Shoulder Pain

Shoulder pain are caused by injuries affecting the shoulder joint, muscles, tendons, ligaments and cartilage.

Since the nerves that supply the shoulder and arm originate from the neck and upper spine. An irritated nerve in your neck, repeated overuse, or an injury, can cause inflammation and stiffness and contribute to pain in the shoulder.

What are the Causes of Shoulder Pain?

Here is a list of some of the most common causes for shoulder pain.

Referred pain from the neck and Midback:
When the structures in the neck and midback are painful, the pain is often felt over the shoulder. It is important to remember this. Your chiropractor will always examine your neck and midback when you come in for shoulder pain.

The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff. Bursitis is an inflammation of a fluid-filled sac, or bursa, that lies between tendon and skin or between tendon and bone. Normally a bursa protects the joint and helps make movement more fluid.

Rotator Cuff Tendonitis:
Tendonitis is when tendons become compressed under the rigid bony arch of the shoulder. The compressed tendons become inflamed or damaged and cause pain. This can occur from general wear and tear, as you get older, an activity that requires constant shoulder use like baseball pitching, or an injury.

Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery. Arthritic changes are more common in the acromio-clavicular joint between the collarbone and the shoulder blade.

Rotator Cuff Tear:
A Rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.

Frozen Shoulder:
Also called ‘adhesive capsuliitis,’ this is a common condition that leads to stiffness of the joint. Physical therapy and stretching are extremely important aspects for treatment.

Calcific Tendonitis:
Calcific tendonitis is a condition of calcium deposits within a tendon — most commonly within the rotator cuff tendons. Treatment of calcific tendonitis depends on the extent of symptoms.

Labral Tear:
A Bankart lesion is a type of labral tear most commonly due to dislocation of the joint. Bankart lesions cause problems of persistent instability.

Shoulder Instability:
Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may develop over time. This can occur with or without producing a secondary impingement syndrome.

Ligament injury (Acromio-Clavicular Tear)
Also called an A/C separation, these injuries are the result of a disruption of the acromio-clavicular joint. This is a very different injury from a gleno-humeral dislocation.

Shoulder Dislocation:
A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.

Shoulder Separation:
Also called an AC separation, these injuries are the result of a disruption of the acromioclavicular joint. This is a very different injury from a dislocation!

SLAP Lesion:
The SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand.

Biceps Tendon Rupture:
A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint.

Referred pain from internal organs
It is important to remember that pain from the gall bladder can be felt over the right shoulder and pain from the pancreas can be felt over the left shoulder, and most importantly, heart attacks can refer pain into the left shoulder and arm.

Signs that you should seek treatment for your shoulder pain include:

  • Shoulder pain that persists beyond a few days
  • Recurring shoulder pain, even if it has a history of settling on its own
  • Inability to carry objects or use the arm
  • Injury that causes deformity of the joint
  • Shoulder pain that occurs at night or while resting
  • Inability to raise the arm
  • Swelling or significant bruising around the joint or arm
  • Signs of an infection, including fever, redness, warmth or swelling

What are the best treatments for shoulder pain?

The treatment of shoulder pain depends entirely on the cause of the problem. Not all treatments listed here are appropriate for every condition, but may be helpful in your situation.

Please remember, resting and taking painkillers only, is not a treatment that is likely to help your shoulder in the long term in the absence of treating the route cause.

  • Rest: The first treatment for many common conditions that cause shoulder pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilisation can cause a frozen shoulder.
  • Ice and Heat Application: Ice packs and heat pads are among the most commonly used treatments for shoulder pain. It is important to use it correctly. If you are not sure which part to cool or heat, ask us!
  • Stretching: Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain, but can also make things worse!
  • Exercise: Rehabilitation exercise is an important part of getting better, but it is important to know what to do and when to start exercises. Some exercises can make your condition worse!
  • Gentle Chiropractic Adjustments and/or mobilisation: The Benefits are improve shoulder and joint movements, improve posture, release pinched or irritated nerves so the body can begin to heal itself properly.
  • Anti-Inflammatory Medication:Non-steroidal anti-inflammatory pain medications, commonly referred to as NSAID’s, are some of the most commonly prescribed medications, especially for patients with shoulder pain caused by problems such as arthritis, bursitis, and tendinitis. There are of course some natural alternatives that your chiropractor can recommend. You should be aware of the possible side-effects of long term use.
  • Cortisone injections: Cortisone is a powerful medication that treats inflammation, which is a common problem in patients with shoulder pain. Discuss with your doctor the possible benefits of a cortisone injection for your shoulder condition. Should not be relied on as a treatment on its own. It is quite an invasive approach and not without adverse-effects.

Frozen Shoulder or Frozen Shoulder Syndrome (FSS) or Adhesive Capsulitis

Frozen shoulder is a condition where the loose capsule of the shoulder becomes so inflamed that the surrounding muscles progressively tighten and stiffen the joint. Generally a frozen shoulder will lead to the person being unable to move their shoulder either on their own or with the help of another person. This condition occurs when the capsule around the shoulder joint tightens and thickens, restricting the range of motion in the ligaments, bones, and tendons of the shoulder. This “freezing” develops gradually over time, and can cause significant pain and sleep disturbances.

The most convincing study results have indicated that prolonged poor posture (rounded shoulders) is the precursor to Frozen Shoulder or Frozen Shoulder Syndrome.

Gentle Chiropractic Adjustments and/or mobilisation: The Benefits are improve shoulder and joint movements, improve posture, release pinched or irritated nerves so the body can begin to heal itself properly. The treatment combined with specific stretching and exercises will help you achieve fast and lasting Pain Relief that is gentle, safe & drug free.

In a study on chiropractic treatment for frozen shoulder, it was found that, “Chiropractic care may be able to provide an effective mode of therapeutic treatment for certain types of these difficult cases.” (J Amer Chiropr Assoc 2008 Sept-Oct; 45(7):12-28)