Shoulder pain is one of the more common reasons for physician visits for musculoskeletal complaints. The shoulder is the most movable joint in the body, but is an unstable joint because of the range of motion allowed.
In 2006, approximately 7.5 million people went to the doctor's office for shoulder problems, including shoulder and upper arm sprains and strains. More than 4.1 million of these visits were for rotator cuff problems.
Table of Contents
3. Common Causes
4. Common Conditions
7. Shoulder Strain/Overuse
8. Frozen Shoulder
9. Rotator Cuff Tear
10. Shoulder Arthritis
11. Shoulder Labral Tear
12. Impingement Syndrome
The two main bones of the shoulder are the humerus and the scapula (shoulder blade). The joint cavity is cushioned by articular cartilage covering the head of the humerus. The scapula extends up and around the shoulder joint at the rear to form a roof called the acromion, and around the shoulder joint at the front to form the coracoid process. The end of the scapula, called the glenoid, meets the head of the humerus to form a glenohumeral cavity that acts as a flexible ball-and-socket joint.
The joint is stabilized by a ring of fibrous cartilage surrounding the glenoid called the labrum. Ligaments connect the bones of the shoulder, and tendons join the bones to surrounding muscles. The biceps tendon attaches the biceps muscle to the shoulder and helps to stabilize the joint. Four short muscles originate on the scapula and pass around the shoulder where their tendons fuse together to form the rotator cuff. All of these components of your shoulder, along with the muscles of your upper body, work together to manage the stress your shoulder receives as you extend, flex, lift and throw.
-Dull aching pain, which can worsen with activity
-Inability to raise the arm
-Lifting the arm overhead commonly produces pain (for example, putting the dishes in the cupboards)
-Slow onset of shoulder discomfort
-Pain in the upper third of the arm and difficulty sleeping on the afflicted side
-Redness and swelling that is warm and tender to touch
-Clicking, giving way, or stiffness
-Shoulder joint deformity
The shoulder is an unstable joint because of the range of motion allowed. It is easily subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments. Some shoulder problems arise from the disruption of these soft tissues as a result of injury or from overuse or under use of the shoulder.
Other problems arise from a degenerative process in which tissues break down and no longer function well. Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder.
(Treatment depends on severity of shoulder dysfunction and the cause of dysfunction. It is important to fully understand the shoulder injury before initiating a treatment program),
-Rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a frozen shoulder.(p>
-Ice packs and heat pads are advised for acute and chronic shoulder pain.
-Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain.
-Acupuncture, and massage therapy.
-Physical therapy modalities such as therapeutic ultrasound, electrical stimulation, cold laser, and bracing can be utilized following an initial trial rest and ice.
At Green Health Acupuncture our therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.
-Specific exercises may help you strengthen the muscles around the joint and relieve some of the pain associated with many conditions.
-Cortisone injections can be utilized by a physician for shoulder complaints inadequately treated by conservative therapies.
-In more severe shoulder injuries, surgical intervention may be necessary.
-Participate in a Green Health Acupuncture wellness program (i.e. acupuncture, massage therapy, personal training program, etc.), to maintain correct biomechanical balance, promote healthy whole body functioning, and increase strength of musculature to prevent injury.
-Warm up before playing sports or participating in activities that require extensive use of the shoulder. Begin a program of stretching several weeks in advance.
-To prevent underuse, participate in a well-rounded exercise program including upper-body activities and strengthening.
- Maintain good posture. Keep your head up and your shoulders slightly back to prevent shoulder pain. Allowing your shoulders to slump forward leads to increased pain in the joints.
-Prevent shoulder pain when working on a computer by positioning your keyboard and mouse so that your arms are relaxed at your side. You should also have a slightly open angle at your elbow and your wrists should be straight.
-Stop doing any activity that is causing your shoulder pain. Rest for awhile or find another way to do the activity that does not cause the pain.
Often times increased shoulder activity can place extensive stress on the shoulders and lead to a decrease in flexibility. This is a common problem in middle age, especially among "weekend warriors," or people who don't exercise regularly but go out every now and then for an intense sport.
Common symptoms of shoulder strain include tightness in the muscle, increased with certain shoulder movements (commonly doing push-ups and shoulder activities will be painful), possible swelling, and diffuse/achy pain upon rest.
Although painful and inconvenient, these overuse problems can usually be treated with rest, cold therapy, light stretching, provocative activity avoidance, and conservative modalities performed at our clinic including acupuncture, massage therapy, and physical therapy.
Frozen shoulder presents as extreme stiffness and pain in the shoulder joint noted with movement. The most common cause of this type of injury is due to the healing of a prior minor trauma in the shoulder joint. As the shoulder injury heals, scar tissue is produced in the shoulder joint.
The scar tissue reduces flexibility in the joint causing stiffness, causes inflammation in the joint, and leaves the shoulder prone to further injury. The major symptom is the inability to move the shoulder in any direction without pain. Frozen shoulder can develop after a shoulder is immobilized for a period of time. Attempts to prevent frozen shoulder include early motion of the shoulder after it has been injured.
There are 3 stages of frozen shoulder:
• 1: “Freezing" stage, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion. (Usually lasts 6 weeks to 9 months)
• 2: “Frozen" stage, marked by a slow improvement in pain, but the stiffness remains. (Usually lasts from 4 to 12 months)
• 3: “Thawing" stage, shoulder motion slowly returns toward normal. (Usually lasts 5 to 24 months)
Frozen shoulder generally will get better on its own, but additional conservative treatment will shorten recovery time and decrease pain.
At Green Health Acupuncture we offer physical therapy modalities such as therapeutic exercise, ultrasound, cold laser, as well as massage therapy, chiropractic, and acupuncture that will increase range of motion and aid in pain reduction.
