The Mystery About Shoulder Pain

Shoulder pain changes lives everyday.  Today, more than anytime in history, more people know something about shoulder pain.  Sports hero’s down for the count due to any number of problems with shoulder muscles, tendons, labral tears, spurs, arthritis… you name it, they’ve got it!  Go beyond that, right in your own living room, more and more of us are suffering from some type of shoulder pain, what type, you name it, arthritis, rotator cuff tear, frozen shoulder, impingement syndrome…  Baby Boomers are now coming of age and well into the ages that there are aches and pains in many locations of the body.  The shoulder is definitely in the top five, somewhere behind; low back pain, neck pain, and a close runner up to knee pain.

How do we develop shoulder pain?  Usually, either by repetitive maneuvers with our shoulders and arms or straight out…trauma.

This article is going to touch upon 4 major types of shoulder pain, how we develop shoulder pain and some ideas on how to treat it once we know what the problem is.

Rotator Cuff Strain:   The term strain means that there is a muscle and or tendon that is overstretched or, outright torn. There are 3 basic types of strain, a mild partial, a moderate and severe total.  The Rotator Cuff stands for 4 different muscles that comprise the cuff of the shoulder.  These muscles are mostly responsible for rotating the shoulder both fast and slow.  A tear usually occurs with sports related occurrences, throwing a ball, swinging a golf club or trauma such as falling on the ice or climbing and straining the arm or shoulder.

With Rotator cuff syndrome, pain and weakness of the shoulder is common.  Inability to raise the shoulder from our side without help from the other arm, difficulty raising arm in front of the body or putting the wallet in your back pocket.  This is usually diagnosed by a proper examination.  Orthopedic surgeons, Physiatrist and Chiropractic physicians can diagnose this problem.  MRI testing may need to be used in order to confirm the diagnosis.  Treatment can be as simple as range of motion stretching and light exercise with elastic bands to gently strengthen the shoulder.  Gentle massage and manipulation by a doctor is also an option. 

Rotator Cuff syndrome also very often responds remarkable well to electro-therapeutic modalities including; Ultrasound, Interferential Current, Electromuscle Stimulation and Microcurrent.

For more severe cases of strain and frank tear,, Orthopedic Surgeons may advise arthoscopic surgical repair or other surgical treatments.

Frozen Shoulder Syndrome:

Frozen Shoulder aka Adhesive Capsulitis,  feels almost exactly as it sounds. The shoulder feels glued down to the side.  In extreme cases, the arm can not be moved from the side without some assistance from the other arm, however even so, only a few degrees of movement can be achieved in this way.  When diagnosing this condition, one critical sign is the persons inability to move the shoulder blade naturally without using the entire upper body to raise the shoulder.  The cause of this condition is often unknown.  Multiple tendons and muscles simply seem to adhere to each other and the ultimate affect is non-movement.  Another characteristic is that this condition is not terribly painful unless the shoulder is forced.  Treatment for this condition usually takes a long time, 6 months to a year or more in some cases.  Complete recovery is often possible with the help of a good therapy program. Orthopedic and Chiropractic Physicians as well as Physical Therapists, can provide good treatment.  At home work is also a must.  Patients must exercise, stretch and perform particular movement patterns consistently in order to overcome this strange condition.  Home Therapeutics’ including the use of Electrotherapy modalities can be very helpful.  Ultrasound, Interferential Electrostimulation therapy, Microcurrent all can help to reduce restrictions, reduce scar tissue and improve circulation are used.  A Proper  Physical Therapy Home Program is essential.

In more severe and non-responsive cases, Orthopedic Surgeons may recommend ‘Manipulation under Anesthesia’ which does exactly as it sounds.

Shoulder Impingement Syndrome:

That stabbing ice pick sensation when you lift your shoulder over your head, the feeling of a ‘dead arm’ when you wake up in the morning, tingling and burning pain from your shoulder to your elbow or from your shoulder to your lower neck.  These can all be the tell-tale signs of Shoulder Impingement.  The cause is usually the development of bony spurs and scar tissue in the outer clavicle (collar bone) region of the shoulder known by doctors as the AC region.  In some instances, the AC has a different shape from birth known as a Type II Acromian process.  This means that the bone slopes downward into the space below where there are nerves that can be pinched or ‘Impinged’.  Other structures in the area including tendons, muscles and bursae can also become inflamed and swollen, causing even more radiating pain, tingling and numbness.
Shoulder Impingement often  responds nicely to in office procedures including specific exercises that improve shoulder stabilization.  In addition, Physical Therapy modalities including Ultrasound, Interferential Electromuscle Stimulation, Microcurrent and even TENS treatments can greatly help.  Once again, in office treatments supported by guided  home therapeutics’ and finally, more home therapeutics’ with modalities and proper Physical Therapy exercises can be the key to complete recovery and ongoing relief. 

If these more conservative measures fail to help attain full relief, some Orthopedic Surgeons may recommend Steroid injection and even surgery in more severe cases.

Labral Tear:

Often times, the Labral tear is an elusive diagnosis.  This can occur in the shoulder that has been  dislocated or sustained other more serious injury.  Sporting injuries can often lead to Labral tear.  This is either by repetitive trauma or again frank injury.  Depending on the physical needs of the patient, this often leads to surgery.  If the patient is more sedentary or even simply not a sports enthusiast and not engaged in daily physically demanding work, this condition is one that is often treated to reduce pain, improve painless range of motion and joint stabilization.  Conservative treatment for Labral tear can be very similar to that for rotator cuff strain or tear.  A proper Orthopedic examination by the Surgeon , Physiatrist, Chiropractic or other Physician.  MRI or other imaging tests including contrast MRI or arthrogram may be necessary.  Restoring proper painless range of motion is a priority.  Stabilization exercise both in office and at home through Physical Therapy Exercise treatment manuals are key to recovery. 
Modalities including Ultrasound, Interferential Electrostimulation, Microcurrent, TENS and even Electromuscle Stimulation can all be very helpful both in office and properly managed at home programs.

In more severe cases, Surgery may be required for proper treatment and increased stabilization. 

No matter what the injury, malady, pain or dysfunction, the more you know, the better off you are.  More and more doctors today appreciate a patient who is interested in their condition.  In most cases, the more the patient does to help themselves,  the more easily their condition will respond to treatment.  Most doctors also would rather less invasive approaches to helping patients recover.  Home Therapeutics’ are becoming more and more important these days than ever before in the history of modern medicine.  Cost containment is one of the driving forces behind this movement.  The use of less medication and more therapy and exercise play a very important role.

Here’s top wishing you all the Best to attaining your goal to improve your Health!