Shoulder Pain and Chiropractic Care

Painful shoulder problems are one of the most common reasons for chiropractic visits 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 most movement of the major joints in the body. On the flip side, because of this large 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 holds it. To stabilize the shoulder joint, the muscles, tendons and ligaments anchor the bones of the joint together. Overuse injuries, degenerative changes and lack of use or movement can all contribute to tissue breakdown, loss of function and disruption to the supporting musculature.

The shoulder is comprised of three osseous structures: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as the supporting musculature, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The muscle groups and tendons that stabilize the shoulder are called the "rotator cuff." These muscles include the supraspinatus, infraspinatus, teres minor and subscapularis, they hold the humerus (ball) in the glenoid fossa (socket).

There are many types of shoulder conditions, for the purposes of this article, are aim is to give a broad overview of three different types and how chiropractic care may 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, pain that is ongoing and lasts more than a few days, unable to lift your arm, swelling or bruising around the shoulder area, redness, joint size changes or other obvious unusual changes to the shoulder area. The pain can be local and just in and around the shoulder joint, or it may be referred and going down the arm and possibly into the hand, or into the middle back and lower neck area. Sometimes gallbladder, liver or heart disease, or cervical spine disease can all cause referred pain into the shoulder through the various nerve pathways. However, shoulder blade pain or scapula pain have a higher probability 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 required x-rays and possibly advanced imaging to determine the exact cause of the pain. If there is a tear, it most likely could be in one of the tendons of the rotator cuff, occasionally a tear may occur in one of the rotator cuff muscles. The supraspinatus tendon is the most commonly torn rotator cuff tendon. The orthopedic tests can help determine or isolate which tendon or tendons and muscles (in a severe injury) may be injured.

Some of the shoulder pain conditions that I see in my office are arthritis, referred pain second to cervical disc degeneration and frozen shoulder. On rare occasion, shoulder pain may be caused by some form of 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 and osteoarthritis. Degeneration in the joint, or "wear and tear," is a progressive wearing away of the cartilage on the boney 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 the cartilage and bone. Gentle chiropractic mobilization of the shoulder and spine, accompanied with stretching and strengthening of the surrounding muscles, may help with the inflammation and improve function of the shoulder joint. Maintaining strength in the shoulder muscles may prevent further atrophy, and possibly slow down any further degenerative changes. In severe cases joint replacement surgery may be an option. Diet modifications and nutritional supplementation may also be beneficial.

Neck Pain or Degeneration

Shoulder pain can happen as a result of degeneration or injury in the cervical or thoracic spine. Degenerative discs narrow the joint space between two vertebra, causing increased irritation and pinching on the nerves in the neck or middle back region. Those nerves leave the neck or upper back area and go into the shoulders and arms, or provide the nerve supply to muscles that are around the shoulder girdle. This type of damage can cause referred pain into the shoulder area. Sometimes shoulder pain is actually due to problems in your neck or a mixture of several different problems. Neck pain as a result degenerative change is relatively common. The pain may radiate, or spread, into the shoulder blade or down the arm. Patients may have an arm or shoulder complaint, such as pain or weakness, as the result of nerve root compression. Magnetic Resonance Imaging (MRI) is one type of advanced imaging to determine if the discs are injured or being encroached upon. Symptoms may include neck pain, pain around the back of the shoulder blades, arm complaints such as pain, numbness, or weakness, and rarely, difficulty with hand dexterity or walking. Treatment of cervical degenerative disc disease provides good to excellent results in over 75% of patients. A multi-disciplinary approach includes: Chiropractic adjustments which can be useful in decreasing muscle spasms and improving mobility. Heat, and exercise may also have benefit 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 the connective tissue around the shoulder joint, inflame and become very stiff. The tissues then start to grow together forming abnormal tissue bands 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 still not certain. It can be very painful and disabling and patients are sometimes slow to recover. Chiropractic may have a few applications when it comes to frozen shoulder. It may be preventative, by maintaining mobility in the joint, as well as lifestyle modifications with a healthy diet and exercise, that may decrease the likelihood of frozen shoulder occurring. Certain diseases such as diabetes and cardiovascular disease can have an effect on joint mobility as they progress. If you are able to keep moving well, perhaps you will age well also. Chiropractic may help to stimulate physical health and may offset the common ailments that are often associated with aging. For treatment, chiropractors generally do not use anesthetics in treating frozen shoulder. Instead they employ a variety of techniques to manage the pain, and to restore range of motion and function in the shoulder. Chiropractors often use heat and cold to relieve pain and gentle chiropractic mobilization of the shoulder and spine, accompanied with stretching and strengthening of the muscles around the shoulder.