What is Shoulder Pain?
The shoulder is one of the most mobile and complex joints in the human body. Due to complexity of the joint shoulder pain is very common in all age groups of people. Pain in the shoulder region can be from an unexpected trauma or injury like a fall, sleeping position, or a car accident. It may also slowly creep up over time from repetitive arm motion in the workplace or in the home like electrical work, poor desk work posture, or moving boxes.
Shoulder pain impacts one’s ability to accomplish daily activities of living like cooking, cleaning, driving, and most importantly sleep. It may interfere with work, personal hobbies or even prevent you from playing with your children. About half of shoulder complaints resolve within 8-12 weeks, but without proper treatment and attention a shoulder problem can become a recurrent and/or chronic issue.
Anatomy of the Shoulder Joint
The shoulder is made up three bones (shoulder blade, collarbone, and upper arm bone (humerus). Together they form two joints: the acromioclavicular (AC) joint, which connects the collarbone to the shoulder blade, and the glenohumeral (GH) joint where the smooth ball of the arm bone (humerus) connects to the socket of the shoulder blade.
Ligaments are structures that connect bones to bone and provide stability to the joint. Most common ligament injury injured in contact sports is acromioclavicular (AC) ligament and the coracoclavicular (CC) ligament. Their main role of ligaments is to keep the shoulder joint stable.
Tendons are structures that connect muscles to bones. When muscles are working, tendons are too! The more widely known tendons of the shoulder are the rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis).
The shoulder labrum (glenoid labrum) is made of fibrous cartilage, shaped like a ring or a cup, around the ball of the upper arm bone and helps to deepen the arm socket. It essentially creates a tight and snug fit between two bones. It blends seamlessly with surrounding ligaments and tendons. When torn, it can lead to a partial or complete shoulder dislocation.
Common Causes of Shoulder Pain Mississauga
Rotator cuff strain
Rotator cuff consists of four muscles that provide the shoulder girdle with ranges of motion. Also, rotator cuff provides the stability to the joint shoulder complex.
The rotator cuff tendon is comprised of 4 muscles: supraspinatus, infraspinatus, teres minor and subscapularis. The rotator cuff’s role is to maintain shoulder stability and pull the arm bone into the socket for proper gliding in the joint. A stable shoulder can accomplish circular motions without pain, but a rotator cuff tear or strain will cause a dull, deep ache, or sharp pain with movement of the shoulder.
Risk Factors
- Repetitive overhead motions (baseball pitchers, swimmers, electricians)
- Forceful pulling motions or heavy lifting
- Sports injury or trauma
- Reduced strength or flexibility in the shoulder region
- Previous shoulder injury
- Age-related changes to the joint
Signs and Symptoms
- Pain – deep, dull, and achy
- Pain is located on the top or side of the shoulder
- Disrupted sleep or cannot lay on the affected shoulder
- Difficulty combing hair or reaching behind the back
- Shoulder weakness and difficulty with moving the arm out, forward and back
- Possible clicking or creaking with arm movements
- Fall
Supraspinatus Tendinopathy
Tendinopathy is a fancy working for supraspinatus tendon injury. The supraspinatus is part of the rotator cuff and most frequently injured muscle in the shoulder. It is located on the top of the shoulder blade and over laps with traps muscle.
Signs and Symptoms
- Dull/deep ache aggravated by movement
- Top of the shoulder pain
- Pain may travel towards the neck.
- Pain aggravated by sleep on effected shoulder
Risk Factors
- Age-related changes to the joint
- Repetitive trauma or overuse
- Repeated overhead motions
- Sports injury or trauma
- Reduced strength or flexibility in the shoulder region
- Previous shoulder injury
Impingement syndrome
Gradual narrowing of the space in the top of the shoulder between the outer edge of the collar bone and arm bone (humerus) leading to a “pinch” of rotator cuff muscles, biceps muscle or a tendon.
