Shoulder Pain Treatment by West Midlands Chiropractors and West Midlands Physiotherapists, 3d animated models for (1) Neck Pain and Whiplash, (2) Bulging disc, Cervical disc injury (3) TMJ Temporomandibular Jaw Disorders (4) Rotator Cuff Injury (5) Shoulder Pain and Injury Treatment (they can be found under the listing” Types of Pain” in our Neck and Shoulder Pain Sections). For the management of Shoulder and Neck Pain, here at Central Chiropractic and Physiotherapy Clinic we use the latest Low Level Lasers which provide Pain Relief, this also accelerates recovery, healing and significantly reduces the inflammatory process. A 5 star rating has been awarded to Low Level Laser Therapy, our laser section can be found listed under “Pain Relief”, please also view our “Low level Laser Testimonial Video”.
Shoulder Pain and injuries include;
Frozen Shoulder Rotator Cuff Tendonitis, Bursitis, Rotator Cuff Tear, Shoulder Joint Tear (Glenoid Labrum Tear) Tendonitis, Tennis elbow, Biceps Tendon Tear, Triceps, Trigger finger, Shoulder Dislocation, Shoulder Instability, Collarbone, Scapula Fracture, Cold/Low Level laser Therapy/Treatment. There all listed below.
Frozen Shoulder.
Who gets Frozen Shoulder?
Frozen Shoulder or Adhesive capsulitis is a painful condition mostly affecting people aged 30-70. It is estimated that 3% of population will develop the condition in their lifetime. There is no known racial preference; however, adhesive capsulitis is associated with certain conditions, particularly insulin-dependent diabetes.
Predisposing Factors
There are multiple risk factors predisposing an individual to developing adhesive capsulitis. These predisposing factors may include, shoulder or neck surgery, diabetes, shoulder trauma, inflammatory conditions. Other systemic conditions such as cervical cancer, autoimmune diseases and hypotyriodosm (underactive thyroid) may also to be linked to the condition.
How Frozen Shoulder is Diagnosed
Diagnosis of adhesive capsulitis is made basing on symptoms and on physical examination of the shoulder. The use of Digital X-rays may show abnormalities such as narrowing of the joint and reduced bone density; however in early phases of adhesive capsulitis shoulder joint appearance in Digital X-ray is normal.
Treatment of Frozen Shoulder
Cold/Low Level Laser Therapy is now used in treating this condition and is employed by us at Central Chiropractic & Physiotherapy Clinic. Physiotherapy treatment combined with Cold/Low Level Laser Therapy is extremely effective in reducing both shoulder pain and restricted movement. At present this type of treatment is not available within N.H.S.
Treatment usually combines use of anti-inflammatory drugs to relieve pain and inflammation with intermittent applications of heat and ice packs. Exercises are prescribed to build strength and improve movement and it is important to persist at these because recovery is gradual but slow. In some cases steroid injections into the joint may be needed. In severe cases the affected shoulder may need to be manipulated under anaesthesia before an aggressive rehabilitation program can be commenced.
Probable Outcomes
The residual symptoms of pain or stiffness are often present even after completion of course of conservative therapy. However, functional disability is rare.
Cold/Low Level Laser Therapy (LLLT) is a Handheld, non invasive, light-emitting medical device which is used over different areas of the body. It provides an unmatched advantage in the treatment of conditions such as ,
Frozen shoulder.
Rotator Cuff Tendonitis or Bursitis Therapy and Treatment
The tendons of the Rotator Cuff rotate the upper shoulder bone (humerus) and help raise the arm by pulling the Humeral head down as the Deltoid muscle pulls the arm up. These tendons may be irritated by pressure from the Acromion process of the Scapula (the upper part of the shoulder blade) and the Coraco-Acromial Ligament. This irritation of the tendons or the lubricating Bursa (connective tissue sack) is referred to as “Tendonitis” or “Bursitis”. This is known collectively as the “Impingement syndrome.
