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 Shoulder
Pain
MARC
DARROW, M.D.
The
shoulder is really a combination of several joints, combined in such a way by an
intricate arrangement of muscles and tendons, that provides the arm a wide range
of motion, flexibility and stability.
The
rotator cuff is a group of four shoulder
muscles that surround the top of the upper arm bone, the humerus, and holds it
in the shoulder joint. These muscles are responsible for moving the arm in
various directions, and unlike the massive deltoid muscle of the upper arm, are
smaller and generally more vulnerable to injury. The four muscles and tendons of
the rotator cuff are the
supraspinatus,
infraspinatus, teres minor, and
subscapularis. It is the supraspinatus that is most commonly inflamed or torn.
The supraspinatus, and the rest of the shoulder, because they are built and
expected to allow a remarkable array of motion, frequently are subjected to
injuries, causing problems of instability or impingement of soft tissue and in
pain. The pain may be constant, or may occur only when the shoulder is moved. In
any case, any
 shoulder
pain that persists more than a few days should be
diagnosed and treated as necessary.
Shoulder Inflammation
In the shoulder this is often an inflammation of the tendons as a result of the
wearing process that takes place over a period of time. It can also occur from
an unusual, awkward movement or fall.
Sometimes, excessive use or injury of the shoulder leads to
Inflammation and
swelling of a bursa, a condition known as
bursitis. Bursas are fluid filled sacs
located around the body and joints. They lessen the friction caused by movement
of the shoulder. Bursitis often occurs in association with rotator cuff tendinitis. Symptoms of shoulder bursitis include mild to severe pain, limiting
the use of the shoulder. In extreme cases the joint stiffens into a condition
known as "frozen shoulder," also referred to by doctors as adhesive
capsulitis.
Shoulder Impingement Syndrome
Shoulder impingement syndrome involves one or a combination of problems:
inflammation of the bursa located just over the rotator cuff, inflammation of
the rotator cuff tendons, (tendinitis), or calcium deposits in tendons—called
calcific
tendonitis, (caused by wear and tear or injury.) The main problem is
usually that the acromium or a bone spur puts pressure on the supraspinatus
tendon.
Chronic Shoulder Instability Syndrome
Chronic shoulder instability syndrome results from trauma caused by subluxations,
dislocations, from less detectable micro-trauma caused by repetitive strain on
the tissues, or from congenitally loose shoulder joints. Recurrent pain or
tenderness in the shoulder joint and weakness in the arm are two of the more
common symptoms, but severe examples include patients whose shoulders pop in and
out of joint. Frequent shoulder dislocations stretch the brachial plexus, the
nerves that run from the neck down the arm. This process can cause permanent
nerve damage, pain, and loss of use of the arm.
Shoulder Dislocations
Sometimes the bones in the
shoulder
joint slip out of normal alignment or are forced out by injury, a condition
known as subluxation—if partial in nature, and dislocation—if completely out of
joint. Most shoulder sprains or, more seriously, dislocations happen when a
person falls on an outstretched hand or sustains a blow to the shoulder
(especially a downward blow). Approximately 95% of shoulder dislocations are
anterior dislocations, in which the anterior static shoulder stabilizers are
stretched or torn away from the bone.
Until recently it was common in cases of dislocation to immobilize the shoulder
for long periods of time. But studies proved that while immobilization helped
alleviate the pain of such injuries, it also contributed to a general weakening
of the
ligaments and predominance of adhesive capsulitis. In one alarming study
of close to 250 patients, about half of those treated with immobilization had
recurring dislocations within the 10 year period of the study. The problem is
greater in younger people. This is one of the few areas where older folks have
an advantage; because their
connective tissue are less elastic, the risk of
dislocation is less likely.
Shoulder Arthritis
There are many types of
arthritis, but most often in the shoulder, it is
triggered by an initial trauma. It can also involve "wear and tear" of the
tissues of the joint, causing
inflammation,
swelling and pain.
Often people will react by instinctively limiting their shoulder movements in
order to lessen the pain. This can lead to a tightening or stiffening of the
soft tissue parts of the joint, resulting in yet further pain and restriction of
motion. In the worst cases, adhesive capsulitis occurs and the arm can not be
moved.
Referred Pain
The musculature of the shoulder area is fertile ground for
trigger
points,
as is
evidenced by the prevalence of a "stiff neck" and referred pain
radiating anteriorly, laterally or posteriorly from all three of the major
scalene muscles into the arms, chest or vertebrae. Trigger points from the
trapezius muscles can refer pain to the head and down the arms.
Okay, You Know About The Problems and Pain, Now What?
A proper diagnosis of shoulder pain is essential to determine the root cause of
the problem and the proper method of treatment. Because many shoulder conditions
are caused by specific activities, a detailed medical history is an invaluable
tool. A physical examination should also include screening for physical
abnormalities—swelling, deformity, muscle weakness, and tender areas—and
observing the range of shoulder motion—how far and in which directions the arm
can be moved.
Since it's been proven to strengthen the connective tissues, and has the benefit
of over fifty years of testing to back it,
Prolotherapy is arguably one of the
best choices of treatment in cases of dislocation,
rotator cuff tendonitis,
muscle tissue impingement or recurring instability.
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