Shoulder Pain

Shoulder pain affects a large number of our population, and almost all of us have had some experiences of shoulder pain in our lives, and the severities can range from a temporary discomfort to serious debilitation. 

The most commonly seen shoulder conditions include tendonitis and tendonosisimpingement syndromearthritisrotator cuff syndromefrozen shoulder, and bursitis (most commonly deltoid bursitis). 

The elderly population typically suffers more from degenerative types of diseases such as arthritis, which is usually associated with pain and decreased range of motion. Among middle aged population, it is more common to see rotator cuff syndrome or tear, as well as frozen shoulder. The formal diagnosis for frozen shoulder is adhesive capsulitis, which is characterized by generalized inflammation of the shoulder joint capsule that results in severe pain and drastically reduced range of motion in all directions of shoulder movement. 

For those who are actively involved in athletic and sports activities, especially activities that involve overhead movement or throwing, such as swimming, baseball, volleyball, tennis, etc., impingementsyndrome and bursitis are most common types of injury. However, more severe problems can occur as well, including rotator cuff tears and labrum tears

Rotator cuff is the name of a group of 4 relatively small muscles at the shoulder that are primarily involved in stabilizing the joint. Repetitive inappropriate use of the shoulder can cause tear of any of the 4 muscles at the tendon areas, most commonly at the supraspinatus tendon. Labrum is a cartilaginous extension of the shoulder joint “socket”, which can be torn due to trauma or repetitive injuries. 

Falls on the shoulder, especially with outstretched arms, could also easily cause shoulder dislocation or tear of the acromioclavicular joint, and any type of shoulder dislocation can lead to instability that cause long term problems including early development of arthritis and decreased range of motion. 

Shoulder problems are frequently intertwined with neck problems, because neck and shoulder are so close to each other, not only with regard to location, but also in terms of their biomechanical  function. Many muscles bridge between the neck and the shoulders, and there are many movements of the shoulders that require the help of the neck. Conversely, neck tension frequently causes shoulder problems as well (please see the article on Neck Pain ). 

To shed some light on the causes of shoulder pain, let us take a closer look at the features of the shoulder joint. The shoulder joint possesses the largest range of motion in the entire body. Each shoulder is actually functionally comprised of 3 joints to achieve this amazing range of mobility. The shoulder provides a stabilizing pivot point for movement and strength of the entire upper limb, therefore good stability and strength is the key for allowing good use of the arm to wrist. 

But On the other hand, how far we can outreach with our hands largely depends upon the flexibility and mobility of the shoulders. Stability and mobility, two seemingly opposite qualities, are both required for a shoulder joint to meet all our needs, which require the good coordination of many muscles to achieve. This is the reason why almost any problems with your shoulder always involve multiple structures (joints, muscles, tendons or ligaments) in or around the shoulder joint. 

So what is your diagnosis? 
Now you know that most shoulder pain involves multiple structures and many of the diagnoses are interrelated functionally – what you are labeled by your diagnosis may not be most relevant to how you should be best and effectively treated. Would you like to stop the pain and maximize your recovery in minimum time? 

Our highly trained doctors with years of successful experiences will analyze your case individually with our expertise in biomechanical diagnosis and implement a unique treatment plan for you and you shall feel the difference within a short period of time if not right away. 

Want to stay out of pain, enjoy what you do, and stay out of sight of doctors including us (our goal)? You need to be educated, trained and coached to implement the simple yet important programs so you are pain and injury free. 

There are many conventional treatment that have been frequently used for shoulder pain such as stretching, ultrasound, heat, electrical muscle stimulation (EMS), exercises, and non-specific soft tissue work. Many are helpful but not specific enough to resolve the problems for the effective and quick recoveries we are looking for. 

For example, stretching is good for overall flexibility, but does not have enough specificity to target the specific muscles that need it the most, therefore it is much better used as an adjunct to reinforce the treatment but not as the treatment itself. Ultrasound, heat and EMS are largely for symptom control by reducing the inflammation or improving circulation, without resolving the root problem. As a result, the problem is prone to recurrence, should you go back to the old activity that you are told to have caused your problems in the first place. 

