Treatment For Shoulder Pain In Cardiff

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The shoulder (glenohumeral joint) is the most complex joint in the human body. It is the most mobile joint too and can perform many more movements compared to say the elbow. The shoulder is a ball and socket joint and consists of three bones, the humerus, clavicle, and scapula. These three bone work today with a complex network of attachments consisting of muscles, tendons, ligaments, and bursa. With complexity comes the increased chances of pain, injury or dysfunction There are many orthopedic, pain issues of the shoulder which we will go into next.

What causes shoulder pain?

Bicipital/biceps tendinopathy (rehab section):

The biceps is a large muscle and very strong muscle (think Arnold Schwarzenegger curling iron), it is responsible for flexing the arm, turning the hand outward and moving your arm up and forward. The biceps muscle has two heads, the short and long head. It is the long head that can become painful, prone to injury and pain. The biceps tendon can either degenerate or become inflamed or both. Sometimes improper healing can lead to the breakdown of the tissues causing dysfunction of the muscle/tendon and affect how the shoulder moves. This condition occurs mostly in the 18-35 population but does happen in later years. Overhead activities like badminton, gymnastics and throwing sports can initiate this painful condition. Up to 90% of biceps tendinopathy occurs due to shoulder impingement. Impingement is the narrowing of the space between the acromion and the humerus compressing structures in the shoulder girdle. Bony changes and growths can cause impingement but more common in the 4th and 5th decade. Often surgery is needed to remove the bone. Poor posture, repetitive loading, inflexibility, and smoking are also some of the causes of bicipital tendinopathy.

Signs and Symptoms: Are commonly reported as a dull, throbbing and or a deep ache. Pain maybe be felt on the deltoid muscle (top of the outside of the shoulder) and can radiate down to the hand and sometimes fingers. Sleeping on the affected side can cause more pain affecting sleep. Overhead activities can aggravate the pain and is a sharper pain. Care needs to be taken during the examination to rule out a dislocation of the tendon or rupture (full tear). Normally a pop eye sign would be evidence that shows a bulge on the lower part of the biceps muscle when a full rupture has occurred. Diagnosis can be tricky, an x-ray may show a bony outgrowth but that does not necessarily mean that is the issue causing the pain. Sometimes the pain may be coming from the cervical spine, an issue deeper in the shoulder, an infection, frozen shoulder or instability of the shoulder. An ultrasound would show up inflammation or irregularities of the tendon. An MRI would show tears and the structure in more detail. Often the rotator cuff muscle can be causing pain and dysfunction along with the biceps tendon.

Treatment and management of biceps tendinopathy: Conservative manual treatment is the first port of call. The aim is to reduce pain while slowly over time increasing mobility, stability, and strength. Home ice can be used as an added pain relief. It is advised to limit repetitive loads and strain in the short term to rest the tendon to allow it to heal. We have multiple treatments for pain relief like acupuncture, manual stretching, percussion massage, shock wave therapy, cross friction therapy, IASTM, and sports tape. Rehab will be given to the patient to improve movement. Certain gym exercises would also be advised against, to avoid further injury and aggravation.

A/C Acromioclavicular Sprain:

The A/C joint connects the clavicle (collar bone) to the top part of the scapula called the acromion. It is held together by fairly tough but loose connective tissues (inferior, superior, posterior, anterior, and AC ligaments.). Sprains of any kind are graded 1-3. A grade one is an overstretch of a ligament or tendon with no tear. Grade 2 is an overstretch with some tearing. Grade 3 is a full tear. For an A/C joint injury there is a Rockwood classification that describes the 6 classifications of injury and the effects on the different parts of the anatomy. You can read those here. A/C injuries are more common in athletes competing in contact sports. Men are affected more than women. An A/C injury can occur falling onto the shoulder with the arm and out to the side (abduction), this sheers the joint at various velocities with varying degrees of damage.

Signs and Symptoms of A/C sprain: Pain and swelling are common with an A/C sprain. The trapezius muscle may also hurt all of which at the top of the shoulder. Certain movements like dips, rolling over in bed onto the affected side and bench pressing may aggravate the condition. If the clavicle is showing more prominently than the other side then dislocation is suspected and referral is made for imaging. Tests in the clinic here in Cardiff will give us a good indication of the severity of the A/C injury and whether or not conservative treatment and management are suitable. Part of the treatment would be to ask a patient to avoid certain movements while the shoulder heals. Passive care would be used to help increase the range of motion of the shoulder within the patient's pain tolerance. Certain movements would not be performed to avoid further injury. The A/C joint is an essential part of the shoulder and it's function. Pain reduction is initiated first, then increasing its range of motion and then strength. Healing times can vary depending on the grade of injury, 10-64 days is the standard healing time for an A/C injury.

