What are the causes of some shoulder pain?
Rotator cuff injury – tears or strains to the rotator cuff muscles
Rotator cuff tendinitis – this is inflammation of one of the rotator cuff muscles usually by overuse.
Frozen shoulder syndrome (adhesive capsulitis)
Thoracic outlet syndrome
Rotator Cuff impingement syndrome
Tenosynovitis (inflammation of the tendon sheath)
Sometimes the causes of pain are due to an injury whether from a repetitive motion or trauma, even more rare is when it is due to a referred pain like ectopic pregnancy or heart attack that refers into the arm and shoulder (these are less common and are a medical emergency).
What is the rotator cuff?
The rotator cuff is made up of 4 muscles, the ball and socket joint and capsule and 2 bones.
Bones: Scapula, humerus
Muscles: Supraspinatus, infraspinatus, teres minor and subscapularis muscle.
Joint: The ball and socket joint is where the scapula and the humerus meet and they have a capsule encasing them with capsular ligaments (ligaments attach bone to bone) and then again encased by the tendons of the 4 muscles listed above.
What are the most common injuries?
1. Rotator Cuff Tendinitis – is by far the most common of the injuries and it is when you repetitively do a motion like painting, keyboard work at a computer or throwing a ball like a pitcher. The tendon usually near its insertion onto the humerus will become hot, painful and swollen.
2. Rotator Cuff Tear – often occurs after tendonitis has been present for sometime or some other wear and tear that finally causes the tendon or muscle to snap leaving the arm weaker.
3. Frozen shoulder (adhesive capsulitis)–is by far more common in women and usually around the 40’s and 50 years of age. The humerus usually adheres to the scapula and the muscular capsule becomes adhesive like glue making reaching things over the head difficult or sometimes even impossible. There is no known direct cause for this condition.
4. Rotator Cuff Impingement syndrome–when one of the 4 muscles talked about earlier becomes pinched by usually a boney prominence of the scapula. The most common muscle of the 4 for this to occur to is the supraspinatus.
5. Osteoarthritis–when the bones start to develop signs of wear and tear showing an increase in bone on some parts of the humerus and scapula and a decrease of bone on other parts.
How is my shoulder pain diagnosed?
The most common type of diagnostic tools are orthopedic tests like the painful arch test (lifting the arm from your side to beyond 90 degrees). Physical or manual muscle tests are performed to see if there is a weakness present in the muscle or if pain occurs suggesting damage. Xray are done to see if there is arthritis followed by MRI’s to see if there are muscle tears or inflammation.
How is shoulder pain treated?
Chiropractic care does testing to determine if there is a mis-alignment of the humerus or scapula and also the thoracic and cervical vertebra as they are a common area that refers pain into the shoulder. They will re-align the area, do muscle work and give at home exercises. If home exercises are not enough or the patient is unwilling to do them, we will refer the patient to a physical therapist for treatment.
Physical therapy will work to reduce inflammation and pain and strengthen the rotator cuff muscles as well as the trunk muscles so that mis-alignment is corrected and future injury is prevented.
Injections done by a pain specialist or an orthopedic surgeon are done in connection with physical therapy or chiropractic care and it is used to stop inflammation that allows for healing.
Surgery is done when repair of a muscle tear is needed and it can be open surgery or arthroscopic.
Acupuncture is done to break the pain cycle and is helpful in cases with arthritis and tendonitis.