The shoulder and surrounding anatomy is a complex region of the body that includes multiple joints, bones, tendons, ligaments and muscles that all play a crucial role in the versatility, stability and wide range of motion of the shoulder. With this many moving parts, it's understandable that one or a combination of these anatomical features could be causing your shoulder pain. In this blog we will discuss some important components to the shoulder, how they are affected with certain conditions and common treatment options for shoulder pain.
One of the most common causes of shoulder pain is due to tendinitis. Tendons are cord-like features that connect bones to muscles. Tendinitis is simply inflammation of the tendon itself. Most commonly this occurs with a throwing motion, overhead activities with your job or simply overworking the tendon with your daily lifestyle. Within the shoulder, the bicep tendon and the four tendons of your rotator cuff muscles are the most common tendons to be inflamed. Sort of along the same lines, bursitis is another common cause of shoulder pain. Throughout the body in between the joints are small, fluid-filled sacs that protect the joint spaces and act as cushions and reduce friction called 'bursae' Inflammation and swelling occur when the bursae get irritated resulting in shoulder pain. In more serious cases the tendon itself can actually be partially or completely torn.
Sometimes your shoulder pain may be due to instability. The shoulder is a ball and socket joint, the head of your humerus sits into a rounded socket portion of the scapula (shoulder blade). The shoulder bones are held in place by a combination of muscles, primarily the rotator cuff muscles, and tendons. With less stability, a partial or complete shoulder dislocation can occur. The partial dislocation is known as a subluxation, which can be adjusted by a chiropractor. A complete shoulder dislocation is when the head of the humerus slips out of the socket joint completely and will need medical intervention. When the muscles, ligaments and tendons surrounding and supporting the shoulder become weakened, the chances of shoulder dislocations increase. Strengthening the rotator cuff muscles would decrease the likelihood of instability along with chiropractic adjustments to the glenohumeral joint to ensure the bones are properly aligned.
Another common issue with the shoulder region is known as 'shoulder separation' or a a sprain/strain of your AC (acromioclavicular) joint. This is a where your clavicle (collarbone) is connected to your scapula (shoulder blade) via a ligament. An injury to your AC joint is most commonly caused by a fall directly onto the shoulder which causes an injury to the ligaments surrounding and stabilizing the AC joint. The degree of injury grade depends on how severely damaged the AC joint ligament is ranging from a grade 1 sprain which means the ligament is overstretched up to a grade 3 AC joint sprain where the AC ligament and the coracoclavicular ligament are both completely torn. In the less severe stages, using a sling, ice packs and limiting overhead range of motion can often lessen the pain. With a compete tear of your acromioclavicular ligament, surgery may be suggested. Whether treated conservatively or with surgery, the shoulder will require rehabilitation to restore and rebuild motion, strength, and flexibility.
With a lot of overhead motion, impingement can become an issue.Lifting your arm causes your acromion process (top of your shoulder blade) to put pressure onto the muscles underneath the bone by digging into the muscle belly. As you lift your arm, the acromion rubs or 'impinges' on the rotator cuff tendons and bursa resulting in tendinitis, pain and limited movement.
Another common cause of shoulder pain is arthritis. The most common form affecting the shoulder joint is osteoarthritis (AKA degenerative joint disease). This is the 'wear and tear' type of arthritis. Mostly we see this in our older patients. Symptoms such as swelling, pain and stiffness occur developing slowly and gradually worsening over time. When people are suffering from OA they try to avoid shoulder movements in order to lessen the pain. When they do this it can lead to a a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.
Lastly, shoulder pain following a fall or an accident could be due to a fracture. In these circumstances you would be experiencing serve pain, large amounts of swelling as well as bruising around the shoulder. The clavicle is the most commonly broken bone in the body and fractures to the humerus and scapula could occur as well. X-ray imaging would be necessary to diagnosis a fracture of one of the bones of the shoulder girdle.
Those are just some of the most common issues when dealing with shoulder pain. Much less common, more severe conditions such as tumors, infections and nerve related problems do occur but would need a more thorough examination and clinical imaging to assess. Stay tuned for our next video where we will display some range of motion exercises, resistance exercises and treatment options for specific conditions discussed today as well as a couple chiropractic adjustments that can correct subluxations of the shoulder and decrease pain and improve range of motion!
Sources:
https://orthoinfo.aaos.org/en/diseases--conditions/biceps-tendinitis/
https://orthoinfo.aaos.org/en/diseases--conditions/chronic-shoulder-instability/
https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-shoulder/
https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-separation/