Shoulder pain is a common symptom that can be caused directly by the shoulder, neck, heart, or digestive system. It is important for the physician to conduct a thorough examination so that an appropriate diagnosis and correct course of treatment can be made. In this week’s blog, we will discuss the anatomy of the shoulder joint, different conditions that affect the shoulder, and what we can do to help.
Anatomy of the Shoulder Joint
Before we dive into the major functions of the shoulder, we are going to quickly discuss the shoulder girdle. The shoulder girdle includes the clavicle (collarbone) and the scapula (shoulder blade). Including four different joints and articulation points, the shoulder girdle’s main function is to anchor the upper limbs to the spinal column.
Like the hip joint, the shoulder joint is a ball and socket joint that allows all movements: forward, backward, sideways, and rotating movements. The head of the humerus articulates with the glenoid cavity of the scapula to make up the glenohumeral joint. Just like any joint, ligaments, muscles, blood vessels and nerves surround the shoulder joint and work together to provide optimal function and movement. Shoulder ligaments provide stability and limit excessive range of motion; however, the shoulder ligaments are not nearly as strong as hip ligaments. Consequently, shoulder dislocation is more likely to occur over a hip dislocation. The shoulder joint has a huge blood supply for oxygen and nutrients to not just the shoulder, but the entire upper extremity.
The shoulder joint is surrounded by several powerful muscles that allow movement in all ranges of motion. The most important muscles surrounding the shoulder joint are the four rotator cuff muscles: subscapularis, supraspinatus, infraspinatus, and teres minor. Together with tendons, they cup the front of the shoulder to help raise and rotate the arms along with providing structural support to the shoulder joint.
What Are Some Common Conditions Affecting the Shoulder Joint?
Many conditions affecting the shoulder can be managed with chiropractic care; however, there are some conditions such as fractures, dislocations, severe rotator cuff tears, or labral tears that are beyond a chiropractor’s scope of practice and require deeper interventions such as surgery. Most shoulder cases encountered in a chiropractic office typically are caused by degenerative joint disease, bursitis, osteoarthritis, rotator cuff tears, and the one we see most often, nerve interference.
Degenerative Joint Disease (DJD)
DJD is just like Degenerative Disc Disease (DDD), but a joint is beginning to breakdown and weaken rather than a disc. DJD in the shoulder typically occurs due to significant trauma and repetitive motions, causing bone on bone situations. Patients with DJD typically complain of stiffness and pain that radiates in the neck down into the shoulder and even into the fingers. In mild cases, patients can live a completely normal and healthy life as long as they are being managed regularly by a health professional and taking extra precautions including mild to moderate intensity exercise and stretching techniques. In more severe cases, patients may need a complete shoulder replacement. They are a common procedure, but they are not nearly as common as hip replacements. If we think a patient needs a shoulder replacement, we are going to tell them that they eventually will need a shoulder replacement.
Bursae are small-fluid filled sacs that reduce friction between moving parts in the body’s joints. Bursitis occurs when these fluid-filled sacs become inflamed due to repetitive motions. In the medical field, bursitis is typically treated with anti-inflammatory drugs and/or injections. The key to treating bursitis is to reduce the repetitive motions that may have caused the inflammation, receive regular adjustments to relax muscles, ligaments, and nerves and apply heat. Heat? I thought ice was used for inflammation? True, but bursitis is the one exception to the rule. Heat promotes blood flow to the area and studies show that applying heat to an inflamed bursa speeds up the recovery time compared to ice.
OA is a topic we already discussed in an earlier blog, so we will briefly re-introduce this condition. It is a degenerative disease that affects the whole joint due to lifetime wear and tear. Over time, the protective cartilage and fluid break down, making joint movement difficult and painful.
OA cannot be reversed; the degeneration identified on an x-ray is there to stay. Although it won’t get any better, it can be managed from getting progressively worse with proper care. Most doctors will recommend anti-inflammatory drugs such as Tylenol and regular physical activity. More severe cases of debilitating pain and minimal mobility may necessitate a bone replacement.
We highly recommend regular physical activity because it continues to keep bones strong and healthy. Instead of taking NSAIDs, take supplements such as Vitamin C, D, and calcium to help keep bones and soft tissue structures strong and stable. For more severe cases, sometimes, a replacement is necessary, and we are not afraid to admit that. In these extreme cases, we realize that we can only buy the patient some time, but eventually, the replacement will be necessary. Remember, we tell all patients upon meeting them that our goal is to serve and to give them the health they want and deserve. After the first visit, we will be able to provide the answer as to whether we can do that or not. If we can help, we will be happy to serve them, but if we cannot, we will get them to someone who can.
Rotator Cuff Tears
Rotator cuff tears are extremely common and occur when one or more muscles/tendons partially tear or completely tear from the shoulder joint. Rotator cuff tears can be caused by several factors including wear and tear, repetitive motions, trauma, athletics, and age factors such as bone spurs and lack of blood supply. Rotator cuff symptoms include difficulty raising the arm, feeling pain when moving the arm in certain positions or laying on it, weakening in the shoulder, trouble lifting certain objects, and clicking or popping when moving the arm.
It is important to properly diagnose rotator cuff tears to establish the right course of treatment. Most medical professionals have a precise set of orthopedic tests for rotator cuff muscles to further determine if medical imaging is necessary. X-rays are a good starting point, but an MRI or an ultrasound will be able to confirm a rotator cuff tear.
There are three different grade tears visible on medical imaging:
- Grade 1- Partial tear
- Grade 2- Partial tear with tissue thickening
- Grade 3- Complete or incomplete tear with full thickness
Can rotator cuff tears be treated by a chiropractor? The answer is yes, but it depends on the grade tear that is present. A Grade 1 tear can be managed by a chiropractor providing spinal manipulation and utilizing different therapeutic modalities such as electric muscle stimulation, ultrasound, and performing different stretching/strengthening exercises. Grade 2 tears can be managed by a chiropractor, but it is more difficult to do so. It requires more time and more vigorous therapy. Physical therapy is a great option for Grade 2 tears. Grade 3 tears typically are surgical cases because patients often have limited to no function at this stage.
What Can We Do to Help?
Chiropractors main focus is to remove any nerve interference so that the body can function at optimal levels. Nerve interference happens when a nerve is impinged between one or more vertebra causing nervous system disruption. Nerve interference symptoms include pain, weakness, numbness/tingling, and organ malfunction.
Two types of nerve interference can stimulate shoulder pain. The first cause can be the shoulder itself. When the shoulder joint begins to breakdown and degenerate, the joint space narrows, causing a bone-on-bone situation. The second and more common cause is due to vertebral misalignment applying direct pressure to the affected nerve root(s). In 85%-90% of cases, most upper extremity symptoms come from the neck. In any case, it is important to perform a series of test to rule out any major issues such as a heart attack or digestive system issues as they can create referred pain into the arm.
In either case, we are going to treat patients the same way. In more rare cases, a patient may need a shoulder replacement, but we will inform the patient if that is the case. Performing a neurological exam and conducting a set of x-rays in the region of complain is necessary to know exactly what is creating the nerve interference and the course of action required.
Whether that course of action includes spinal manipulation, non-surgical spinal decompression, and/or neuropathy management, we provide high-quality care and spend a significant amount of time with each patient so that we can achieve positive results.
For more information or questions about the shoulder joint and management, please call us at (724) 547-3377 and checkout our website at www.drlarrywilkinsspinalcare.com for more content.
Yours In Health,
Larry E. Wilkins, DC
Brian M. Steinert, DC