Exercises are excellent for your recovery, but appropriate exercises are only beneficial after the unique/specific problem is corrected and you are pain free. If exercises are implemented too early, they can cause adverse effects such as worsening an impingement syndrome, and may even prolong the time of suffering. 

Conventional soft tissue work including massages are great for relaxation and reducing the muscle tone, but do not target the most important and relevant muscles specifically enough for your problem. They do not work fast enough, because they usually do not get to the heart of the problem. 

We all know that surgery is the very last resort. The drawbacks include large amounts of scar tissue formation, prolonged rehabilitation and re-adaptation. In addition, surgical intervention for some problems are more like band-aids, because the underlying biomechanicalproblems are not corrected, and the symptoms can easily recur unless the patient completely stays away from the “offending” activities. However, there are no offending activities in our eyes. No activities you enjoy should ever remain off limits, once you have been effectively treated. Our goal is to help you resume all activities that bring you happiness to your life. 

Chiropractic and Shoulder Pain

Shoulder pain is an extremely common complaint, and there are many causes of this problem. We have listed some of the most common conditions here to help you get an idea what they are and what chiropractic treatment can do to help.

When do you need to call your Chiropractor about your shoulder pain?

Like any other pain condition, the sooner you get appropriate care the quicker the pain will go and allow you to go back to normal activities, the sooner you get appropriate care the less likely you are to get a recurrent and chronic problem.

If you are unsure of the cause of your shoulder pain, or if you do not know the specific treatment recommendations for your condition, you should seek Chiropractic help. Treatment of these conditions must be directed at the specific cause of your problem to be effective.

Some signs that you should be seen by a Chiropractor include:

  • Inability to carry objects or use the arm
  • Injury that causes deformity of the joint
  • Shoulder pain that occurs at night or while resting
  • Shoulder pain that persists beyond a few days
  • Inability to raise the arm
  • Swelling or significant bruising around the joint or arm
  • Signs of an infection, including fever, redness, warmth
  • Any other unusual symptoms

What are the best treatments for shoulder pain?

The treatment of shoulder pain depends entirely on the cause of the problem. Therefore, it is important for the chiropractor to accurate diagnose the problem before any treatment can start. If you are unsure of your diagnosis, or the severity of your condition, you should seek advice before beginning any self-treatment. Not all treatments listed here are appropriate for every condition, but may be helpful in your situation. Just remember, resting and taking painkillers only, is not a treatment that is likely to help your shoulder in the long term. But may well be part of what you need to do when the treatment start.

  • Rest: The first treatment for many common conditions that cause shoulder pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilisation can cause a frozen shoulder.
  • Ice and Heat Application: Ice packs and heat pads are among the most commonly used treatments for shoulder pain.
  • Stretching: Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain. A good routine should be established, and following some specific suggestions will help you on your way.
  • Anti-Inflammatory Medication: Non-steroidal anti-inflammatory pain medications, commonly referred to as NSAID’s, are some of the most commonly prescribed medications, especially for patients with shoulder pain caused by problems such as arthritis, bursitis, and tendinitis. There are of course some natural alternatives that your chiropractor can recommend.
  • Cortisone injections: Cortisone is a powerful medication that treats inflammation, and inflammation is a common problem in patients with shoulder pain. Discuss with your doctor the possible benefits of a cortisone injection for your shoulder condition. It can be a useful adjunct to chiropractic treatment, but should not be relied on as a treatment on its own. It is quite an invasive approach and not without adverse-effects.

What are the Causes of Shoulder Pain?

Here is a list of some of the most common causes for shoulder pain, for a more detailed explanation please click on the condition.

Referred pain from the neck

When the structures in the neck are painful, the pain is often felt over the shoulder. It is important to remember this and your chiropractor will always examine your neck when you come in for shoulder pain.

Bursitis/ Rotator Cuff Tendinitis = Impingement syndrome

The most common diagnosis in patients with shoulder pain is bursitis and tendinitis of the rotator cuff musculature causing impingement syndrome.

Rotator Cuff Tear

Different degrees of rotator cuff tears can occur. If the tendons of the rotator cuff separate from the bone, surgery is sometimes necessary.

