Don't shrug off your shoulder pain

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Shoulder pain can be difficult to shift. Due to the highly mobile nature of the shoulder and the fact that the shoulder has less integrity than many other peripheral joints (ie the muscles of the area are primarily responsible for its integrity), there is increased risk of injury to the structures of the shoulder. The good news is osteopathy can help with many of the symptoms of shoulder injury/dysfunction, and can also help manage the associated pain.

Anatomy
I don’t want to bog you down with too much detail, but there are some interesting facts relating to shoulder anatomy. Firstly, there are four joints in the shoulder complex, but more often than not when we are talking about the shoulder we are principally looking at two. The first is the acromioclavicular joint (the connection of the shoulder blade and the collarbone) and the second is the glenohumeral joint (made up of a shallow depression on the lateral aspect of the shoulder blade and the top of your arm bone). There are 17 muscles that attach to the shoulder blade to both keep it adhered to the ribs and move it in ways that enable it to function appropriately when moving the arm, etc. The four muscles that pass between the shoulder blade and the upper arm are the rotator cuff muscles, and these enable all the fantastic movements that we can do – literally everything from brushing our hair to throwing a ball.

Hence dysfunction of the shoulder blade or muscles of the area can cause immediate problems with movement. And where there is inappropriate movement, generally pain follows not far behind.

Let’s focus a little more on a few of the most common reasons for shoulder pain.

Postural
We often use our bodies repetitively and inappropriately at work. Sometimes this can lead to shoulder and neck pain. For example, holding prolonged postures (for example, sitting at a desk all day) can lead to shortening and chronic contraction of some muscles and lengthening and weakening of others. This often results in muscular pain.

This muscular pain may lead to restrictions in movement and can occasionally irritate the nerves passing through the shoulder and chest that supply the arm. This may cause pain, numbness and/or pins and needles in the arm or hand.

At the Balcombe Clinic we are experts in the assessment of posture and will be able to diagnose the source of your pain and its cause, and provide you with effective treatment to decrease your symptoms.

Rotator cuff
The rotator cuff muscles are the muscles in your shoulder responsible for orientating the position of your arm.  They are very active throughout the day, and are therefore prone to overuse injuries and strains.

Rotator cuff pain will commonly be felt at the front or side of your shoulder. As the shoulder joint relies so much on the rotator cuff for its integrity, imbalance in these muscles can lead to lots of pain, joint restriction and often to night pain. These symptoms are not dissimilar to the early symptoms of a ‘frozen shoulder’. However, the prognosis with a rotator cuff injury is far better.

Despite the complexity at the shoulder, its reliance on muscular balance makes it very responsive to osteopathic treatment.

Frozen shoulder
Adhesive capsulitis commonly known as ‘frozen shoulder’ is a condition that leads to inflammation and adhesions within the shoulder joint. These adhesions lead to shoulder restrictions and pain. Frozen shoulder has three stages, which on average span over 18 months. Osteopathic treatment can help with the pain and adaptions relating to the decreased available movement. Treatment is more likely to work if it the issue arises from associated musculoskeletal conditions of the shoulder and neck, rather than as a truly isolated occurrence. In the case of the latter, it may not be possible to change the longevity or the physiology of the condition.

The good news is lots of more common shoulder issues (which are more responsive to osteopathic treatment) are often misdiagnosed as frozen shoulder. If you are suffering with shoulder pain which has been diagnosed as frozen shoulder it is always worth getting a second opinion.

Moreover, the decreased shoulder movement in a condition like frozen shoulder will cause the muscles of the shoulder to shorten, which in turn will lead to compensation in the upper back and neck and will be likely to increase localized pain. Therefore, it is advisable to have these areas worked on to maintain function and prevent any additional symptoms.

Thoracic outlet syndrome
Thoracic outlet syndrome (TOS) is a condition that leads to irritation of the nerves or compression of the vascular vessels near the shoulder joint causing pain and sometimes neurological symptoms into the shoulder, arm and hand. Altered sensation, pins and needles, numbness, weakness and muscle twitching are all symptoms you want to look out for with TOS.

TOS typically occurs due to mechanical issues such as tight muscles, rounded shoulders and poor posture. Luckily this means that it is responsive to osteopathic treatment. TOS is common due to the sedentary nature of many jobs and the increase in use of laptops, tablets and phones.

Acromioclavicular (A/C) joint
This is the joint between your clavicle (collarbone) and scapula (shoulder blade). There are two main causes of A/C joint pain – impact injuries causing displacement of the clavicle due to trauma to ligaments and/or muscles supporting the joint, or degeneration of the joint itself.

In the event of displacement, it is often advisable to obtain an X-ray to elicit the extent of the problem. Often the advice is to leave the area to heal, although therapy may be needed later to increase functionality and advise on strengthening.

With regards to degeneration and osteoarthritis of the A/C joint, the pain will often be felt on the top of the shoulder and sometimes more widely into the lateral upper arm (deltoid area). Pain will generally be increased with adductive movements (reaching the arm across the body) and/or above the shoulder level. Repetitive use or historical injury are often factors in later presentation of A/C degeneration. Therefore, those who work overhead or repetitively with their arms are often more likely to develop a problem.

Dislocation
In cases of traumatic dislocation it is advised to visit hospital to have the shoulder relocated under X-ray. This helps to avoid any complication with nerve impingement and can rule out any fracture or large labral tear that may have been caused during the trauma.

It is common for patients to experience significant pain in the shoulder region after a dislocation due to the strains placed on the integral tissues. At Balcombe Osteopathy are experts in diagnosing which tissues are leading to pain and can provide effective treatment, and, if necessary, can advise on the rehabilitation needed to relieve any symptoms.

It is common for a shoulder to dislocate more easily after the initial dislocation. Therefore, it is advisable to obtain and practise some shoulder rehabilitation and strengthening. Where necessary, our osteopaths will be able to guide you through, and provide you with, tailored rehabilitation programmes aimed at getting the shoulder back to full function - decreasing any pain and strengthening the musculature to prevent future dislocation.

Other conditions
There are many other common conditions I see frequently that can cause shoulder pain. If you have any pain or restriction in or around the shoulder, then please do get in touch.

It is worth adding that the shoulder is an area that can have pain referred to it from the heart, lungs, gall bladder, stomach etc. Osteopaths are highly trained to screen for any signs of visceral or systemic issues, so you are always in safe hands at the Balcombe Clinic.