Understanding and Eliminating the Cause of Shoulder Pain

Do you suffer from shoulder pain? Shoulder pain can have many possible origins – it could be caused by some kind of trauma like a car accident, sports injury or even a major fall where you landed on or caught yourself with your shoulder. Or it could be something that has worn down the shoulder over time – muscular imbalances, repetitive stress related to a job or bad posture over time. In order to understand shoulder pain, we need to cover some anatomy. The anatomy will include parts of the shoulder but will also include the neck as well. Much of the shoulder pain that individuals experience actually originates at the neck. Let’s first look at the shoulder itself.

The bone structure of the shoulder consists of the ball of the humerus (upper arm) attaching into a very shallow socket of the scapula (shoulder blade). It is a ball-in-socket joint similar to the hip, which is also a ball-in-socket joint. The difference being that the socket of the shoulder joint is much more shallow. Because of that shallowness, this allows a larger range of motion for the shoulder. In fact, the shoulder joint has the largest range of motion of any joint in the body. On the downside, because of this large range of motion, it is also the most unstable joint in the body as well. The shoulder is held in place largely by what’s called the rotator cuff. The rotator cuff consists of 4 muscle. The rotator cuff muscles are as follows:

1. The supraspinatus muscle is located on top of the shoulder joint. It assists in lifting your arm out to the side.

2. The subscapularis muscle attaches the front of the humerus to the scapula. It assists in rotating your arm inward.

3. The teres minor muscle attaches to the back of the humerus. It assists in rotating the arm outward.

4. And the final rotator cuff muscle is the infraspinatus muscle which like the Teres Minor, attaches to the back of the humerus. It also assists in rotating the arm outward.

In addition, the subscapularis, teres minor, and infraspinatus also assist in holding the arm toward your side as well (abduction).

There are many other bones, muscles, ligaments, and tendons associated with the shoulder joint making it, arguably, the most complex joint in the body – but the parts listed above are the major players.

Now that we have established the anatomy of the shoulder, we can now discuss the specifics of why shoulder pain occurs due to problems in the shoulder itself.

1. Subluxation – Subluxation is defined in chiropractic as any joint that becomes slightly misaligned or stops moving correctly. When the shoulder becomes subluxated, nerves become irritated leading to pain.

2. Ligamentous weakness or sprain. In addition to the rotator cuff, there is a multitude of ligaments that help keep the shoulder joint in place as well. When these ligaments become weak or injured, it can lead to shoulder instability and pain as well.

3. Muscle weakness or injury – The final major cause for shoulder pain originating from the shoulder itself, is due to problems associated with the rotator cuff – the 4 muscles listed above that surround and hold the shoulder joint in place and is responsible for much of its movement and range of motion.  These muscles can weaken and/or tear over time due to repetitive overuse or imbalances that develop over time leading pain.

As mentioned, a lot of shoulder pain actually originates at the neck. The anatomy of the neck is also very complex. There are a lot of moving parts and thus many things that can go wrong resulting in neck or shoulder pain. The main reason for shoulder pain that originates in the neck is from irritation of nerves emanating from the neck into the shoulder joint. To understand how this plays out, we need to review some neck anatomy. The neck bone structure consists of 7 cervical vertebrae stacked on top of each other. The cervical vertebrae all have a cartilaginous disc in between each of them that allow the spine to flex and twist. Also in between each vertebra is a place where nerve roots exit on either side of each vertebra.   It is the irritation of these nerve roots which causes a vast majority of shoulder pain. These nerve roots can become pinched by misaligned vertebrae or when discs bulge out or even herniate (the disc material leaks out under pressure) putting pressure on the nerve roots that lead to the shoulder, thus causing shoulder pain.

Neck muscles are divided into 4 main groups. And their function is largely determined by their structural location around the neck:

1. Flexors – Any neck muscle that is located in front of the spine is considered a flexor. To envision the action of a flexor, it is the motion of bringing your chin to your chest.

2. Extensors – Any neck muscle that is located posterior to the spine is considered an extensor. Extension of the neck is the action performed when you look up toward the ceiling.

3. Lateral Flexors – Regardless of if they are in front or back of the spine, muscles that are either to the right or to the left of the spine in the neck are lateral flexors. To envision the motion of right lateral flexion, for example, imagine tilting your head to the right so that you are bringing your right ear toward your right shoulder.

4. Rotators – Muscles that rotate the neck can be located in any structural location of the neck – the front, back or sides of neck contain muscles that rotate the neck. To envision the action of neck rotation, it is simply the act of turning your head to either side (like when you turn to look when you are backing your car out).

- Any muscle of the neck can belong to more than one functional group listed above. For example, the upper trapezius has the ability to extend, laterally flex, and contralaterally rotate the neck.

Now that we have established the anatomy of the neck, we can now discuss the specifics of why shoulder pain occurs due to problems in the neck. Below are the 2 most common causes:

1. Subluxation – As mentioned above in the discussion of the shoulder, subluxation is defined in chiropractic as any joint that becomes slightly misaligned or stops moving correctly. The most common type of subluxation in the neck involve facet joints. The facet joints are the most posterior joints connecting each of the seven cervical vertebrae. When the facet joints become subluxated it can lead to irritation of nerves that extend into the shoulder joint causing shoulder pain.

