Shoulder pain, likely causes and treatment

​As chiropractors, we very often encounter patients suffering from pain in the shoulder.  Finding the source of this pain can be quite challenging, as there are so many different potential causes that may be local to the shoulder region itself, or caused from referral from other parts of the body.

Shoulder complaints don’t have to be due to a single traumatic event such as a fracture, dislocation, or rupture of a tendon.  Repetitive strain and overuse in sports such as weight lifting, swimming and throwing can all be sources of shoulder pain.  In a work place setting, where there is need for over head lifting, there is also the risk of chronic shoulder injury.

​One of the most common causes of shoulder pain is inflammation of the tendons and tissues that support the shoulder joint itself, the rotator cuff muscles (terms such as tendinitis, bursitis, frozen shoulder or joint capsule sprain may sound familiar).  These soft tissues are susceptible to Ltrauma, for example a fall on an out stretched arm, overuse and repetitive strain.

Poor posture with rounded shoulders and slumped spine has been found to increase the risk of damage to the shoulder tendons due to the increased stress on these tissues during shoulder movement.  The elderly are at particular risk of this due to the increased incidence of hyperkyphosis (increased thoracic spinal curve).

Another common cause of shoulder pain is referral from the neck.  Cervical spine dysfunction can very often result in shoulder pain.  This may be due to dysfunction of the joints of the spine, muscular referral, or nerve root compression or entrapment.  A careful history must be taken by your practitioner to ascertain if there is involvement of this area.

It is also important to be mindful of potentially serious causes of referred shoulder pain such as gall bladder, diaphragm, heart or lung disease, and infection or tumour.

In the absence of fracture, dislocation, infection or tumour, all other shoulder disorders may be managed with conservative therapy unless otherwise indicated.

Careful assessment of the spine, the shoulder joint itself, and the supporting muscles, ligaments and tendons is needed to determine potential involvement.  Treatment can include chiropractic adjustments to the spine to restore movement and improve posture, soft tissue therapy to hypertonic and/or inflamed tissues, and ice therapy.  An exercise program to encourage healthy repair and recovery of these tissues is often integrated into the treatment regime.

It is recommended that a conservative approach be used for 6 months before referral for special imaging and /or surgical intervention is indicated.

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by Dr Emma Wilkinson