By Rick L. DaSo, D.C.
Shoulder pain is a common musculoskeletal complaint that we see in our office fairly often. Shoulder pain can come from a variety sources and making a proper diagnosis is crucial in determining the proper course of treatment. In many cases, conservative treatment is very effective in managing shoulder pain.
The shoulder is a remarkable joint built primarily for movement, but also possesses a great deal of stability. Most joints such as the knee, spine, and ankle derive their stability from ligaments. The shoulder however, is different in that the majority of its stability is provided by muscles. Since the movement pattern of the shoulder is so complex, shoulder injuries can be very complex as well.
Two types of dysfunction can be found in the injured shoulder. Mechanical instability that is made up of the muscles, joints, ligaments, and tendons. Functional instability is made up of the neurological programing behind muscle movement and coordination. The shoulder is a unique complex of joints that comprise the movement patterns of the shoulder and upper extremity. All 5 of the following must be functioning correctly for full, pain-free shoulder motion:
- Glenohumeral joint – Ball and socket joint between scapula and humerus ( arm)
- Acromioclavicular joint- Top of shoulder between clavicle and part of scapula
- Sternoclavicular joint-Sternum (breast bone) and clavicle (collar bone) junction
- Scapulothoracic – Articulation between rib cage and scapula
- Upper thoracic spine-Various muscles associated with proper shoulder motion
Injury to any of the above-mentioned regions may create deficits in neuromuscular control of certain muscles which creates altered movement patterns. When this occurs, other muscles are recruited to perform movements and the injured muscles become inhibited. Over time, pain syndromes develop, muscle weakness occurs, certain joints become extremely limited in movement and a chronic dysfunctional shoulder develops.
Imaging can be very helpful in determining the underlying cause of shoulder pain. Also, MRI is often ordered if muscle tears are suspect, such as a rotator cuff. Complete tears are usually in need of surgical repair.
Treatment can vary depending on the type of injury and whether or not it is a new injury or a chronic condition. A common course of treatment may include specific adjustments to the spine and shoulder to improve motion patterns, massage therapy to reset muscle movement patterns and increase shoulder range of motion, and a graduated exercise program targeted towards improving muscle balance and strength in the shoulder region and to reset the neuromuscular connection of these muscles. Pain can be addressed with cold laser therapy, ultrasound diathermy, muscle stimulation and ice / heat application.
If you are suffering from shoulder pain, schedule an evaluation and let us help you in determining the cause of your pain and discuss treatment options.