injection
- Throraco-scapular bursa injection
- Shoulder joint denervation
- Stellate ganglion blocks
- Brachial plexus block
- Ulnar, median, radial nerve blocks
- Tennis elbow injection
- Golfers elbow injection
- Trigger point injections
Leg & buttock pain
- Piriformis injection
- Superior and inferior gluteal nerve blocks
- Posterior cutaneous nerve of the thigh block
- Ischial tuberosity bursa injections
- Sciatic and femoral nerve blocks,
- Popliteal block
- Pulsed radiofrequency denervation
Hip, knee & ankle pain
- Hip joint injection
- Knee joint Injection
- Genicular nerve blocks to knees
- Genicular nerve denervation to knees
- Ankle blocks
- Pulsed radiofrequency denervation