In addition to these therapies, heat application, range of motion exercises, and provocative activity avoidance should be done by the individual. In severe cases, referral to an orthopedic specialist may be necessary.
“In a Hong Kong study, 35 patients with frozen shoulder were randomly assigned to an exercise group or an exercise plus acupuncture group. The patient was asked to exercise the shoulder during the treatment. Improvement scores (measured by the Constant Shoulder Assessment) showed significantly greater improvement in the acupuncture group (76.4% versus 39.8%) at 6 weeks, and these were maintained at follow-up (77.2% versus 40.3%).”
--Hong Kong Journal of Medicine (2001)
The rotator cuff muscles are a group of 4 muscles that support the shoulder joint and serve to raise and rotate the arm. As the population ages, the overall strength of these structures decrease and physical activity also decreases.
These changes and weakening of the shoulder can lead to a rotator cuff tear. Rotator cuff injuries occur in the younger population due to excessive force put on the muscles (such as athletic throwing injuries), but for the most part rotator cuff tears occur mostly in older patients with previous shoulder problems.
This is a very problematic area of injury because the shoulder area has a very poor blood supply, therefore injuries in this region take a long time to heal.
The rotator cuff tendons can be injured or torn by trying to lift a very heavy object while the arm is extended, or by trying to catch a heavy falling object. Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder during an activity that uses the shoulder. A tendon that has ruptured may make it impossible to raise the arm. It may be difficult to sleep lying on that side, and you may feel pain when pressure is put on the shoulder.
Shoulder bursitis/tendinitis of the rotator cuff can also present as a cause of shoulder pain. This condition arises from inflammation to soft tissues of the shoulder, often from overuse injuries or improper biomechanics.
Treatment of rotator cuff tears depends on the severity of tearing present. If it is a minor tear, treatment at Green Health Acupuncture usually can relieve symptoms. This treatment consists of rest, cold therapy, physical therapy modalities (cold laser, ultrasound, therapeutic exercises, etc.), chiropractic, massage therapy, and acupuncture which can all help alleviate pain and increase range of motion and strength. Although, more serious cases of rotator cuff tearing may require surgical intervention.
Most often patients develop osteoarthritis after the age of 50. Many times this develops in the shoulder joint causing extreme pain with movement. In shoulder arthritis, the smooth cartilage that normally covers the surfaces of the ball and socket is lost.
The result is bone on bone rubbing between these two joint surfaces. This bone-on-bone contact produces pain, stiffness, difficulty sleeping and the inability to do activities of daily living, work and sports. The most common cause of osteoarthritis is overuse.
The most common symptoms of shoulder arthritis include: pain with activity, limited range of motion, stiffness of the shoulder, swelling of the joint, tenderness around the joint, and a feeling of grinding or catching within the joint. Arthritic symptoms vary from time-to-time, patients may note flare-ups and periods of pain-free activity. In addition, weather changes often affect pain in an arthritic shoulder.
Treatment of shoulder arthritis depends on the severity of arthritis present. If it is a minimal amount present, usually rest, cold therapy, physical therapy modalities (cold laser, ultrasound, therapeutic exercises, etc.), chiropractic, massage therapy, and acupuncture can help alleviate pain and increase range of motion and strength. But, more advanced arthritis may require orthopedic consultation.
A labral tear is an injury to the cartilage supporting the shoulder joint. The shoulder is a ball and socket joint. The ball is the end of the arm bone which fits into the bowl-shaped socket of the shoulder.
Cartilaginous tissue lines the socket to keep movement of the ball and socket joint smooth (labrum). When the cartilage supporting the shoulder joint tears it is called a shoulder labral tear. Labral tears are caused either from long-term wear-and-tear or through acute trauma.
Some common causes of labral tearing include: dislocated shoulder, falling onto shoulder, repetitive movements of shoulder, lifting heavy objects, breaking a fall with arms, and a direct blow to shoulder.
Symptoms of shoulder labrum tears include: shoulder and/or arm pain, catching or loosening feeling of shoulder, loss of shoulder range of motion, weakness to shoulder and/or arm, pain with shoulder movement, popping or grinding sensation, and achiness to the shoulder.
Treatment of a shoulder labrum tear depends on the severity of tearing present. If it is a minimal tear, usually rest, cold therapy, physical therapy modalities (cold laser, ultrasound, therapeutic exercises, etc.), chiropractic, massage therapy, and acupuncture can help alleviate pain and increase range of motion and strength. But, more advanced labrum tearing may require orthopedic consultation.
When one of the rotator cuff tendons becomes inflamed and thickened, it may get trapped under a bone in the shoulder joint called the acromion, which causes a pinching of the rotator cuff.
This pinching can cause pain at the front and/or side of the shoulder joint with overhead activity such as throwing or pain at the back and/or front of the shoulder when the arm is held out to the side and turned outwards.
Impingement syndrome is caused by insufficient room between the acromion and the rotator cuff. Normally, the rotator cuff tendons can easily slide under the acromion each time your arm is raised; however, it is normal to have some degree of rubbing or pinching of the tendons and bursa. Overuse of the shoulder in an elevated position can cause the impingement to become a problem and can lead to ongoing pain or damage to the rotator cuff tendons.
Treatment of impingement syndrome usually consists of rest, cold therapy, physical therapy modalities (cold laser, ultrasound, therapeutic exercises, etc.), massage therapy, and acupuncture can help alleviate pain and increase range of motion and strength. Green Health Acupuncture can develop a personalized program to meet your needs and find a plan to maximize recovery and decrease pain in the shoulder.