FOCUS ON HEALTH
Recovering from shoulder pain
By Virginia Nsitem
Difficulty reaching, pushing, pulling or lifting with the shoulder? Limited shoulder movements? Pain while sleeping on your shoulder? This column will discuss some common causes of shoulder pain.
How does the shoulder joint work?
The shoulder joint is formed by the joining of the humerus bone (upper arm bone), the scapula (shoulder blade) and the clavicle (collar bone). The stability is provided by the various muscles, tendons, ligaments, and other soft tissue structures around the joint. The shoulder joint is actually the most flexible joint in the body, providing movement in numerous directions. The shoulder joint also has sacs called bursa that provide cushioning between the bones and muscles. The main group of muscles at the shoulder joint are called the rotator cuff muscles, and they are the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. These muscles provide stability at the shoulder joint and also help move the shoulder in various directions. The deltoid muscle forms the round shape of the shoulder, and works to raise the shoulder at the side.
What are the common shoulder joint injuries?
Rotator Cuff Injuries are a common cause of shoulder pain. This injury can involve tendonitis or severe tears of one or more of the rotator cuff muscles at the tendon (the part of the muscle that attaches to the bone). Tendonitis of the muscle can be the result of repetitive movements of the shoulder. Rotator cuff injuries can also be the result of trauma to the shoulder. Finally, wear and tear of the shoulder, over a long period of time, can cause rotator cuff injuries. Typical symptoms of rotator cuff injuries include:
- Shoulder pain and weakness
- Reduced shoulder movements and shoulder joint stiffness
- Snapping and crackling noises at the shoulder joint
Frozen Shoulder Syndrome, also called adhesive capsulitis, is the term used to describe pain and severe stiffness at the shoulder. This problem can develop gradually following trauma to the shoulder, surgery to the shoulder or chest, or after having the shoulder in a sling for a long period of time. Frozen shoulder can also be triggered following a stroke. The shoulder “freezing” can last several months before the joint starts to “thaw” and movement returns to the shoulder. Typical symptoms include:
- Shoulder pain that is dull and achy
- Severe shoulder stiffness
- Severe limitation of shoulder movements, especially lifting the shoulder up or reaching behind with the shoulder
- Difficulty with daily tasks such as grooming your hair, washing your back, or putting on a shirt, sweater, or coat due to shoulder pain and stiffness
- Shoulder pain that disturbs the sleep, especially when lying on the affected shoulder
Shoulder Joint arthritis is another source of shoulder pain. Arthritis at the shoulder can be caused from diabetes, infection, and rheumatoid arthritis. Arthritis can also be caused by wear and tear of the shoulder joint (degeneration), trauma (fractures), and rotator cuff tear injuries (tendonitis and rotator cuff tears). Typical symptoms of shoulder joint arthritis include:
- Shoulder pain that is achy
- Painful movements in the shoulder
- Shoulder pain when resting but made worse with movements and activities
Shoulder Injury Treatments
Chiropractors specialize in diagnosing, treating, and rehabilitating injuries of the muscles, joints and nerves. The first step to relieving your shoulder pain is understanding the cause of the problem. Your chiropractor or health care provider can provide you with a diagnosis after conducting an examination, and reviewing possible ultrasound studies, x-rays, CT scans, or MRI studies. Your rehabilitation program may vary, depending on your diagnosis and the severity of the injury. Your chiropractor or health care provider can also identify more serious causes of shoulder pain that may require urgent attention.
- Chiropractic techniques: Manual therapies are used to improve tightness of the muscles and ligaments, and restore proper movement of the shoulder joint. Therapeutic Laser therapy is a useful device that works to reduce inflammation and pain, and allow the patient to start the exercise portion of the rehabilitation program. Cold therapy (ice) can be helpful in the initial stages of inflammation to reduce the pain and swelling. Heat application can soothe tight muscles and help with flexibility exercises.
- Patients are instructed to continue the pain control techniques at home as part of their rehab program.
- Exercises (stretching and strengthening) are taught gradually, and help to improve the flexibility and stability of the shoulder joint.
- Massage therapy and Acupuncture: Studies have shown that these techniques are helpful for providing a pain-relieving effect throughout the body, an anti-inflammatory effect, and a general sense of improved well-being.
- Modifications at home: Using a pillow between the arm and your body may help you sleep more comfortably at night. Your chiropractor can advise you on other ergonomic modifications, based on your injury, to help you return to your daily activities.
Stop the Pain … Before the Pain Stops You!
(Dr. Virginia Nsitem is a chiropractor specializing in laser therapy for muscle, joint, and nerve injuries, and is a Fellow of the Royal College of Chiropractic Sports Sciences in Canada. She may be reached at (905) 275-4993, or by email at firstname.lastname@example.org )