WARNING – This is quite a substantial topic. I’ve even left out quite a few bits in order to make it more reader friendly (more shoulder information will be out soon…) so if you are interested in learning more about shoulder issues then I’d advise making yourself comfortable and getting a coffee. It gets a little bit technical!
Shoulder pain is one of the most common complaints at Banchory Chiropractic Clinic. In most cases it is quite easy to “fix”, as long as we get to the root cause of the problem.
Your shoulder joint (or shoulder girdle as it’s often known as) is quite a complex piece of kit. It is made up of 7 little joints and lots and lots of different muscles. All of these joints and muscles work together to enable your shoulder to do a wide variety of movements, your shoulder is the most flexible joint in your body. This is great as it means we are able to throw a ball or swing from the rafters should we wish, but it also means that when things go wrong it can be quite debilitating. Often shoulder pain will affect most of your daily activities.
So what causes shoulder pain?
There can be many different causes, but I would like to cover the most common ones we see here:
In our experience, shoulder pain can often stem from poor posture (I know, it’s not like us to bang on about poor posture!). Allow me to explain…
For all 7 of the smaller joints to articulate together effectively, the shoulder blade has to be in the correct position to begin with. Herein lies the problem – most of us hunch our shoulders forward, whether it be through stress, too much deskwork or a lifetime of driving or knitting.
This upsets the “biomechanics” of the shoulder, and results in some muscles working ineffectively. This contributes to the smaller shoulder joints end up with too much load going through them. In the short term this can lead to pain and stiffness, but in the long term can lead to much more serious problems such as immobility and early degenerative change of the shoulder.
Sometimes poor posture in the neck can cause shoulder pain. The nerves that come from the spinal cord at the bottom of your neck form a type of nerve “junction box” called the brachial plexus. A lot of the nerves from the brachial plexus branch out to supply the muscles and other tissues that support the shoulder joint. If these nerves are getting compressed in the neck then the pain can refer to the shoulder or even down the arm.
Symptoms include: sharp pain in shoulder or arm, sometimes worse with turning head, pins and needles in shoulder or arm (day or night), dull achey pain in upper shoulder, neck pain.
Rotator Cuff Muscle Strain
The rotator cuff muscles are a group of muscles situated around the shoulder. They are called Supraspinatus, Infraspinatus, Teres (major and minor) and Subscapularis.
These muscles are primarily responsible for internal and external rotation of the arm, as well as general shoulder stabilisation.
Most people (in my experience) aren’t aware that the rotator cuff muscles are not working effectively until the problem is more advanced. Symptoms of rotator cuff muscle strain are varied, but often patients will notice a general discomfort in the shoulder that is difficult to pinpoint, the shoulder will feel stiff, and it will often get worse after a long day at the desk.
I also see this a lot in athletes, specifically those who like to lift weights above their heads, so it’s seen a lot in Crossfit, gym enthusiasts and bodybuilding.
So if you are told you have rotator cuff muscle strain or dysfunction, generally speaking if it’s caught early enough it is manageable. However as I said earlier, most people DON’T catch this early so if you think you have this then please seek help ASAP.
Rotator Cuff Tendonitis
This could be seen as the next step of rotator cuff problems… If the rotator cuff muscles are forced to work under “bad conditions” then they might start to show signs of inflammatory change. Usually the musculo-tendinous junction is the first area to get unhappy. This is known as tendonitis and I’m sure you will have heard of it. Yes sadly you can get tendonitis of the shoulder! It can be quite uncomfortable and definitely requires intervention.
Tendonitis is also manageable, but it is much less manageable than a simple muscle strain! Treatment for tendonitis is more complicated and requires a greater frequency of treatment and usually home care as well.
Bursitis of the shoulder is also a bit more serious. Bursitis means inflammation of the bursa. A bursa is a fluid filled sac (think of a water balloon that has been flattened) that helps create smooth movement in the shoulder joint. You have several bursa in your shoulder, but the subacromial bursa is the most commonly inflamed of the shoulder bursa.
Subacromial bursitis is usually related to shoulder impingement of your bursa between your rotator cuff tendons and acromion bone. It is almost always caused by suboptimal biomechanics in the shoulder, so once treated, rehabilitation of the shoulder is essential.
Symptoms might include a gradually worsening pain in the shoulder, difficulty raising the arm sideways or doing anything above your head. Interestingly with this condition the patient often feels relief of the pain when raising the arm over 90degrees sideways. We test this by doing the “painful arc” test PIC OF ANDERS?
Bursitis is an inflammatory condition, so usually responds well to ice! It is very likely that bursitis goes hand in hand with rotator cuff muscular strain so treatment will include general shoulder work.
Impingement syndrome is sometimes called swimmer’s shoulder or thrower’s shoulder and is caused by the tendons of the rotator cuff muscles becoming impinged as they pass through a narrow bony space called the subacromial space. The subacromial space is so called because it is under the arch of the acromion. With repetitive pinching, the tendons become irritated and inflamed.
It may follow a partial tear of a rotator cuff tendon, or come on gradually through overuse. So sometimes a shoulder impingement syndrome can accompany any of these other problems above!
Symptoms of shoulder impingement are pretty much identical to shoulder bursitis. The painful arc test is also positive with shoulder impingement.
Both of these conditions are more difficult to deal with but definitely manageable.
Shoulder instability can be quite unpleasant. The ball-and-socket joint of the shoulder is quite shallow, which allows it to be super flexible but also leaves it quite vulnerable to dislocation or partial dislocation.
Shoulder instability almost always comes about after an injury of some sort. So often you will be aware that you have done yourself some damage!
Sometimes through repeated use (especially lifting your arms up over your head) in a person who is hypermobile can result in shoulder instability. If you are the kind of person who can pop your shoulder in and out of it’s socket, I strongly advise that you DON’T!
With this condition, if you turned up on our clinic doorstep with it, we will send you to A+E. Please just skip this step and go straight to hospital. Believe it or not this has happened more than once. We won’t try and re-locate your shoulder for you!
The most important thing to take away from this article about shoulder issues is that you should not self- diagnose a shoulder problem. The way the shoulder articulates and moves is complicated, so you should really seek professional help if you have shoulder pain.
The chances are it will be a straight-forward issue which we can address and work on easily, but we are also trained to notice when things are more complicated and further investigations are necessary.
I have created a shoulder rehabilitation exercise sheet HERE. These exercises are meant for those who are under the care of a qualified health professional, and Banchory Chiropractic Clinic does not accept any liability for those trying these exercises at home without professional advice.
This is for anyone who has been diagnosed with a postural shoulder syndrome or if you are symptom free but want to keep your shoulders in good health then have a look at these. If you are unsure whether these exercises are right for you then please contact us on 01330 824040.