One thing is certain when your shoulder is sore, you know about it. The shoulder is the center point of many activities that occur in our daily lives and despite it being an area that is somewhat stubborn to resolve when there is pain, here at Chirolink we have helped several people suffering from shoulder pain and their many different causes. Here is an example:
A month ago, Linda arrived at Chirolink wondering if this was the right place to go. She was struggling to brush her hair and reach up into the kitchen cupboards because her shoulder was sore. This had gradually gotten worse over a few weeks and had become a real bother to her. She had never experienced this before, but it correlated to the same time that she started going to the gym for the first time in 58 years. Going to the gym has been a wonderful thing. Linda’s body started getting stronger. She wasn’t tired all the time and she had far less discomfort overall. Linda was significantly happier. Unfortunately, we discovered that the problem we were facing was poor gym form. The correct gym form is of utmost importance. Linda was suffering from impingement syndrome which is discussed in further detail below. The important thing is that we found the cause, treated the issue, and knew how to prevent it and within a month we had Linda pain-free.
The shoulder girdle is complex. Many structures can be the cause of pain.
It is made up of the glenohumeral, acromioclavicular, sternoclavicular, and scapulothoracic joints and all their associated muscles, tendons, ligaments, and other important soft tissue structures. This is an entire system that works together to benefit us in almost every action we perform in daily life.
The shoulder requires a lot of mobility. Its entire structure is designed to provide this but, unfortunately, at the expense of stability. Despite this, the shoulder is a good example of ‘dynamic stabilization’. Even though the anatomical structure allows a large amount of movement, the muscles (which are dynamic) stabilize the joint very well. This means that the system of muscles surrounding the shoulder works very hard, all the time, and can be more susceptible to problems and thus, need to be properly taken care of.
Shoulder instability can be one of the conditions associated with this increased mobility. It is primarily due to trauma (blunt force or repetitive microtrauma) but could be secondary to generalized ligament laxity. Shoulder instability can result in partial or complete dislocation. This is when the head of the upper arm bone (humerus) loses contact with the joint surface and comes out of the socket. A complete dislocation is extremely painful, and relocation needs to be done as soon as possible by a medical professional who can assess if there has been neurovascular damage associated. When a shoulder dislocates, there is always surrounding soft tissue injury. The tendons, ligaments, and all other associated soft tissue structures overstretch and possibly tear. This is including the labrum – a cartilaginous structure that surrounds the head of the humerus which functions to gently stabilizes the shoulder and provides an attachment site for several muscles and ligaments. It takes a long time to heal.
Because there are so many delicate structures in this very mobile joint, keeping the shoulders strong and stable is of utmost importance. Treatment for a dislocation aims to reduce inflammation, aid in the proper healing of the injured structures, and stabilize and strengthen the shoulder to prevent it from happening again. In some cases, surgery is required.
When most people hear the term shoulder pain or injury, they think of ‘rotator cuff’. The rotator cuff isn’t one structure. It’s a group of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. Each of these muscles performs specific movements and simultaneously activates to stabilize the shoulder during all movements.
The most affected muscle in this group is the supraspinatus muscle and even more so, its tendon. Tendonitis is a common affliction and occurs with either overuse (usually excessive overhead movements) but also chronically with degeneration of aging tissue. The supraspinatus tendon arises from the muscle belly at the top of the scapular, reaches under a thick bony arch called the coracoacromial arch, and inserts on a bony prominence on the outside of the humerus (bone of the upper arm). Because of the tight space that the tendon runs through, leaves it susceptible to compression and friction. When this is repetitive, inflammation starts, and tendonitis begins. That constant pinch when the arm is raised is an impingement syndrome. The most important key to this condition is the get it treated as soon as possible! The sooner the friction is reduced, the better. There are cases where chronic inflammation and associated poor blood supply and long-term overuse result in calcific deposits into the tendon which is calcific tendonitis. This condition is managed with maintenance care.
Bursitis can also be a cause of shoulder pain. Bursae are small fluid-filled sacs that sit between various bony prominences of the body and their corresponding tendons to reduce friction and gently protect the surface it sits on. Bursitis is inflammation of the bursa and normally occurs secondary to other conditions such as tendonitis. In the shoulder, it is usually a supraspinatus tendonitis/impingement syndrome with associated subacromial bursitis. When the tendonitis is treated and resolved, the bursa generally follows suit. Occasionally bursitis can occur in isolation when the shoulder is overused especially with overhead movements. This requires rest, chiropractic treatment to allow proper biomechanical movement of the surrounding joints, and possibly anti-inflammatory treatment.
Shoulder pain could simply be from active muscle spasms of the upper trapezius, levator scapulae, or rhomboid muscles and their referral patterns. None of us are immune to stress. We all experience it at some point or the other and when healthy stress turns to unhealthy, we often experience somatic effects in the muscles of our bodies. Consistent poor posture is also a trigger for these muscles to spasm and with desk work and cell phones, the reality of this is rife. An upper cross syndrome occurs when there is prolonged slouching of the upper body, shoulders rounding forward, overstretching of the upper back tissues, forward head posture, and down the road – pain, pain, pain.
As chiropractors, we focus a lot of attention on the upper back area and ensure that the thoracic stiffness is addressed. When this is clear, the rest of the body starts to open up. Yes, cell phones and computers will be here for the remainder of our lives, and we have to be realistic about it but the key is to be wise about the volume of use and our ergonomics when we do.
Osteoarthritis of the shoulder girdle can affect any of the joints mentioned above. The acromioclavicular more likely. Degeneration or osteoarthritis is the gradual erosion of the cartilage covering, cushioning, and lubricating the joint. Even though every average aging joint is susceptible to wear and tear of cartilage, there is still a higher predisposition when there is abnormal mechanical stress for extended periods or a history of major injury. The latter is more likely as the shoulder is non-weight bearing. The most common symptoms are pain and stiffness with a limited range of motion.
Fractures can be a cause of shoulder pain. This is when there is a break in the bone. It occurs with high energy impact such as a motor vehicle accident or in the aging bone with a major fall. This is treated with complete rest or bracing and occasionally surgery.
All these conditions commonly result in the avoidance of movement for fear of pain. This is fear avoidance. In contrast to what it may seem – the best thing one can do is keep moving. A pain-free range of motion is key. Keep it moving if it’s not pushed through significant amounts of pain.
Often what happens when the shoulder is injured and not moved, it freezes up in an inflammatory stress response. We have all heard the dreaded term ‘frozen shoulder’. A frozen shoulder, adhesive capsulitis, is when the capsule surrounding the head of the upper arm bone becomes diffusely inflamed, contracts, thickens, and adheres to all the deep structures. Suddenly, the joint space is significantly reduced and with the diffuse inflammation, is extremely limited and painful to move. With Chiropractic treatment, this movement can be gently restored, allowing the body to properly process the inflammation and allow to joint to come back to normality.
Ultimately, shoulder pain is something that can easily be assessed and treated with your Chiropractor. We find that each one of these conditions is frustrating for patients as they are notoriously stubborn. But with the right attention and care, they don’t need to be. If you are struggling with shoulder pain, give us a call and we will help you.