Shoulder pain is a REALLY common problem that can arise from many causes. There are actually several joints that make up the shoulder, so shoulder injuries can be quite complex!
Probably the most common source of shoulder pain arises from the muscle tendons and the bursa—the fluid-filled sacs that lubricate, cushion, and protect the sliding tendons near their attachment to bone. The rotator cuff is made up from a group of four muscles and their connecting tendons. Typically, when the tendons tear, the bursa swells and “impingement” occurs. When this happens, it’s very painful to raise the arm up from the side.
The term “strain” applies to injuries of the muscles and tendons and are classified as mild, moderate, or severe (some refer to this as first, second, and third degree tears), depending on the amount of tissue that has torn. Overexertion, overuse, sports injuries, dislocation, fracture, frozen shoulder, joint instability, and pinched nerves can all give rise to shoulder pain.
The diagnosis of what’s actually causing a patient's shoulder pain is often determined by the history of how the injury occurred, or the “mechanism of injury.” This is followed up by measuring the range of motion and performing provocative tests to see which positions bother the shoulder the most. A doctor may use X-rays to assess for fracture/dislocation and an MRI to assess muscle tendon tears, labral tears (a rim of cartilage surrounding the glenoid fossa or cup of the ball & socket joint), and other soft tissue injuries.
People with jobs that require heavy lifting or repetitive pounding (carpenters and jack-hammer operators, for example), who play sports such as football and rugby, and those who smoke, have diabetes, and/or an overactive thyroid are at higher risk of injury. Because the shoulder joint is normally not very stable, MANY people tear their rotator cuff or injure their shoulder during their lifetime. One study found 17% of participants had full thickness rotator cuff tears (as opposed to partial tears). The researchers reported that age was an important determinant, as the incidence of full tears was only 6% in those less than 60 years old vs. 30% in those over 60! So obviously, this IS NOT an injury limited to the younger active person!
Outside of a medical emergency, patients should always try non-surgical treatment options first. Doctors of chiropractic offer the shoulder injury patient a non-surgical option that emphasizes exercise and self-management strategies in addition to manual manipulation, mobilization, and more. The most important message is BE PATIENT as these usually take time to manage, often up to a year.
