This is a very common problem that is seen daily in chiropractic practices. I have patients who come in to my offices and complain about their painful and stiff shoulder. By this they usually mean that their upper trapezius muscles are tight and painful and that they have restricted movement and pain in the region of the upper thoracic spine where it meets the cervical spine at the neck.
Chiropractors enjoy a large success rate with these patients who respond well to manipulation and muscle stretching. The second category of patients are those who have a genuine problem with the shoulder. By this I mean the area where the head of the humerus or upper arm bone inserts into the glenoid fossa of the scapula or shoulder blade.
The muscles that hold the humerus in place are called rotator cuff muscles and there are four of those. Painful shoulder conditions that limit movement are common, and are caused by problems with the shoulder joint and its surrounding structures. The shoulder is more prone to injuries than other joints because of its wide range of movement
What are some of the common causes of shoulder pain? There are several conditions that cause pain and limit movement of the shoulder joint, including:
* Rotator cuff disorders. The rotator cuff is a group of muscles and tendons that help to move the shoulder and hold the joint in place. Rotator cuff disorders result from
inflammation or damage to the rotator cuff muscles or tendons, or inflammation of the subacromial bursa (which is a fluid-filled pad that sits under the highest part of the shoulder). The inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above
shoulder level), heavy lifting, trauma, or poor posture. Serious injuries and untreated inflammation of the tendons can cause the rotator cuff to tear.
The pain associated with rotator cuff problems is normally felt at the front or on the outside of the shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed. Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous pain.
Your rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and help move the shoulder. The 4 muscles (and their tendons) that make up the rotator cuff include:
* the supraspinatus;
* the infraspinatus;
* the subscapularis; and
* the teres minor.
Usually it is the rotator cuff tendons (the thick bands of tissue that connect the muscles to the bones) that tear, but sometimes the tear occurs in the muscle. The most common site of a tear is in the supraspinatus tendon. Severe injuries can cause several of the tendons and muscles to tear. There are special movement tests that your doctor can use to help determine which of the muscles or tendons has been torn.
Frozen Shoulder is another painful condition. Frozen shoulder, also known as adhesive capsulitis, is characterised by progressive pain and stiffness in the shoulder. The pain is felt deep in the shoulder joint and may be worse at night. It can be treated by cortisone injections or by a hydrodilatation, a surgical procedure developed by Dr. Frank Burke of Melbourne. This procedure involves an injection of saline and local anesthetic into the shoulder capsule. It is usually not overly painful and is done at his practice in Prahran, Melbourne. This procedure has been very successful in a great majority of patients. The old idea that one had to endure pain for 2 years has been largely disbanded.
Dislocation of the shoulder can occur after a fall. Shoulder dislocation occurs when the ball-shaped head of your upper arm bone (humerus) comes out of the shoulder socket. It may be caused by a fall, a sporting injury, or trauma, and is an extremely painful condition. A dislocated shoulder is visibly deformed or out of place, and there may be swelling or bruising around the joint. Shoulder movement is severely restricted in people with a dislocated shoulder. Doctors can usually put the shoulder bones back into place using gentle manoeuvres.
Following a dislocation, the shoulder joint sometimes becomes unstable and is susceptible to repeated dislocations. This condition is known as shoulder instability, and causes pain and unsteadiness when you raise your arm or move it away from your body. Your shoulder may feel as if it is slipping out of place when you lift your arm over your head.Arthritis can cause shoulder pain. Arthritis causes progressive joint pain, tenderness, swelling and stiffness. Both rheumatoid arthritis and osteoarthritis can affect the
shoulder joint. Shoulder pain can come from other causes such as referred pain. Sometimes shoulder pain is actually due to problems in your neck or a mixture of several different problems. Rarely, shoulder pain may be caused by infection, problems with the nerves, or a tumour.
Tests need to be done to determine the cause. You may also need to have an X-ray, or other scans, such as an ultrasound scan or MRI. Sometimes, an arthroscopy is needed. In this test, your doctor can look inside the shoulder joint using a small, telescopic instrument that has a camera on the end. Your chiropractor will refer you to your doctor if necessary and a referral to a shoulder specialist can be arranged.