Frozen Shoulder

Also called ‘adhesive capsulitis,’ this is a common condition that leads to severely restricted movement of the shoulder.

Calcific Tendinitis

Calcific tendinitis is a condition of calcium deposits within a tendon – most commonly within the rotator cuff tendons. Treatment of calcific tendinitis depends on the extent of symptoms.

Shoulder Instability

Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition.

Shoulder Dislocation

A dislocation is an injury that occurs when the ball-part of the shoulder joint (top of the arm bone) slips out of the socket (part of the shoulder blade).

Ligament injury (Acromio-Clavicular Tear)

Also called an A/C separation, these injuries are the result of a disruption of the acromio-clavicular joint. This is a very different injury from a gleno-humeral dislocation.

Labral Tear

There are several patterns of a torn labrum and the type of treatment depends on the specific injury.

Arthritis

Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery. However, arthritic changes are more common in the acromio-clavicular joint between the collarbone and the shoulder blade.

Biceps Tendon Rupture

The upper part of the biceps tendon can rupture and cause shoulder pain.

Referred pain from internal organs

It is important to remember that pain from the gall bladder can be felt over the right shoulder and pain from the pancreas can be felt over the left shoulder, and most importantly, heart attacks can refer pain into the left shoulder and arm.

Chiropractors are trained in medical diagnosis and one of the priorities in the examination is to rule out more serious medical conditions before any treatment can start. For more information on how chiropractic can help, contact us.

Impingement syndrome

What is Impingement syndrome?

Chiropractic treatment for sub-acromial bursitis (or shoulder bursitis) and rotator cuff tendonitis is very effective. These are two conditions that often occur simultaneously. There is inflammation of a particular area within the shoulder joint that is causing a common set of symptoms. The best terminology for these symptoms is ‘impingement syndrome.’ Impingement syndrome occurs when there is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons.

Where is the problem that causes shoulder bursitis?

Impingement syndrome, or shoulder bursitis, occurs when there is inflammation between the top of the humerus (arm bone) and the acromion (tip of the shoulder). Between these bones lies the tendons of the rotator cuff muscles, and the bursa that protects these tendons. The muscles affected are the teres minor, infra spinatus and supra spinatus. Normally, these tendons slide effortlessly within this space.

What causes this problem?

The most common cause is a combination of overuse and faulty mechanics of the shoulder, which is often caused by a muscle imbalance. If the upper trapezius muscle is hyperactive and the scapular stabilising muscles and the rotator cuff are weak, it prevents the shoulder from moving normally and causes impingement. The postural changes often seen in association with this muscle imbalance would be rounded and forward drawn shoulders, and a head-forward posture.

The problem can be exacerbated by wear and tear of the A/C joint and thickening of the rotator cuff tendon. In some individuals with this problem, the shape of their bones is such that they have less space than normal. Therefore, only slight thickenings of the tendons or bursa can cause symptoms. Often there is an initial injury, either due to trauma or overuse that sets off the process of inflammation. Thereafter, the problem can be self-exacerbating. Once there is an initial injury, the tendons and bursa become inflamed. This inflammation causes a thickening of these structures due to fibrosis and scar-tissue build-up. The thickening then takes up more space, and therefore the tendons and bursa are pinched upon even more – this is the impingement. This causes more inflammation, and more thickening of the tendons and bursa, and so on. This can lead to a chronic condition, therefore early treatment is very important.

What are the symptoms of shoulder bursitis / impingement syndrome?

Common symptoms include:

  • Pain with lifting the arm out away from your body and up (abduction), activities above shoulder height. The painful arc is between 80-120°.
  • Pain while sleeping at night
  • Pain over the outside of the shoulder/upper arm

Impingement syndrome and a rotator cuff tear are different problems, and although they are related, the treatment is different. Impingement syndrome is a problem of inflammation around the rotator cuff tendons. A rotator cuff tear is an actual tear within the tendons. The best sign that differentiate these problems is the strength of the rotator cuff muscles. Your Chiropractor will be able to specifically isolate these muscles to better determine if a rotator cuff tear is present. Once the problem has been diagnosed the chiropractor can start to give advise and start the treatment