Chiropractors often find that in cases of arm pain, injuries to muscles, joints and ligaments in the neck are often overlooked. It is very common to have referred pain from these structures causing pain in the arm. Positions and activities that strain muscles repetitively are likely to result in an insidious (slow and unknown) onset of wrist or forearm pain such as carpal tunnel syndrome or lateral epicondylitis (tennis elbow). Constant overuse or micro trauma can go unnoticed on a daily basis. If you go to the gym, play racket sports, use a computer, play musical instruments or even text on a mobile phone enough, then overuse is a likely cause of pain.
Arm Pain due to poor posture
One of the most common postural distortions is that of forward head and forward shoulders. This shift of posture causes muscular tension in the shoulders and the neck having to cope with the weight of the head (the average head weighs as much as a bowling ball!). This change in posture causes misalignment of the neck bones (subluxation), a straightening of the normal curve of the neck and actually stretches and puts tension on nerve roots which can cause referred pain into the arm, causing a deep ache that often gets worse as the day goes on. By the time a patient experiences shoulder, arm or hand pain or numbness and tingling, the postural distortions have likely been present for a year or more. One incident like a sneeze, reaching overhead or “sleeping wrong” is often simply the proverbial last straw.
Referred Pain from the Neck
Subluxations from the neck can put pressure on the delicate nerves that exit the spine and travel down your arms causing shoulder arm and hand pain or even tingling and numbness. We sometimes call this a pinched nerve because it actually feels like something is being pinched causing shooting pain that spreads down the arm into the hand and fingers. Left untreated the nerve can become damaged causing weakness and atrophy in the hands or arms. It is one of the most common co-existing causes of shoulder pain seen in chiropractic practice. [Video Animation]
Frozen Shoulder is commonly used to describe any persistent shoulder pain and restricted movement. This is not the same as a rotator cuff tear even though patients often assume because they have restricted shoulder range of motion and pain that it must be a rotator cuff tear. Shoulder problems can be complex and are notoriously difficult to treat because patients with longer term shoulder injuries go without treatment and their body begins to compensate for the loss of motion, often over-working accessory muscles leading to additional mechanical problems and soft tissue injuries.
Frozen shoulder, or “adhesive capsulitis” to give it the medical term, refers to loss of arm movement at the shoulder joint combined with inflammation of the tissues within the joint capsule that surrounds the shoulder and is often accompanied by a great degree of pain during even the slightest movements. These tissues become thickened and shortened and eventually ‘stick’ together, hence the medical term – adhesive capsulitis.
What are the symptoms?
There are three stages:
“Freezing Phase” Initially, there is progressive limitation of all movements of the shoulder. This may follow a recent minor trauma, dislocation, prolonged immobilization, heart attack (myocardial infarction) and sometimes neck problems (cervical radiculitis). Pain may or may not accompany this, although pain will be felt if you try to exceed the limited movement. This phase can last anywhere between 2 and 9 months.
“Frozen Phase” As the fluid in the joint becomes thickened there may be more pain and eventually, the condition progresses until all movement is greatly restricted. This phase can last from 4 to 12 months.
“Thawing Phase” As the inflammation begins to subside so does any pain experienced. During this phase movement in the shoulder begins to gradually return but may or may not recover 100% if left untreated. This phase characteristically lasts between 6 to 9 months.
Early diagnosis is vital because the condition is reversible, but as stated above, can become more complicated due to compensation the longer it is present. Once it has progressed into the adhesive/frozen stage, some persistent restriction may remain. The recovery period varies depending on how long the problem has been there and the severity of it. It is not uncommon for it to take up to 6 months to recover with treatment and up to 12-24 months without treatment. But as other shoulder problems are often labelled ‘frozen shoulder’, it is important to have your shoulder examined for an accurate diagnosis and treatment to be given.
“Here is a video that shows how spinal subluxations can inhibit proper shoulder motion.”
Rotator Cuff Tendinitis
The rotator cuff muscles play an important role in the movement of the shoulder. They consist of the supraspinatus, infraspinatus and teres minor muscles. The rotator cuff tendon is a major source of pain and disability. If it becomes inflamed (tendonitis) or torn; voluntary abduction, elevation and rotation of the shoulder is lost. However, the chiropractor will be able to move the shoulder noting only a slight loss in movement due to pain. Whereas with frozen shoulder, the chiropractor will not be able to move the joint. Rotator cuff muscle pain is usually due to trauma or overuse movements.
Bursas are fluid filled sacs that surround certain joints of the body and act to prevent excess friction between tissues and/or bony surfaces. In the shoulder, you will find the sub-deltoid bursa that lies underneath the deltoid muscles. (These muscles make the rounded shape of the shoulder/arm). The bursa can become inflamed (bursitis) or pinched which in turn will produce pain and some limited movement of the shoulder. Slight swelling and heat production may be felt.
Shoulder Impingement syndrome
Impingement syndrome, occurs when there the structures between the top of the humerus (arm bone) and the acromion (tip of the shoulder) become inflamed. This often occurs as a result of repetitive trauma of the tendon and bursa from raising the arm above shoulder height repeatedly, but can also be caused by walking with crutches or falling onto an out-stretched arm. Between these bones lies the tendons of the rotator cuff muscles and the bursa that protects these tendons. The structures most commonly affected are the supra-spinatus tendon (part of the rotator cuff) and the bursa that surrounds these tendons. Impingement syndrome occurs when these structures become inflamed and thickened. The best terminology for this problem is ‘impingement syndrome’. Muscle imbalance from over use of one group of muscles or poor posture are the most common causes of impingement syndrome
Common symptoms include:
Pain with lifting the arm sideways away from your body and up (abduction), activities above shoulder height. The painful arc is between 80-120°.
Pain while sleeping at night
Pain over the outside of the shoulder/upper arm
Impingement syndrome and a rotator cuff tear are different problems, and although they are related, the treatment is different.
Impingement syndrome is a problem of inflammation around the rotator cuff tendons. A rotator cuff tear is an actual tear within the tendons. The best sign that differentiate these problems is the ability to resist load of the rotator cuff muscles. Your Chiropractor will be able to specifically isolate these muscles to determine if a rotator cuff tear is present and which part of it has been injured. Once the problem has been diagnosed the chiropractor can start to give advice and start the treatment.
Don’t wait! Early chiropractic treatment can make all the difference between a quick recovery and longstanding and chronic pain.
Treatment of shoulder issues may include physiotherapies such as ultrasound, electric muscle stimulation, manipulation, deep trigger point therapy or myofascial release and ice or heat or even acupuncture. Spinal adjustments to the neck, specifically C5-T1 are important as well because the nerve supply for the shoulder, arm and hand is supplied from these nerve roots originating in the neck, and any down regulation in nerve supply should be addressed. There are many different ways to adjust the spine and shoulder. The techniques used will always be customized to your comfort level and needs.