The shoulder joint is one of the most commonly injured extremity joints that I treat in my practice. Unlike what most may think, it is not seen in athletes only and crosses the gender and age line. While many rock climbers, avid weight lifters, and fit people used to be the sufferer, today, I see many desk jockeys that suffer from this condition. Before getting into the treatment of the shoulder joint, let’s review the basic anatomy without making this an anatomy session! 🙂
The shoulder joint is where the arm meets the torso! I say this because many refer to the area above the shoulder blade and across the top of the mid back as their shoulders!
The shoulder joint is a ball and socket joint meaning the end of the arm at the joint forms a ball that sits inside a socket from the shoulder blade or scapula. The clavicle or collar bone also meets that joint.
There are tendons attached to the area that are referred to as the rotator cuff. The most commonly injured tendons among the rotator cuff tendons that I treat at my clinic are of Infranspinatus and Supraspinatus muscles. In my practice, I see mostly infraspinatus muscle injuries without any specific trauma. How is that possible? Well, let’s see.
What causes shoulder pain?
Under healthy conditions, one which does not include a sedentary life style, the brain is sufficiently activated by the healthy daily activities and therefore the command to be upright against gravity is sent to the body at all times unless otherwise dictated by the activity at hand.
This command area is located in the middle brain and in fact is the location where the command to breath in and out is (Vegas nerve nuclei). When sitting for extended lengths of time, day in and day out, the demand for the mid-brain to send the upright command goes down. The slouch position means forward flexion of the torso and the rolled forward shoulder. With the “ball” sitting in the socket and centered perfectly, the slouch position demands the ball to be positioned closer to the front of the socket.
This means every time the arm moves, the ball is closer to the front of the socket than it needs to be. A great example to relate to is when shopping, you grab a cart that pulls to one side vs straight.
After a while of fighting this cart, you either get a new one or you will notice the extra work this ‘mis-alignment’ causes on your body.
When the ball is not sitting centered to the socket, the surrounding soft tissue recognizes the imbalance, tries to pull, push, stretch, tighten and do whatever it can to bring the anatomy of the area closer to how it is supposed to be.
Arthritis is commonly seen in the shoulder joint as a result of this long term misalignment. Let me make something very clear! The most common type of arthritis, Osteoarthritis, has nothing to do with age but every thing to do with misalignment of the joint. I so wished they taught us the truth when we went to school!!
You can have an old door hanging straight on its frame and after decades all you see is an aged wood, no wear or tear at the edge of the wood where it hits the frame properly. On the other hand, the same door could be hanging crooked on the frame and it is only a matter of a short while before you start seeing wear and tear at the places where the wood hits the frame. It is NOT the age but the alignment that causes the wear and tear.
In the case of the shoulder joint, the misalignment of the actual joint leads to a decrease in joint space in some parts, improper tone of muscles and tendons surrounding the area which will lead to a tear at the tendon without or hardly any specific incident. It is easy to just play that same volleyball game that now causes severe shoulder pain that later on with MRI reveals a tear of a kind.
After getting the ‘story’ down and then examining to see if the ‘story’ and clinical findings match, I proceed to treat the patient. Many times the ‘story’ does not match the exam findings. Generally the first thing is to rule out any dislocation at the joint or AC joint. Once that is ruled out, if there is still a mismatch of ‘story’ and findings, I may send the patient out to get an MRI scan. MRI is a more expensive test and I don’t wish to have it done unless it is indicated even if the insurance company more than likely will pay for the test.
NOT all positive MRI findings means surgery. Depending on the findings, I find that ART (Active Release Technique) of the specific muscle or tendon provides great relief and increase in range of motion. At times, I may refer the patient to the Ortho, specializing in upper extremity to inject the patient with PRP which is essentially your own plasma having been run through a centrifuge process, concentrated and injected to your joint. Plasma contains the most ‘healing’ cocktail made by your own body so I don’t see a problem with that.
Anything that can cause improvement without the use of a chemical or medication is good in my book. While most claim there is an increase in pain for a few days after this injection, most of those I refer out do not experience pain. After a few days, my work begins! ART, Trigger point therapy, adjustment of the neck, upper mid back, AC joint, and elbow when indicated make up the majority of that work at the beginning.
I may use Cold Laser and/or ultrasound at joint and typically after all work, there is a cooling down process of ice application for about 15 minutes. I start patients with some sort of movement exercise within the first couple of days when indicated.
I am a huge fan of TENS unit which is purely used to diminish pain level. I look at TENS unit as an electronic pain killer and am for it if the alternative is pain medication.
Nutritionally, I recommend an increase in Vitamin C and protein powder to give the body what it needs to heel faster. My favorite type of protein powder is whey protein. A plant-based alternative is pea protein. The unsweetened powders are great for adding to foods like spaghetti sauce.
In the video below, I show how to rehab Infranspinatus and Lateral Deltoid muscles and will be doing one for Supraspinatus muscles soon. If you have not subscribed to my Youtube channel, please do so here and also make sure to like and follow my Facebook page for valuable information that adds to your knowledge about your body and commonly seen problems at my office with prevention in mind.
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