Shoulder pain

The most common causes of the shoulder pain are rotator cuff problems, impingement syndrome or acute strains.

By far the largest cause of shoulder pain is repetitive stress injuries where a movement, motion or activity is simple performed too much. This can include anything from gardening to playing tennis. Generally speaking shoulder pain can be classified in three easy ways.

  1. The unstable painful shoulder (dislocations or genetically loose)
  2. The weak painful shoulder (rotator cuff problem)
  3. The stiff painful shoulder (osteoarthritis and frozen shoulder)

We use evidence based treatments to reduce shoulder pain and improve shoulder function. Our chiropractors and physiotherapists use the latest and highest standards in treatment.

The following is a list of conditions that our chiropractors treat

  • Frozen shoulder
  • Rotator cuff tear
  • Shoulder impingement
  • SLAP tears of the shoulder
  • Biceps tendinitis of the shoulder

Rotator Cuff Tear

The rotator cuff is term used to describe a group of muscle that support the shoulder and allow for proper shoulder positioning and motion. There are four muscles that make up the rotator cuff and these are call the supraspinatus, infraspinatus, teres minor and subscapularis. At rotator cuff tear of the shoulder describes a tear in one of those muscles or their tendons (joins a muscle to bone). This can be a complete tear or a partial tear. The supraspinatus is the most commonly torn muscle of the rotator cuff. Most rotator cuff tears will not need surgery, however an experienced chiropractor or physiotherapist must complete an individualised clinical assessment of the shoulder. The presence of a tear on MRI (MR arthrogram) does not necessarily mean someone will need surgery, especially if they are over 50 years of age.

Symptoms of rotator cuff tear

Rotator cuff injuries and tears are a very common injury and will typically present with:

  • Pain at night (and rest)
  • Pain worse with compression such as lying on it
  • Pain on shoulder movements (contracting muscle)
  • A painful arc (sore in certain movement positions like overhead)
  • Inability to move upper arm (for acute and sudden large tears)

Rotator cuff tears can send pain down the arm and it is important that you see a chiropractor or physiotherapist to make sure your neck is also not involved as this is common and can lead to serious complications in your shoulder recovery.

Causes of rotator cuff tear

The causes of rotator cuff tears are typically grouped in two distinct but related categories: Acute rotator cuff tears and degenerative rotator cuff tears.

Acute rotator cuff tears occur as a result of an injury. Common injuries that are typically associated with a rotator cuff tear are:

  • A fall on an outstretched arm (FOOSH injury)
  • Pulling or lifting a heavy object
  • Shoulder dislocated or breaks
  • Sporting injury such as rugby or contact sports

Degenerative rotator cuff tear occur when the tendons become worn down over time and the aging process. This is considered a normal part of aging and is more common in the dominant arm as this is used more throughout life. These types of tears may or may not produce pain. Common risk factors for getting a degenerative or chronic tear include:

  • Age. We will all age, and as we do the blood supply to the rotator cuff reduces. Without blood there is no healing. Little tears and inflammation no longer heal and add together to form tears.
  • Overuse. This is just an accumulation of repetitive stress, over time continuous bouts of microtrauma in the tendons and muscles wears them down and tears develop. This is common in overhead athletes like tennis players and baseball pitches.
  • Anatomy. Some people will have bones in the shoulder that rub more on the rotator cuff and slowly wear it down (type III acromion). As we age we can also develop bone spurs and these may also rub on the rotator cuff. In both instances rotator cuff tears are more likely to develop.

Treatment of rotator cuff tear

At Incline Health treating shoulder pain is our passion. It is estimated that around 50% of people will get better without surgery. The way our chiropractors and physiotherapists will treat your shoulder pain will largely depend on which type of tear it is. Ultimately our chiropractic treatments for rotator cuff tear will aim to reduce pain and restore function. For acute tears, there is a large focus on reducing the pain and inflammation associated with the tear and for degenerative tears that are symptomatic improvement is a key goal. For both acute and chronic tears strengthening that rotator cuff and making it more tolerant to load and movements is the ultimate goal to treatments.

The important thing to note with any rotator cuff tear is that everyone is different, will have different shaped shoulder bones, tears in different places, be different ages and have different lifestyle and activity goals. It is important to seek a personalised treatment that is individualised to your specific case.

Biceps Tendon Tear in Shoulder

The biceps runs from the shoulder to the elbow and allows for shoulder and elbow flexion (flex biceps). The biceps tendons anchor the main muscle bulk of the biceps to its bony attachments. This can either tear completely called a complete tear or only tear partially, called a partial tear. Depending on the location of the tear and the severity (completeness) of the tear, a biceps tendon tear can be treated by a rehabilitation expert such as a chiropractor or physiotherapist.

It is important to consider two things when looking at biceps.

  • Complete tears usually start with repetitive micro-injuries to the tendon that progress until a heavy object is lifted creating a complete tear.
  • Usually only the long head of the bicep will tear, it is very unlikely that the short head will tear, statistically speaking. This can tear the cartilage of the shoulder joint and this must me examined. Because the short head still is intact people can still use their bicep.

Symptoms of biceps tear in the shoulder

Since the bicep tendon can have a partial tear or a complete tear.

  • Ongoing shoulder pain, and arm weakness
  • Sudden sharp pain, popping sound when lifting object
  • Bruising following pain
  • Difficulty, weakness or pain when pushing off the ground
  • Muscle deformity, ‘bulge of muscle in the arm’

Causes of bicep tear in the shoulder

This is categorised into two main categories including, repetitive stress or acute injury. Repetitive stress really just means the bicep is used too much (over use) and it breaks down and eventually tears. This is common as we age and use the arms more and more, especially in the sporting sense. An acute injury to the bicep may be caused by a fall, gym injury lifting weights or a sporting accident.

Treatment of biceps tear in the shoulder

Most people will recover from a biceps tear with no to minimal function loss and no surgery required. If there is a deformity some people will not care, however for strength loss and complete tears early surgery may be suggested. We focus on reducing pain and restoring function. This will be done through hands on treatments and treatments designed to reduce inflammation and pain and early strengthening exercises. Active strategies that aim to restore the qualities of the biceps muscle tear are a large focus and these include strength, endurance, power and functional task execution.

Frozen Shoulder

Frozen shoulder is also known as adhesive capsulitis. This is a condition that affects the shoulder and leads to pain, inflammation and limited mobility. Usually shoulder tightness gradually gets better over time and this can take 1-3 years. Pain is typically worse at night and this may mimic a rotator cuff tear and acute rotator cuff tendinitis.

Symptoms of frozen shoulder

Frozen shoulder can come on slowly and insidiously and its symptoms can be as vague as the condition itself. Typically frozen shoulder will come on in this manner. Our chiropractors describe its three stages.

  • The freezing stage: This is where the shoulder slowly starts to stiffen up and loose its motion. The range of motion will reduce over the period. Pain is usually most in this stage.
  • The frozen stage: Shoulder mobility reduces and the shoulder becomes stiff and loses most of its motion. Movement of the shoulder becomes more and more difficult. Most shoulder pain typically diminishes.
  • The thawing stage: Mobility of the shoulder typically improves over time until the condition resolves.

Causes of frozen shoulder

Frozen shoulder is a condition that is not well understood. It has been suggested that frozen shoulder can its causes are multifactorial, however we do know populations that are more at risk. The following list are risk factors for developing frozen shoulder:

  • Age: Individual over 40 are more likely to get frozen shoulder
  • Sex: Females are more likely to get frozen shoulder
  • Injury: People who have a rotator cuff injury, pathology or condition are more likely to get frozen shoulder
  • Systemic disease: People who have diabetes, hyperthyroidism, hypothyroidism cardiovascular diseases, tuberculosis or Parkinson’s disease are more likely to get frozen shoulder.

Treatment of frozen shoulder

Our treatment treatments for frozen shoulder will typically be geared at reducing any pain, inflammation or irritation to the shoulder or nearby structures such as the neck. Mobility restoration and maintenance is a large focus and this is by done our chiropractors using safe, gentle effective treatments such as range of motion exercises, directional preference exercises, and hands on treatments. It is worth remembering that true frozen shoulder is a self-limiting condition and this means it will get better by itself typically within 18 month on average. Early diagnosis is the key to effective management of shoulder problems.

Dislocated Shoulder

The shoulder joint is the most commonly dislocated joint in the body, the primary reason for this is that is it also the most mobile joint in the body. More movement means more opportunity to move too far and dislocate. Shoulder dislocation can occur forward (anterior dislocation), backwards (posterior dislocation) or down (inferior dislocation). Shoulder dislocation can be described as either of the following:

  • Subluxation. Partial dislocation
  • Dislocation. Implies a complete dislocation

Causes of shoulder dislocation

The most common causes of a shoulder dislocation include:

  • Sports injuries. Sports injuries in contact sports
  • Trauma: Motor vehicle accidents, or just a hard blow to the shoulder.

Symptoms of shoulder dislocation

The symptoms of a shoulder can include:

  • Intense shoulder pain
  • Restricted motion of the shoulder
  • An alerted in the contour of the shoulder —squared-off appearance in anterior dislocations or anterior flattening in posterior dislocations.
  • Shoulder bruising, hardness or associated fracture (25% of dislocations)

Treatment of shoulder dislocation

The first step after a suspected shoulder dislocation is to make sure it is back in properly and in Australia this must be done by a medical practitioner at the hospital. Following this the shoulder is immobilised for a period of time. It is at this next point that the chiropractors will be able to start intense rehabilitation of the shoulder to ensure pain is reduced and function is restored. Our chiropractors will use evidence-based techniques that include mobility strategies, control exercises and strengthening protocols.

Arthritis of the Shoulder

Arthritis simply means inflammation of a joint. Inflammation of a joint may cause pain and stiffness and produce what we call a painful stiff shoulder (PSS). There are many different causes of arthritis but it in the shoulder the most common type of arthritis is the wear and tear as we age or repeatedly stress the joint in activities such as sport. The wear and tear type of arthritis is called osteoarthritis. There is no cure for arthritis so education, knowledge and ultimately prevention are best.

Causes of arthritis of the shoulder

Arthritis can come in many forms. Our chiropractors and physiotherapists will canvass and describe the most common ones here starting with the most common type of arthritis of the shoulder, osteoarthritis.

Osteoarthritis

Wear and tear of our joints as we age is a simple reality of living on planet Earth as a human. We will all get this to some degree as we age. However for some, this process will be advanced and can require ongoing support and treatments. In osteoarthritis the cartilage ends of bones that allow the joint to move freely and without restriction is destroyed. The edges of bone lose their lubrication, fray and eventually are drawn in together to become ‘bone-on-bone’. This will lead to rubbing of the bone ends against each other and pain, stiffness and dysfunction. As this is typically age related it is most common over 50-60 years of age, previous shoulder dislocation or injury makes this shoulder condition more likely and this is sometimes called ‘post-traumatic arthritis’. When arthritis develops after long standing rotator cuff tendon problems this has been termed ‘rotator cuff arthropathy’.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease. This means our body attacks our own body and specifically our joints. Our joints have a lubrication lining and this is called the synovium and synovial fluid. In rheumatoid arthritis this layer swells and creates a painful stiff joint. A key feature of rheumatoid arthritis is that it attacks both sides of the body (left and right) in a symmetrical fashion even though one side may be worse than the other.

Avascular Necrosis

Although not as common, in individuals who have high steroid or alcohol use, have an shoulder injury such as a fracture or for unknown causes can develop cell death in the shoulder joint and this will lead to arthritis. It is worth considering here as it highlights that not all arthritis is from mechanical or autoimmune causes.

Symptoms of shoulder arthritis

The hallmark of any arthritis of the shoulder is pain and stiffness. Typically shoulder arthritis is aggravated the more you use the shoulder. Night pain and morning stiffness are common complaints.

Treatment of shoulder arthritis

The treatment of shoulder arthritis will largely depend on what type of arthritis it is. In cases of rheumatoid arthritis, specialist medical care is needed along with chiropractic and physiotherapy management to limit shoulder pain and regain lost function. Osteoarthritis of the shoulder is a clinical interest at Incline Health our chiropractors treat many athletes with the posttraumatic subcategory of shoulder arthritis and work heavily with patients to come up rehabilitation programs that are evidence-based, promote recovery of mobility and restoration of lost function.

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