2. Disc problems – The discs located in between each of the vertebrae can bulge or herniate. Located in the center of each disc is a gelatinous material. Over time the walls of the disc can weaken and break down allowing this gelatinous material to push out or bulge toward the outside of the disc. If the wall breaks and the material actually leaks out, this is called a herniated disc. The problem with a bulge or a herniated disc comes when the displaced disc places pressure posteriorly toward the nerve roots that are exiting on either side of the spine at any of the various levels of the vertebrae. This can cause not only neck pain but also pain in the shoulder as well.

Below are some suggestions for things that you can do for yourself at home to help relieve your shoulder pain:

1. Apply ice – Many find considerable relief from applying ice to the shoulders. Ice works to reduce inflammation and swelling thus providing relief. Apply ice for 15 minutes every 2-3 hours as needed.

2. Watch your sleep – Sleeping on your back is best providing the least amount of stress on the shoulder. But if you sleep on your side, lay with your “bad” shoulder up and “hug” a pillow to your chest to prop your arm up relieving stress on the shoulder.

3. Take NSAIDs – Non-steroidal anti-inflammatory drugs like ibuprofen can be taken to reduce swelling in the shoulder. By reducing the swelling, more space is created in the shoulder joint, thus taking pressure off of the nerves.

4. Stretching – A simple stretch to help maintain mobility and decrease pain in the shoulders is to simply clasp your hands together and slowly reach toward the ceiling. You want to reach as high as to the point of pain – you don’t want to reach past the point of pain. Do this a couple of times a day.

5. Strength exercises – Stand in a doorway facing the door jamb with your elbow at your side and bent at 90 degrees with the palm of your hand against the side of the door jamb. Simply lean or twist your body toward the door jamb so that your palm is putting pressure on the jamb. This will create resistance to the inside of the shoulder joint, thereby strengthening it over time.

Next, switch to placing the backside of your hand against the door jamb and again lean or twist toward the jamb. This will now work the outside of the shoulder joint.

6. Watch your posture – Many people tend to walk rigidly with their arms at their sides. As you walk throughout the day focus on just allowing your shoulders to just relax in their sockets and let your arms just swing and flow by your sides. This will bring more blood and oxygen to your shoulders and decrease the chance of arthritis and stiffness as we age.

Being a multi-specialty clinic, there are many ways that we can treat shoulder pain in our clinic.

1. Chiropractic adjustments – Adjustments are able to normalize imbalances in many joints of the body including the shoulder and thus release pressure off nerves causing shoulder pain. Often times, more than one adjustment is necessary to stabilize shoulder pain, but many find considerable relief after the first adjustment alone.

2. Physical therapy – Physical therapy is another way we can treat the neck or shoulder in order to decrease shoulder pain and improve mobility. The focus of physical therapy is on treating the soft tissue – the muscles, ligaments, tendons, fascia etc. There are a multitude of services offered by physical therapy in order to treat a shoulder problem. Some of them include:

            a) Cryotherapy – cold pack treatment helps to reduce inflammation and thus reduce pain.

            b) Stretching – stretching helps to loosen tight muscles that are in spasm, thus reducing pain

            c) Strengthening – specific exercises can be given to strengthen weak muscles, thus restoring muscular balance to the shoulder and neck.

            d) Axial decompression – This is a specialized form of treatment typically for the treatment of disc bulges or herniation in the neck. The patient is placed on a special computerized table that gently and slowly distracts the spine over a 30 minute session. The action of the distraction creates a negative pressure or “vacuum” effect that draws the disc material back inside, thus getting pressure off of the nerves that are being compressed in the neck causing shoulder pain.

3. Acupuncture – Acupuncture is an ancient healing art started in China over 4000 years ago. The premise of acupuncture is based on meridians (or pathways of energy) that run throughout the body. When a practitioner of acupuncture places needles into the body, they are placing those needles on key points along those meridians in order to manipulate that energy in order to promote healing in the body. Acupuncture is very effective at treating shoulder pain and restoring overall function to the body.

4. Family Medicine – At Health Quest we emphasize conservative care with drugs and surgery as the last resort when possible. But sometimes, if you are in extreme pain, it is necessary to have a little help to get you through. In extreme cases, medicine could be prescribed to help get you through the pain in the short term.

5. Massage – Often shoulder pain is the result of tight muscles. Or sometimes the tight muscles might result from having the shoulder pain. Either way, shoulder pain can be relieved with massage by relaxing muscles, increasing blood flow to help speed healing and flushing out toxins in the soft tissue.

If you or someone you know is suffering from shoulder pain, we may

be able to help you at Health Quest through chiropractic, physical therapy, massage, acupuncture or family medicine. Call us today to schedule an evaluation at 573-635-9655.

Yours in health,

Dr. Ted Tang D.C.