Painful shoulder problems are one of the most common reasons for visits to the chiropractor for musculoskeletal symptoms. The shoulder joint is the region of the body where the humerus attaches to the scapula and the supporting muscles around the joint. The shoulder has the greatest movement of the major joints in the body. On the other hand, due to this wide range of motion, it is relatively unstable and easily subject to injury. The head of the humerus (ball) is larger than the socket of the shoulder joint that supports it. To stabilize the shoulder joint, muscles, tendons, and ligaments attach the bones of the joint together. Overuse injuries, degenerative changes, and lack of use or movement can contribute to tissue breakdown, loss of function, and disruption of supporting musculature.
The shoulder is made up of three bony structures: the clavicle (clavicle), scapula (shoulder blade), and humerus (upper arm bone), as well as supporting musculature, ligaments, and tendons. The joints between the shoulder bones form the shoulder joints. The groups of muscles and tendons that stabilize the shoulder are called the “rotator cuff.” These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis, they support the humerus (ball) in the glenoid fossa (socket).
There are many types of shoulder conditions, for the purposes of this article our goal is to provide a broad overview of three different types and how chiropractic care can improve the health and function of the shoulder region.
Some indications that you may be experiencing a shoulder problem or shoulder pain and need further examination include: the inability to carry objects or use your arm without pain, pain while sleeping or at rest, ongoing and lasting pain more than a few days, unable to lift your arm, swelling or bruising around the shoulder area, redness, changes in joint size, or other unusual obvious changes in the shoulder area. The pain may be local and only in and around the shoulder joint, or it may be referred and travel down the arm and possibly into the hand, or into the mid back and lower neck. Sometimes, disease of the gallbladder, liver, or heart, or disease of the cervical spine can cause pain referred to the shoulder through various nerve pathways. However, pain in the shoulder blade or pain in the scapula have a higher chance of the problem coming from the cervical spine.
A comprehensive evaluation should include a personal history, a complete physical examination, including orthopedic and neurological tests, and if necessary, x-rays and possibly advanced imaging to determine the exact cause of the pain. If there is a tear it is most likely in one of the rotator cuff tendons, occasionally a tear in one of the rotator cuff muscles can occur. The supraspinatus tendon is the most commonly torn rotator cuff tendon. Orthopedic testing can help determine or isolate which tendon(s) and muscles (in a severe injury) may be injured.
Some of the shoulder pain conditions I see in my office are arthritis, referred pain secondary to cervical disc degeneration, and frozen shoulder. On rare occasions, shoulder pain can be caused by a pathology or tumor inside the body.
arthritis
Arthritic shoulder pain is not as common as the other types. It is usually progressive and develops slowly over time. The shoulder joint area may have tenderness, swelling, and stiffness when aggravated. The shoulder joint can be affected by both rheumatoid arthritis and osteoarthritis. Degeneration in the joint, or “wear and tear,” is a progressive wearing away of cartilage on the bony surfaces of the joint, exposing bare bone. Rheumatoid arthritis, on the other hand, is a systemic condition that causes inflammation of the lining of the joints. This inflammation can, over time, invade and destroy cartilage and bone. Gentle chiropractic mobilization of the shoulder and spine, accompanied by stretching and strengthening of the surrounding muscles, can help with inflammation and improve function of the shoulder joint. Maintaining strength in the shoulder muscles can prevent further atrophy and possibly slow any further degenerative changes. In severe cases, joint replacement surgery may be an option. Diet modifications and nutritional supplements may also be beneficial.
Neck pain or degeneration
Shoulder pain can occur as a result of degeneration or injury to the cervical or thoracic spine. Degenerative discs narrow the joint space between two vertebrae, causing further irritation and pinching of nerves in the neck or mid-back. Those nerves leave the neck or upper back and go to the shoulders and arms, or provide the nerve supply to the muscles around the shoulder girdle. This type of damage can cause referred pain to the shoulder area. Sometimes shoulder pain is actually due to neck problems or a combination of several different problems. Neck pain as a result of a degenerative change is relatively common. The pain may radiate or extend to the shoulder blade or down the arm. Patients may have arm or shoulder discomfort, such as pain or weakness, as a result of nerve root compression. Nuclear magnetic resonance (NMR) is a type of advanced imaging to determine if the discs are damaged or invaded. Symptoms may include neck pain, pain around the back of the shoulder blades, discomfort in the arms such as pain, numbness, or weakness, and, rarely, difficulty with manual dexterity or walking. Treatment of cervical degenerative disc disease provides good to excellent results in more than 75% of patients. A multidisciplinary approach includes: Chiropractic adjustments that may be helpful in decreasing muscle spasms and improving mobility. Heat and exercise may also be beneficial in improving function and stabilizing the degenerative area. In severe cases, surgery may be an option.
frozen shoulder
The proper term for frozen shoulder is adhesive capsulitis. The shoulder capsule and connective tissue around the shoulder joint become inflamed and very stiff. The tissues then begin to grow together, forming abnormal bands of tissue called adhesions. These adhesions cause a reduced range of motion or movement and chronic pain. The pain is often felt deep in the shoulder joint and may be worse at night. The exact cause of frozen shoulder is not yet clear. It can be very painful and disabling, and patients are sometimes slow to recover. Chiropractic may have some applications when it comes to frozen shoulder. It can be preventative, maintaining mobility in the joint, as well as lifestyle modifications with a healthy diet and exercise, which can decrease the likelihood of a frozen shoulder occurring. Certain diseases such as diabetes and cardiovascular disease can have an effect on joint mobility as they progress. If he can keep moving well, maybe he’ll age well too. Chiropractic can help promote physical health and can offset common ailments often associated with aging. For treatment, chiropractors generally do not use anesthetics to treat frozen shoulder. Instead, they employ a variety of techniques to control pain and restore range of motion and function in the shoulder. Chiropractors often use heat and cold for pain relief and gentle chiropractic mobilization of the shoulder and spine, accompanied by stretching and strengthening of the muscles around the shoulder.
This is a very general description of the three types of shoulder pain. Treatment varies from person to person and may include any of the following: chiropractic, massage therapy, and surgery in severe cases. The response to treatment and the time it may take varies from person to person, depending on the level of damage. Chiropractic can be a safe, gentle, and effective approach to help with shoulder pain conditions. As with any type of health problem, it is recommended to consult your healthcare professional for further evaluation and examination for a more precise individual treatment recommendation.