Adhesive capsulitis AKA Frozen Shoulder:

Frozen shoulder is one of the most painful shoulder conditions there is. Frozen shoulder is a gradual painful limitation of the shoulder joint. Primary frozen shoulder is still a grey area and no cause as of yet has been found. Some speculate it could be a bacterial infection. Secondary frozen shoulder is thought to be caused by immobility of the shoulder through either injury or bed (5-9 increased chance) rest from illness. There is also a link with diabetes.

There are four stages of frozen shoulder:

Stage 1: Precursor phase, pain is present especially with end range movement, inflammation is present in the joint capsule of the shoulders

Stage 2: Known as the freezing phase, pain is more severe and the shoulder range of motion is markedly restricted. The proliferation of inflammation in the structures of the shoulder is present and new nerve growths may be a factor for the increase in pain levels.

Stage 3: This is the frozen phase where the pain is still severe and the capsule is thickening, greatly limiting the shoulder range of motion. Care needs to be taken as muscle wasting can occur with the lack of movement. Frozen shoulder can be very debilitating and makes simple tasks like getting dressed very difficult.

Stage 4: This is a thawing phase, pain levels reduce and the shoulder range of motion starts to improve. It can sometimes take 2 years to get to this point and another 9 months for full resolution.

Signs and Symptoms of Frozen shoulder: Frozen shoulder affects women more than men and usually at the age of 40-65, there are higher instances in Asian populations and people with type 1 and type 2 diabetes. Symptoms can range in severity, sleeping on the affected side can cause night pain, women report trying to put a bra on impossible, cooking, driving and reaching for items out of a kitchen cupboard very painful.

Treatment and management of frozen shoulder: The main aim of treatment here in Cardiff is to reduce pain and try to normalize the shoulder range of motion. We use acupuncture, deep tissue work, stretching, home advice, and gentle manipulation to help relax the shoulder. One thing to remember is that frozen shoulder is over-diagnosed, which means misdiagnosed. Many conditions can cause similar pain as frozen shoulder such as osteoarthritis, rotator cuff dysfunction, neck pathology, infection, and fibromyalgia. An MRI is the best imaging technique to diagnose frozen shoulder but x rays should also be taken in cases where there is no improvement to rule out anything potentially dangerous. Steroid injections are given for severe pain with varying results and surgery is also an option for cases that are not improving.

Osteoarthritis (OA) of the shoulder:

Creaky, stiff and painful, this is how many patients who have osteoarthritis describe their symptoms when they come to our clinic in Cardiff. OA affects many joints of the body and is the natural wear and tear of the joint cartilage the cushions the joint surfaces. Stiffness is one of the first symptoms to appear followed by pain and dysfunction. From the age of 40-50 symptoms can start to present themselves. Inactivity and obesity is an accelerating factor of OA in the shoulder. Some cases will need surgery but if managed in time then manual treatment can make large improvements in pain levels and shoulder function. Care needs to be taken to rule out any other arthritis that could potentially damage the shoulder, this includes ruling out an infection and any relationships to organ health as many dysfunctional organs can refer pain to the shoulder. Manual treatments such as shoulder manipulation help restore normal function, as too the home exercises given to help manage it themselves.

Thoracic Outlet Syndrome (TOS):

TOS affects the upper limb nerves, veins, and arteries. It can occur on one arm or both. Most cases are neurological where people will feel pins and needles, loss of sensation and a sense of weakness. It is important to rule out compression of the arteries and veins with TOS. A cervical rib can compress the arteries and veins causing damage and dysfunction. Stenosis of the cervical spine can also cause these problems and a tumor which are all relatively rare. Poor posture is a driving factor for neurologic TOS. The first ribs, pectoral muscles, and the scalene muscle can put too much pressure on the nerves causing an altered sensation. There is a large group of nerves exiting the neck called the brachial plexus, these are the nerves that can become compressed causing the TOS symptoms. Here in Cardiff, we see many TOS cases. Ages range from 20-40 and occur in women more than men 9:1. Office workers who constantly slouch can be affected, people with a naturally slouched posture are predisposed. Large breasted women also due to the shoulders rounding over time causing compression. Symptoms, as mentioned, are motor weakness, pins, and needles, feeling cold in the hands especially the outer fingers. We often find poor movement in the thoracic spine and cervical spine does not help with this condition. Treatment involves taking a thorough case history and examination. If there are signs and symptoms that bring up red flags then a referral is made to another professional.

Treatment and Management for TOS:

Treatments help by increasing thoracic, cervical and shoulder mobility. Neurodynamic movements that help free up the nerves to reduce the altered neurological sensations. Posture and specific movements are also given to help the patient self manage. Spinal manipulation has great effects on the function of these joints. Most cases are simple to treat but self-care needs to be sustained for long term relief. When the pain goes away then too does the home care in many cases.

