Shoulder pain is the third most common musculoskeletal complaint for which people seek information and health assistance. It may be due to an intrinsic shoulder problem or be referred from other structures such as the cervical spine (the neck), the diaphragm, or the heart. Dr. Gorchynski at the Bayview-Finch Chiropractic Clinic in Toronto shed light on the many causes of shoulder pains.
The anatomy of the shoulder joint is made up of the humeral, glenoid, scapula, acromion, and clavicular bones and surrounding muscles, ligaments and tendons. There are three significant shoulder joints: the sternoclavicular joint, the acromioclavicular joint, and the glenohumeral joint, the last being the most commonly dislocated major joint in the body. Ligaments and surrounding musculature, and the rotator cuff muscles, contribute to shoulder strength and joint stability. The rotator cuff is composed of 4 muscles: the supraspinatus, the infraspinatus, the teres minor and the subscapularis. These muscles help with internal and external rotation of the shoulder and also hold the humeral head against the glenoid.
Most commonly, shoulder problems are caused by a cervical spine problem, arthritis, dislocation or instability, fracture, frozen shoulder, sports injury, synovitis, tendonitis, bursitis, impingement syndrome, or a torn rotator cuff, or a combination of these conditions. When assessing shoulder pain, a history and an examination are necessary to determine the source of the shoulder problem. Questions that must be answered are – how did the pain start, was there a specific injury, is the condition acute or chronic, does the problem impact upon activities of daily living, is the pain on the dominant hand, is there pain at rest or on movement, and is there night pain that affects sleep? Is there any associated pain, for example, neck, chest or other upper limb or joint pain? Is there a history of shoulder pain/instability/dislocation? Does the patient’s occupation expose them to repetitive movements, vibration from machine tools, psychosocial factors such as stress, job pressure, social support and job satisfaction issues? Are throwing sports, sports that involve repetitive arm movements, or high-impact sports a part of the patient’s life? Is the patient’s occupation prone to create painful shoulder syndromes such as cashiers, garment makers, bricklayers/construction workers, pneumatic tool workers, welders, meat/food-processing workers, hairdressers, plasterers, assembly/production line workers, keyboard workers, dentists and other related professions? Are there any signs or symptoms of systemic illness, a past medical history (particularly any history of diabetes, ischemic heart disease, or cancer), a drug history and adverse drug reactions?
Pain from generalised capsulitis is felt at the outer aspect of the upper arm or deltoid region and may keep the patient awake. Anterior capsulitis usually causes localised pain is felt anteriorly over the upper biceps insertion. Rotator cuff/supraspinatus pain is also felt in the upper aspect of the arm or deltoid region and will be accompanied by a painful arm arc movement. Problems within the shoulder may be a rotator cuff disorder – rotator cuff tendinopathy, impingement (trapping of rotator cuff tendon, particularly the supraspinatus muscle in the subacromial space), subacromial bursitis, rotator cuff tears, or calcific tendonitis; it may be a glenohumeral disorder – capsulitis (‘frozen shoulder’), or arthritis; an acromioclavicular disease; an infection, which is rare; or, a traumatic dislocation. Problems outside the shoulder, but feeling within it, can be caused by referred pain such as neck pain, myocardial ischemia, referred diaphragmatic pain (e.g. gallbladder disease, subphrenic abscess); polymyalgia rheumatica; malignancy such as apical lung cancers or metastases.
Dr. Gorchynski of the Bayview-Finch Chiropractic Clinic in Toronto is able to assess the cause of the shoulder problem and provide appropriate care and chiropractic adjustments to restore function and reduce pain. If further consultation or additional professional health resources are necessary to deal with the patient’s problem, appropriate referrals will be suggested.
For more information and/or to book your initial health assessment contact us at 416-224-2225 or click here to book your appointment online.