Risk Factors
- Athletes or Active Jobs (see list below)
- Previous shoulder injury
- Repetitive overhead motions without adequate rest
Signs and Symptoms
- Pain – deep, dull, and achy on the top or front of the shoulder
- Increased pain with overhead activity or excessive use lifting/reaching
- Gradual onset of pain
- Pain may radiate down into the side of the arm
- Swelling and tenderness in the shoulder
- Loss of strength or range of motion
- Increased pain at night
Professions that are MOST at risk:
- Painters
- Construction workers
- Electricians
- Factory Workers
Bicipital tendinopathy
This is inflammation and/or irritation of the biceps tendon where it attaches into the shoulder (front of the shoulder). Bicipital tendinopathy often doesn’t occur alone and is caused mainly from repetitive lifting. It may also be from scar tissue build up after multiple shoulder injuries or from a direct trauma to the shoulder.
Signs and Symptoms
- Mild swelling and redness on the front of the shoulder
- Desire to rub or hold the shoulder to reduce pain
- Pain is sharp, localized and may “snap” or “catch” with repeated movement
- Most painful movements are bringing the arm straight up in front of the body and reaching for a cup with outstretched hand.
- Pain increased with activity and relieved by rest
Frozen Shoulder (Adhesive Capsulitis)
Painful shoulder condition with severely decreased ranges of motion. More common in females and has association with thyroid glad involvement.
Stages of Frozen Shoulder Mississauga:
- Painful Inflammatory stage – shoulder pain with movement of the shoulder and gradual decrease of motion in the shoulder complex.
- Freezing Stage – during the freezing stage, shoulder pain has decreased however the ranges of motion are severely impaired. Increasing difficulty to wash the hair, inability to unstrap the bra or brush the hair.
- Resolving Stage – Arm movements begin to feel easier again and the arm can be lifted and used gradually. With time, motion will return to normal abilities.
It is known to be an inflammatory process and most often occurs because of shoulder disuse, injury, surgery or illness. This condition progresses in the following order: painful start, frozen stage, and finally thawing stage. Each stage has characteristic traits and the shoulder will eventually improve in range of motion. Without treatment, the condition tends to get worse with time and then spontaneously recover in approximately 18-24 months.
Risk Factors
- Females tend to get this condition more often than Males (2:1)
- Prolonged use of an arm sling
- Previous shoulder injury or trauma to the shoulder
- Lack of exercise therapy or rehab program after shoulder injury
- Immobility post-surgery (bedrest)
- A diagnosis of diabetes or thyroid gland conditions
AC joint sprain
This is most commonly an injury resulting from contact sports, extreme sports, or severe accident like a fall from a significant height or severe car crash. Male athletes aged 15-25 are most likely to sustain this condition from either a direct hit to the outer edge of the shoulder or after a collision falling onto an outstretched arm. Most AC joint sprains are successfully treated without surgery.
Grades
Grade 1 – Mild AC joint sprain. No visible bump on top of the shoulder.
Grade 2 – Incomplete tear in the AC ligament (most painful grade). There will be a slightly noticeable change in collarbone position, and you may see a visible bump.
Grade 3 – The most severe shoulder sprain/separation resulting in complete tear of the AC ligament. The alignment of the collarbone is more noticeable, and a larger bump is seen.
Signs and Symptoms
- History of trauma
- Need to hold or support the arm to feel secure, protected or stabilized
- Collar bone deformity (noticeable difference in appearance when comparing the opposite shoulder)
- Pain and tenderness over the outer edge of the shoulder
- Swelling
Chiropractic Care for Shoulder Pain Mississauga
Whether your shoulder pain is new or something you have had for a long time it is important to seek chiropractic care to prevent further damage or complications.
To provide a correct diagnosis and treatment plan, a chiropractor will take a full medical history and perform physical examination of the shoulder. Also, it is extremely important to assess the shoulder, neck and wrist to see if those structures are contributing to the presenting condition.
Treatment Options:
- Mobilization
- Acupuncture
- Manipulation
- Massage Therapy
- Active Release Therapy (ART)
- Myofascial release (MRT)
- Instrument Assisted Soft Tissue Therapy / Graston Technique
- Electrotherapy
- Medications
- Rehabilitative Program – It is important to preserve ranges of motion with chiropractic care, massage therapy, acupuncture and individualized shoulder exercises.
Written by: Igor Gongalskyy BS, DC and Micaela Dickhof Chiropractic Intern