The symptoms of Impingement syndrome present not only as pain on movement, but also as constant pain. This can be accompanied by snapping or cracking sensations on movement. Symptoms may start after an injury which may result in a weakening of the shoulder muscles caused by the pain from the injury.
A clinical diagnosis of Impingement Syndrome is made by physical examination, and X-rays. Sometimes an M.R.I. scan is necessary to exclude rotator cuff tears.
Tendonitis
Tendon problems what are they?
Two main problems associated with tendons include Tendonitis and Tenosynovitis. Tendonitis is an inflammation of the tendons-the tough cords of tissue that connect muscles to bones. This inflammation can affect any tendon, but is most commonly seen in the wrist and fingers. As the tendons become irritated, pain and swelling will occur.
Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. Sometimes both the sheath and the tendon may become inflamed. The cause of Tenosynovitis is usually strain, excessive use, or injury. Tendonitis may also be related to diseases such as Rheumatoid Arthritis or Diabetes can be implicated in this condition.
Common tendon disorders include:
Lateral Epicondylitis. (Known as tennis elbow)
This condition is characterised by pain in the back of the elbow and forearm, and along the thumb side of the forearm when the arm is alongside the body when the thumb is turned out. The cause of pain is the damage to the tendons that bend the wrist backwards away from the palm (wrist extensors).
Medical Epicondylitis. (Known as Golfer’s Elbow).
This is a condition characterised by pain from the elbow to the wrist on the palm side of the forearm the pain is caused by damage to the tendons that bend the wrist toward the palm (wrist flexors).
DeQuervain’s Tenosynovitis.
This is far the most common type of Tenosynovitis disorder, when the sheath of the tendons of the thumb become swollen.
Trigger Finger.
A Tenosynovitis condition in which the tendon sheath of one of the finger flexors becomes inflamed and thickens, preventing the smooth extension or flexion of the finger. The finger may lock or suddenly hence the name “Trigger Finger”.
What are the Symptoms of Tendonitis?
The most common symptoms of Tendonitis are:
- Pain in the tendon with movement
- Fluid accumulation, swelling and inflammation
- There may be grating sensation in absence of swelling
Tendonitis Diagnose
Tendonitis is usually diagnosed after careful medical history and physical examination. The diagnosis is established after diagnostic tests have been completed to rule out other conditions or diseases. Joint aspirations may help to rule out gout or an infection, while X-rays may help to rule out arthritis.
Treatment for Tendonitis:
- Modification of your activity
- Splinting or immobilization
- Steroid injections
- Anti-inflammatory medications
- Surgery
Shoulder Joint Tear (Glenoid Labrum Tear) injury Treatment.
Three bones make up the shoulder joint, the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The head of the upper arm bone (humeral head) rests in a socket in the shoulder blade called the glenoid. The upper arm bone called the head is larger than the socket; a soft fibrous rim of tissue rim called the labrum surrounds the socket to help stabilize the joint. This rim deepens the socket, so that the head of the upper arm bone fits better. They also serve as an attachment site for several ligaments. Injuries to the tissue rim surrounding the shoulder socket can occur from acute trauma or repetitive shoulder motion.
Examples of traumatic injury include:
- Falling on an outstretched arm
- A blow to the shoulder
- A sudden jerk, as in trying to lift to heavy an object
- A violent overhead stretch or reach, as in when trying to stop a fall
Symptoms of a Shoulder Tear.
- Pain, in overhead activities
- Pulling locking, cracking or grinding
- Occasional pain with daily activities
- Perhaps a sense of instability in the shoulder
- Decreased range in movement
- Lack of strength
Biceps Tendon Tear at the Shoulder
The tendons attach muscle to bone. The biceps muscle in the upper arm divides into long head and a short heads near the shoulder both attach to the shoulder at different points. At the other end of the muscle the distal biceps tendon connects to the smaller bone in the lower arm called the radius. These connections help the muscle stabilize the shoulder and rotate the lower arm; it also controls the acceleration or deceleration of the arm during overhead motion.