Rotator Cuff Tendinopathy:

As we mentioned, the shoulder is a highly mobile joint, unfortunately, we sacrifice stability for mobility. The rotator cuff is made up of four muscles, supraspinatus, infraspinatus, subscapularis, and teres minor (SITS muscles acronym). Most rotator cuff issues are injury-related from either pulling, throwing, lifting or pushing. It can be age-related, obesity-related and health-related. People with high cholesterol are predisposed to rotator cuff dysfunction as to with diabetics. Many rotator cuff issues are due to impingement and cause a break down in the cellular structures of the tendons. The supraspinatus muscle/tendon is usually affected first. Tears are also more common in the supraspinatus muscle from repetitive motion and overloading. Weightlifters, carpenters, window washers, car cleaners and really any job or sport that requires repetitive actions with little break. It affects the dominant arm in most cases. Patients find moving their arm in certain directions increases pain, especially with weight. Pain can range from a deep ache to sharp pain. Loss of function may indicate a partial or complete tear of one of the SITS muscles. Conservative care trumps many other treatments or surgeries, rest is important but its the actual progressive loading that wins the day. Too much rest will promote thicker tissues that become weaker. Loading help rebuilds the tendon and improves the function of the shoulder. Our chiropractic treatment in Cardiff help reduce pain, increase mobility and given the right exercise dose to restore function to the shoulder.

How can chiropractic help shoulder pain?

If you have read through the different conditions of the shoulder then I hope you have gained valuable information for you to take the next steps. If you are not a shoulder pain sufferer then you can point someone who does in the right direction. Chiropractic focuses on a whole-body approach. Treating just a symptom has poor results. We aim to always deep dive into a person's pain and well-being. There are many causes of shoulder pain, sometimes we can get the diagnosis wrong due to the large overlap of shoulder conditions and their signs and symptoms. The key is to know if we can treat it or if we need to refer to another professional. We help shoulder issues by using many of our treatment modalities to reduce pain, increase mobility and strengthen the shoulder girdle.

How long will it take for my shoulder pain to feel better?

We all heal at different rates. If the elbow pain is chronic then it will take a little longer. Most people start feeling pain relief after 2-3 treatments. With chronic issues 5-8 sessions. Home care is just as important as the treatment we provide in the clinic.

What can I do to help my shoulder pain?

Ice and heat may be of benefit which is a safer alternative than pain medication. Rest in small doses and strengthening seems to be the best option with the current research. It’s advisable to not sleep on the affected side to avoid aggravating the shoulder. Reducing some of the motions that caused pain in the first place is beneficial but sometimes not realistic. Always seek a professional for the right exercises.

How much will it cost to treat my shoulder pain?

We are not the most expensive, neither the cheapest. We invest a lot into Corbin chiropractic so our prices reflect this. Click here to see our fee schedule.

How can I make an appointment for my shoulder pain?

We have multiple ways to book. Send us an email at health@corbinchiropractic.co.uk

Book online here.

References:

1. https://healthengine.com.au/info/shoulder-pain#Statistics

2. https://www.sciencedirect.com/science/article/pii/S074980631001056X

3. https://europepmc.org/article/med/3342572

4. Rockwood CJ, Williams G, Young D. Disorders of the acromioclavicular joint. In: Rockwood CJ, Matsen FA III, editors. The shoulder. 2nd edition. Philadelphia: WB Saunders; 1998. p. 483–553.

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174051/

6. https://www.tandfonline.com/doi/pdf/10.3109/ort.1969.40.suppl-119.01

7. https://www.aafp.org/afp/2008/0901/p605.html

8. Fugate, Mark W.; Rotellini-Coltvet, Lisa; Freischlag, Julie A. (2009). "Current management of thoracic outlet syndrome". Current Treatment Options in Cardiovascular Medicine 11 (2): 176–83.

9. https://www.thoracicoutletsyndromes.com

10. Kibler WB. Rehabilitation of rotator cuff tendinopathy. Clinics in sports medicine. 2003 Oct 1;22(4):837-47.

11. https://www.jospt.org/doi/abs/10.2519/jospt.2006.2146

12. https://www.sciencedirect.com/science/article/abs/pii/S0268003310002214

13. https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620x.74b1.1732247

14.https://journals.lww.com/clinorthop/Fulltext/2000/03000/Adhesive_Capsulitis__A_Treatment_Approach.12.aspx

A 3D render of bicipital tendinopathy.jpg

The above image shows an x-ray of an arthritic shoulder. You can see the narrowing of the joint space which is responsible for stiffness.

The above image shows an image of bicipital tendinopathy. Pain is located high on the front of the shoulder. Moving your arm up and forward can aggravate this condition.