Shoulder pain: What is it and what can you do about it?|
The shoulder joint in the body allows the greatest range of motion of any joint in the body, hence it is the most unstable joint in the body and also the most prone to dislocation.1 Although numerous ligaments are attached to the joint, they provide little stability and only provide minimal strength to the joint. Most of the strength of the joint is due to a group of muscles called the rotator cuff muscles surrounding the joint. Because the inferior part of the joint do not have any rotator cuff muscles, it is the weakest area and likeliest area of injury.1
A recent study found that a minimum of one third of people suffering from shoulder pain and experience some restriction in their daily activities for at least one week do not visit a general practitioner or physiotherapist. The symptoms of shoulder pain may also persist for up to one year in 40% of patients.2 Shoulder problems usually cause pain which extends from the neck to the elbow.3
Apart from increasing age, factors that increase the risk of having shoulder pain include the lifting of heavy loads, doing the same movement repeatedly in an awkward position and prolonged elevation of the arm.2,3,4 Occupations that require constant lifting of the arms include construction work and hairdressing, both of which increases the risk of shoulder pain. Some psychosocial factors can also cause shoulder pain.4 Shoulder pain may also follow a stroke.5
The causes of shoulder pain fall into three categories, shoulder joint problems, muscular pain, and referred pain from the cervical spine or diaphragm.3
Shoulder joint problems include adhesive capsulitis (frozen shoulder), rotator cuff disorders, acromioclavicular joint pain. Rotator cuff disorders are associated with an unstable shoulder joint, excessive overloading, degeneration of the rotator cuff with increasing age, and musculoskeletal diseases that cause rotator cuff muscle wasting.5 Other causes include impingement syndrome, inflammation of the biceos tendon, bursitis, osteoarthritis and rheumatoid arthritis.5,6
Shoulder dislocations commonly involve significant trauma. In younger patients, dislocation of the shoulder is due to direct trauma or sports injuries. In elderly patients, falls are usually the cause of dislocation. A significant majority of shoulder dislocations are anterior, and patients often present with a slightly abducted arm and reluctance to move the affected arm.6 A dislocated shoulder joint may also present with swelling and muscle wasting.3
Dislocation problems usually occur when the ball at the top of the bone (head of the humerus) in the upper arm pops out of the socket. This happens more often if the shoulder is twisted or is pulled very hard.
Many studies have found chiropractic treatment to be favourable for the treatment of upper extremity conditions such as shoulder dislocation.7 Treatment of shoulder pain is usually multimodal and may include spinal manipulative therapy of the spine or periphery ultrasound, mobilization, splinting, soft tissue massage, and stretching.7,8
Dislocation of the shoulder may also happen more than once. This happens more in young, active people.6 Once the dislocation injures tissues or nerves around the shoulder, surgery may be needed. Hence, visiting a chiropractor may be beneficial in relieving shoulder pain.
Please seek an allied health professional if you are suffering with shoulder pain and/or stiffness.
- McKinley MP, O’Loughlin VD, Pennefather-O’Brien E, Harris RT. Human anatomy. 4th ed. New York, NY: McGraw-Hill Education; 2015.
- Brox JI. Regional musculoskeletal conditions: shoulder pain. Best pract res Clin Rheumatol [serial online]. 2003 [2016 Sep 7];17(1):33. Available from: Science Direct. http://www.sciencedirect.com/
- Warren E. Shoulder pain soft tissue trouble is the cause of most shoulder pain, two common problems being adhesive capsulitis (frozen shoulder) and rotator cuff disorders. Acromioclavicular joint pain is usually the result of injury. Pract Nurs. 2008 [2016 Sep 7];36(6):32. Available from: General OneFile. http://find.galegroup.com
- Mitchell C, Adebajo A, Hay E, Carr A. Shoulder Pain: Diagnosis And Management In Primary Care. BMJ: Br Med J. 2005;331(7525):1124-8. doi: 1136/bmj.331.7525.1124
- Murphy RJ, Carr AJ. Shoulder pain. BMJClin Evid [serial on the Internet]. 2010 [2016 Sep 7];2010. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217726/
- Ramponi DR. Shoulder pain. Adv Emerg Nurs J. 2011;33(2):114-26. doi: 10.1097/TME.0b013e318217c983
- McHardy A, Hoskins W, Pollard H, Onley R, Windsham R. Chiropractic Treatment of Upper Extremity Conditions: A Systematic Review. JManipulative Physiol Ther [serial online]. 2008 [2016 Sep 7];31(2):146-59. Available from: ScienceDirect. http://www.sciencedirect.com/
- Pribicevic M, Pollard H, Bonello R. An Epidemiologic Survey of Shoulder Pain in Chiropractic Practice in Australia. JManipulative Physiol Ther [serial online]. 2009 [2016 Sep 7];32(2):107-17. Available from: ScienceDirect. http://www.sciencedirect.com/
- Longo UG, Denaro V, Huijsmans PE, Maffulli N, De Beer JF. Video analysis of the mechanisms of shoulder dislocation in four elite rugby players. J Orthop Sci. 2011;16(4):389-97. doi:
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should contact your own physician or other qualified health can provider with any questions you may have regarding your condition. Do not disregard professional medical advice or delay seeking it based on information from this content. Relying on information provided by this content is done at your own risk. Although the authors have made every effort to provide the most up-to-date evidence-based health information, this content should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations.