The Shoulder: Pain Symptoms, Causes, and Chiropractic

The shoulder/s are the joints where the upper-arm bones known as the humerus, the shoulder blades or scapula, and the collarbone/clavicle come together. The upper-arm bone fits into the scapula socket and is held in place by muscles and tendons. This is the rotator cuff. It covers and protects the upper-arm and allows for raising and movement of the arm. Pain in the shoulder can have a variety of causes.   Injuries can occur in a slip and fall or automobile accident. A task like painting the house could cause a repetitive/overuse injury. The soft tissues in the shoulder, muscles, tendons, and ligaments can get injured from excessive strain, falls, and improper motion. Shoulder pain can come from certain conditions like arthritis. And it can present from problems or issues in other parts of the body. This is known as referred pain. The shoulder takes on more than we realize. It is made up of an intricate network of ligaments and muscles, with the rotator cuff taking most of the load when moving. It is the most flexible joint in the human body, and one of the most unstable. It is unstable because of its unique construction. Other joints like the ankle or elbow are limited in their range of motion. Shoulder injuries are common, as the shoulder sustains more injuries than almost any other part of the body.

Injury Symptoms

Here are some questions to help figure out if there is a shoulder injury:

• Does the arm move normally?
• Is there extreme stiffness?
• Is there pain and what type – throbbing, stinging, shooting
• Does it feel like it could pop out of the socket?
• Is it strong enough for normal activities?

Certain shoulder injuries can be treated at home for a few days with rest and ice. The shoulder can be bandaged with Kinesio tape to hold it in place if necessary. But serious injuries require professional medical help. Symptoms/signs that a medical professional is needed:

• The shoulder joint looks deformed
• The shoulder cannot be used at all
• The pain is extreme and intense
• The shoulder is swelling rapidly
• The arm and/or hand is weak and/or numb

Common injuries

Dislocation

When the shoulder gets pulled back hard or rotated too far, the top of the arm can get popped out of the socket. This can cause pain, weakness, swelling, numbness, and bruising.

Separation

This is an injury affecting the joint where the collarbone and shoulder blade come together. It is the acromioclavicular or AC joint. An accident, fall, or traumatic impact can tear the ligaments holding it together. If the collarbone gets shifted out of place, a bump on top of the shoulder will appear.

Fracture

After a fall or a hard hit, the bones can break or become cracked. The most common breaks are to the collarbone and the arm bone that is the closest to the shoulder. Pain presents along with bruising can occur. If the collarbone is broken, the shoulder may sag and there will be no ability to lift the arm.

Cartilage tear

The cartilage or rubbery padding that runs around the rim of the shoulder joint can suffer injury and/or get torn. Repetitive motions and overuse can lead to a tear. It can also be injured in a fall, or anytime it absorbs the brunt of the force. Pain can be felt when reaching over the head, or the shoulder feels/seems to be weak. Sensations like catching, locking, or grinding may also be felt.

Rotator cuff tear

The rotator cuff belongs to a group of muscles and tendons that hold the arm in place and allow for lifting the arm up and overhead. It can suffer damage through overuse or in an accident. The rotator cuff begins to show wear and tear with age. It can hurt at night and when trying to lift objects. Individuals have also reported a crackling sound when moving.

Frozen shoulder

This is a condition that limits how much the joint moves. Bands of tissue or adhesions build up in the joint and keep the shoulder from moving freely. This is where the freeze happens. It comes from the pain, causing the individual to not use it, this allows the adhesions to build.

Impingement

This is when the tendons of the rotator cuff become pinched within the bones of the shoulder. It can cause swelling and pain. It is often set off when lifting the arms over the head repetitively.

Bursitis

This is when the fluid-filled sacs or bursa that cushion the joints get swollen and irritated. Usually, the onset occurs from repetitive motions. However, it can also be caused by a fall or other injury. The pain occurs most when moving the shoulder.

Other causes

Osteoarthritis

Also known as degenerative joint disease. It is the most common form of arthritis. It can affect any joint, including the shoulders. The cartilage between the bones breaks down and allowing them to rub against each other causing pain and stiffness.

Rheumatoid arthritis

This is a disease that causes the immune system to attack the protective lining in the joints. It causes pain and stiffness in the shoulders.

Referred pain

There could be nothing wrong, yet pain or discomfort presents. This could be a sign of a condition involving the lungs, gallbladder, liver, nerves, etc.

Heart attack

Shoulder pain could be brought on from the tightness in the chest and trouble breathing. Get emergency medical help immediately.

Tendinitis

The tendons that make up the rotator cuff become inflamed. It can happen progressively over time or quickly from an accident, fall, or a direct hit to the shoulder.

Bone spurs

These are small, smooth pieces of bone that begin to rub up against the rotator cuff keeping the shoulder from proper movement. They can lead to tendonitis or a tear.  

Diagnosis

A doctor or chiropractor will begin with a physical exam to check for structural problems to rule out anything involving the spine or neck. Next, is the range of motion exam to see how strong and flexible the shoulder is. This involves moving the arms in different ways, like:

• Above the head
• Across the body
• Behind
• Rotate 90 or 180 degrees

The doctor could recommend imaging tests to get a closer look:

X-rays

These can help find bone spurs, arthritis, and other bone-related causes of shoulder pain. The doctor could recommend an arthrogram. This involves using a dye to enhance the details allowing them to render more clearly.

MRI scan

Radio waves and a powerful magnet generate detailed images of the shoulder.

CT scan

This is a series of X-rays taken from various angles. When placed together, they allow for optimal views to be seen.

EMG

This measures electrical activity in the muscles to see if there are any problems with the nerves.

Arthroscopy

A surgical procedure that utilizes a tiny fiber-optic camera, allowing the doctor to see high-definition images. With certain cases, the doctor could be able to treat the problem during the procedure.  

Treatment

Dislocations, separations, and fractures require medical attention. Getting the shoulder back to the right position followed by a sling to hold it in place while healing and in recovery. For less serious issues, the doctor could recommend rest, heat/ice, and medicine like ibuprofen or aspirin to help with the pain and swelling. Chiropractic treatment for shoulder injury/s and pain. A Chiropractor can:

• Relieve pain
• Improve range of motion
• Increase flexibility
• Restore function to the joint

If the shoulder does not show improvement after the first steps, the doctor could recommend injecting an anti-inflammatory medication straight into the joint for the swelling and pain relief. There are times when cartilage tears, rotator cuff tears, and a frozen shoulder does not improve with rest, physical therapy, or medication. As a last resort, the doctor could recommend surgery. Any problem with the shoulder means that the treatment plan will probably include stretches and exercises to help strengthen the joint and improve the range of motion.

Prevention

Consider how often the shoulders are used at work and play. Then find ways to protect it:

• If working at a desk, make sure the chair has proper back support and promotes proper posture.
• Take several short breaks to move around at least once an hour.
• If work requires heavy lifting, proper technique is essential.

1. First face the object being lifted
2. Keep the back straight
3. Bend the knees using the legs for power

• When reaching for a heavy object overhead, use a step-ladder to get a better position.
• Ask the doctor or chiropractor about a strength and conditioning regimen for the muscles around the shoulders, to keep them strong and flexible.

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Shoulder Pain Rehabilitation

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Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*