The long head of the biceps tendon is vulnerable to injury because it travels through the shoulder joint to its point of attachment. The tears of the long head of biceps result in arm weakness; this could also affect arm further by being unable to turn the arm from palm down to palm up. Because the torn tendon can no longer keep the muscle taut, a bulge may also appear it eh upper arm. In case of the distal tendon tears the arm is unable to bed at the elbow.
Causes
Ruptures of the distal tendon near the elbow are not common. They usually occur when an unexpected or extreme force is applied to a bent arm.
The proximal biceps tendons ear the shoulder tear more readily. The tears can be partial or complete, more prevalent in people aged 35 or over and in people with previous shoulder injuries.
Symptoms
- Perhaps an audible snap.
- A bulge in the upper arm
- Bruising to the upper arm, down towards the elbow
- Sudden, sharp pain in the upper arm.
- Pain or tenderness at the shoulder
Diagnosis
A Chiropractor will examine the neck, shoulder and arm and ask you to bend the arm and tighten the biceps muscle. This is done to determine the extent of the injury.
Treatment
- Non-surgical treatment is usually all that is needed for tears in the proximal biceps tendon
- ice applications 20 minutes every hour keep down the swelling
- Anti-inflammatory medications, such as ibuprofen will reduce the pain
- Rest the muscle completely
- Flexibility and strengthening exercises will keep the shoulder mobile
- Surgical repair of a complete tendon tear
- Complete tears of the distal biceps tendon require surgery to reattach the tendon to the bone
- Partial tears of the distal biceps tendon may be treated either non surgically or surgically
Triceps Anatomy
The Triceps Brachii consists of three heads: the lateral, medial, and long heads. Triceps joins the Humerus (shoulder bone) and the Scapula (shoulder blade) to the ulna which is the forearm bone. If you working out in gym you must assure you implement Triceps exercises that target all three of the Triceps heads, as this will fully develop the heads of triceps muscle.
In Training the triceps muscles, you must keep a constant tension throughout triceps isolation movements over the full range of motion. It is also imperative to flex the entire triceps muscle by simply extending the arms fully to get the most muscle fibre recruitment.
Shoulder Dislocation
West Midlands shoulder dislocations occur when the head of the humerus which is the upper arm bone, jumps out of the shoulder socket of the scapula, which is called the glenoid. This can happen during severe wrench pulling the shoulder upward or outward, or from combined over-extension and external rotation of the humerus.
Glenohumeral dislocations are generally classified by the direction of dislocation of the humerus.
A dislocation can be full or partial:
- A partial dislocation which also known as subluxation, when the head of the humerus slips out of the socket momentarily and then snaps back into place (socket)
- A full dislocation, when the head of the humerus comes completely out of the socket
Shoulder dislocations are normally associated with fractures to different parts of the shoulder; there may be a fracture and dislocation at the same time. Nerves and blood vessels can sometimes be injured with a severe shoulder dislocation.
Causes
- Falling on an outstretched arm
- A direct or powerful blow to the shoulder area.
- Repetitive sports or activities i.e. throwing or lifting
- Any kind of force applied to an outstretched arm
Symptoms
- Swelling
- Bruising
- Pain, often severe
- Shoulder contour appears abnormal
- Bruising Instability and weakness in the shoulder area
- Inability to move the shoulder
- Bruising Instability and weakness in the shoulder area
- Numbness and tingling around the shoulder or in the arm or fingers
- Seek immediate medical attention.
Shoulder instability
Shoulder instability is a condition in which one of the bones in the shoulder joint moves partially or fully out of place. The head of the humerus, the upper arm bone, moves within the socket of the shoulder in more than one direction. Instability happens when the head of the humerus slips outside its normal position. The classification of this disorder is defined by the changes in degree of movement in the joint and by the change of direction in the movement of the joint.
Dislocation
When the humeral head moves completely out of the socket
Subluxation.
Humeral head moves partially out of the shoulder socket.
