SHOULDER PAIN
ANATOMY OF THE SHOULDER
The shoulder joint consists of 3 bones: the scapula, the clavicle and the humerus.
The majority of shoulder movement occurs in the
The Glenohumaeral joint has a very large range of motion. This joint does not rely on ligaments to limit and control excess movement, it engages the use of 4 small muscles known as the Rotator Cuff. If one or more of these muscles is injured, weak, or swollen, the joint will be misaligned, ranges of movement will be decreased, and pain will follow.
There are also several large muscles which add strength to the shoulder, including deltoid, biceps, triceps, pectorals, latissimus dorsi and rhomboids. If one of these muscles is injured, weak or overly strong it will cause dysfunction of the shoulder and may also
CONDITIONS
Rotator Cuff Tendonitis
Symptoms
of a rotator cuff injury include: pain, deep aching over the shoulder and top of the arm, restricted ranges of motion, decreased strength, etc.. Pain is normally worse at night and can be very sharp with certain movements such as putting on a coat, or reaching behind. If the arm is abducted away from the side, there is a
painful arc
between 60º and 120º. If the arm is fully externally rotated the abduction may be full range and painless.
TREATMENT of a rotator cuff injury by a Chiropractor includes Low Volt Current or TENS, Ultrasound, Joint Mobilization, and Adjustments. TENS and Ultrasound help to eliminate inflammation within the musculature allowing it to heal with little of no permanent scar tissue. Joint manipulation allows correction of joint mechanics, enabling the Glenohumeral joint to produce synovial fluid and repair itself. Treatment should begin as soon as possible, a rotator cuff injury leads to bursitis and a condition known as frozen shoulder if left untreated.
BURSITIS
A bursa is a fluid filled sac that protects tendons from injury where they rest over bone. There are many bursae in the shoulder, the
most commonly affected is the
Subacromial bursa
. This bursa protects and enables smooth movement of the supraspinatus tendon and head of humerus under the coracoacromial arch. Chronic injury, to the supraspinatus tendon, rotator cuff imbalance or even carrying heavy objects resting on the shoulder joint may cause the bursa to become inflamed. Sports injuries and direct trauma to the area can also lead to bursitis.
Effective treatment of shoulder bursitis begins with decreasing inflammation. TENS, Ultrasound are modalities used to decrease the inflammatory process. Patients with bursitis are encouraged to avoid repetitive shoulder movements, sleep on the unaffected shoulder, and apply ice compresses to the area. Bursitis responds to treatment within the first 4-6 visits. Cold therapy works as a natural anti-inflammatory, and should be continued until normal ranges of movement are pain free.
Patients undergoing treatment should avoid any heavy lifting, abduction of the arm, excessive rotation, etc. If treatment is started early most patients can avoid Cortisone injections.
FROZEN SHOULDER
Frozen shoulder is also known as Adhesive Capsulities. A frozen shoulder condition is an inflamed shoulder joint that becomes
Treatment by a Chiropractor involves decreasing the inflammation that is present, reducing muscular hypertonicity, restoring normal shoulder movement including the Cervial/Thoracic spine, Glenohumeral joint, AC joint, SC joint. Massage Therapy helps in reducing muscular spasm of the Rhomboids,Traps, Scalenes, Deltoids, Levator Scapula, Teres and Pectoral muscualture.
Patients are encouraged to start treatment early to avoid the long term effects of the inflammation which can lead to Capsulitis. Treatment includes modalities to eliminate inflammation and restore joint mobility. Patients should avoid physical activity, apply cold compresses to the shoulder region, sleep on opposite shoulder, to help improve recovery time.
BICEP TENDONITIS
This condition is caused by straining the biceps tendon located on the front of the shoulder. Injury to the tendon can occur during
Treatment for BT is similar to most shoulder injuries with the main objective being to limit and reduce inflammation of the tendon as quickly as possible to avoid permanent damage. Modalities are use to reduce inflammation and restore normal mechanics and blood flow to the area. Massage is incorporated to aid in reducing scar tissue formation. Patients are encouraged to rest, avoid physical activity, sleep on opposite shoulder, apply ice to the area, and gradually start ranges of motion exercises. This condition responds well when treatment is started early.
SHOULDER DISLOCATION
Shoulder dislocation can occur with an acute sports injury common in contact sports like hockey and football. The shoulder normally
ACROMIOCLAVICULAR JOINT DISLOCATION
OSTEOARTHRITIS
Usually of the acromioclavicular joint due to recurrent injuries, subluxations and chronic rotator cuff tendonitis. Causes pain on reaching high overhead, which is therefore best avoided! Best managed by improving rotator cuff stability.Of the glenohumeral joint