- Anterior
when the humeral head moves forwards. This is a very common injury in young men. Men having great shoulder flexibility are more prone to this injury. - Posterior
when the humeral head moves backwards. This is due to severe muscle spasm during an electric shock or epileptic seizure. - Multidirectional
this occurs in people born with loose joints. Muscles contracting and relaxing may trigger a multidirectional instability episode. Also certain sports that require greater shoulder range of motion such as swimming may also lead to multidirectional instability.
Shoulder instability usually results from an old injury producing a dislocation that, even when healed, leads to stretching of the shoulder capsule and ligaments.
Diagnosis
Symptoms of shoulder instability may include:
- Numb feeling down the arm
- Shoulder can slip out of place
- Pain in and around the shoulder area
- Shoulder or arm may feel weak
- Shoulder feels loose. (Slack)
- X-Ray may be needed
- Treatment Options
- Cold/Low Level Laser Therapy: this treatment is excellent for this type of injury reducing the healing time and inflammation. View our section on Cold/Low Level Laser Therapy.
- Rest
- Ice will help control pain
- Nonsteroidal anti-inflammatory drugs These include: aspirin, ibuprofen (Motrin, Advil)
Rehabilitation
Can last several months and may include: physical therapy to strengthen the muscles that control the shoulder joint.
For further in depth information on shoulder pain or conditions please go to top left corner under “Pain” or “Conditions” and “treatments” for Cold laser Therapy.
Collarbone fracture
The collarbone is a part of the shoulder. Its function is to connect the arm to the body. The collarbone sits directly above several important nerves and blood vessels. These vital soft tissues are rarely injured when the collarbone breaks. The collarbone is a long bone, and most breaks occur in the middle of the bone.
Causes
A broken collarbone, or the medical term a fractured clavicle is a common injury. Many babies are born with a broken collarbone this is due to child birth, also to people in contacted sports such as rugby or just general accidents where a fall results in a severe blow or a heavy fall to the shoulder .
The collarbone doesn’t harden until a person is about 21 years old; a child’s collarbone can easily be broken from a direct blow or fall.
Symptoms include.
- A hump or “bump” over the fracture area
- Shoulder hanging down and forward
- Unable to lift the arm due to the pain
- A grinding sensation attempting to raise the arm
Diagnosis
There is always an obvious deformity, or “bump,” around the fractured area. A small amount of pressure over the fracture area will bring about pain. Also, a grinding feeling can be felt when the patient attempts to raise the arm. It’s rare for a fragment of bone to break through the skin; An X-ray is often done to pinpoint the location and severity of the break. Then an assessment should be carried out by a medical trained practitioner.
Nonsurgical Treatment
- Most broken collarbones heal well without surgery.
- A simple arm sling will be used to immobilize the arm. A child may have to wear the sling for 4 to 6 weeks; an adult may have to wear it for 4 to 8 weeks. Depending on the location of the break
- Medications, such as aspirin or ibuprofen, will help reduce pain. But for a speedy recovery see our cold laser therapy section this is under inflammatory conditions on the home page
Scapula Fracture
The scapula is of triangular shape and mobile. It’s also protected by a complex system of surrounding muscles. The shoulder blade or scapula fractures are very rare. Scapular fractures are usually classified at the high end of the impact scale. Falling from a significant height or a major car accident are usually the types of impact that required the scapula to fracture and is usually associated with other major injuries including broken ribs, damage to the head, lugs or spinal cord. Without treatment fractured scapula may result in chronic shoulder pain.
Symptoms
- Abrasions to the skin.
- Swelling at the back of the shoulder.
- Sever pain when moving the arm.
Diagnosis
For appropriate treatment, your Physiotherapist/ Chiropractor will probably need to take X-rays of the chest and shoulder. This can determine if one or more parts of the scapula may be fractured. The parts of the scapula that are prone to fracture are:
- Scapular body
- Scapular neck
- Glenoid
- Acromion
- Coracoid
Treatment
Non-surgical treatment such as sling works for most fractures of the scapula. The immobilization due to the sling holds the shoulder in place while the bone heals. This type of fractures may need 2 to 6 weeks of immobilization.
The shoulder may feel stiff when the sling is removed. You should begin limited active use of your shoulder immediately
