Have you experienced shoulder pain? Maybe you “tweaked” your shoulder from a strange sleeping posture or have soreness from taking up a new exercise activity or class in the gym. Most people are familiar with the shoulder as the joint connecting the upper torso to the arm. We use our shoulders every day for almost every single activity we do, and when we have shoulder pain, it’s a challenge to ignore. To understand shoulder pain, we begin with a review of how the shoulder works and functions in the human body.
What is the shoulder?
The shoulder is a complex structure involving the joint, several bones, ligaments, connective tissues, a matrix of muscles, and fluid-filled sacs designed to absorb forces. Shoulder performance is drastically affected if one or more of these structures are injured, damaged, or otherwise unable to work properly!
The joint of the shoulder is a ball-and-socket joint. [This means a bony (osseous) ball is nestled in a cup-like shape of another one. The shoulder joint is made by the connection of the humerus, or the arm bone, in a shallow socket known as the glenoid fossa. The glenoid fossa is part of another bone called the scapula, more commonly known as the shoulder blade.
Inside the glenoid fossa is a suction cup or plunger-like structure, the labrum. This rim of fibrocartilaginous tissue helps keep the bony part of the arm bone right where it needs to be – inside the socket.
In the front of the shoulder lies the clavicle, also known as the collar bone. The outer part of the clavicle connects with another part of the scapula called the acromion, creating the acromioclavicular joint. You may know this structure as the “AC joint” for short, and it is commonly injured during sporting events involving contact sports like football.
The sternoclavicular joint is the other inner end of the clavicle. This joint sits at the bottom front of your neck and chest, where the collar bone connects to the breastbone (sternum).
Around the shoulder bones is a complex arrangement of muscles, tendons, and the glenohumeral shoulder joint itself, lending to the versatility of the shoulder to engage in elevation, rotation, scaption, and other ranges of motion.
What about the muscles? Our shoulder muscles help provide much-needed support to the bones and joints. The primary shoulder muscles are known as the rotator cuff. Rotator cuff muscles also have tendons that connect muscle to bone, giving the shoulder its wide range of motion and providing further stability for the joint. These are:
- Teres Minor
The rotator cuff also recruits other muscles around the upper back, neck, ribs, and shoulder regions for assistance:
- Trapezius is a thick muscle that extends down the spine and across the back of the neck and shoulders into the arm.
- Serratus anterior spans the first eight ribs and helps elevate the scapula, such as throwing a punch.
- Deltoid is a large, triangular muscle spanning the glenohumeral joint and is shaped like a shoulder pad.
- Pectoralis major is located along the front of the chest and connects the collarbone to the middle of the chest region.
- Rhomboid major connects the second, third, fourth, and fifth vertebrae to the scapula.
Other supportive muscles of the shoulder include the biceps brachii, known as the biceps, the latissimus dorsi, pectoralis minor, and triceps.
The shoulder joint also has several fluid-filled sacs called bursae to absorb friction, a joint capsule with excellent flexibility, and a matrix of connective and supportive ligaments.
Read more about shoulder anatomy here: https://teachmeanatomy.info/upper-limb/joints/shoulder/
The complex interplay of these different shoulder components gives us great flexibility and movement to perform various activities. This interplay of muscle, bone and joint makes the shoulder the most mobile joint in the entire human body, allowing us to catch basketballs, brush our teeth, and reach overhead for groceries on the top shelf! However, this flexibility also lends itself to the varying injuries that can develop within the shoulder. With so many structures working together to help our shoulders perform, is there a single culprit for shoulder pain?
The short answer is, shoulder pain isn’t always straightforward.
Here is a video of Dr. Gouveia discussing some of the most common causes of shoulde pain and what can be done about them!
Where does shoulder pain come from?
Shoulder pain is not one-size-fits-all. Shoulder pain may come from the shoulder joint itself or any of these surrounding structures. Sometimes, shoulder pain does not arise from the shoulder at all and instead comes from an organ inside the body elsewhere! This is known as referred pain.
The cause and the type of the shoulder pain are essential to determine as not all shoulder pain is felt equally. Pain coming from the shoulder joint can worsen with activity or movements of the arm or shoulder compared with other causes. For example, pain while playing overhead sports, elevating the arm, or engaging in repetitive activities can vary in type and severity compared to the tight, squeezing sensation that accompanies a heart attack.
You may find it beneficial to keep a journal and catalog the type of pain you experience with your shoulder, any activities that aggravate or accompany the pain, the time of day it is felt, and if you have any changes in moving your arm (range of motion).
Common causes of shoulder pain include age and repetitive motion, such as performing overhead motions like painting or throwing a ball. The muscles and tendons of the rotator cuff can become inflamed, and these inflammatory components are irritating to the local soft tissues, resulting in pain. Other common causes include damage to the shoulder muscles, including muscle tears, inflammation of the tendons (tendinitis), torn cartilage, sprains, and more.
However, the causes for shoulder pain are varied and will depend on a specific mechanism of injury or trauma or if the pain was preceded (caused by) repetitive movements. Sometimes, the pain is insidious, with no identifiable cause for shoulder pain inside the actual shoulder. This can occur when the source of the pain is coming from somewhere else other than the shoulder, such as an impingement or “pinch” of the nerves from the neck. Although pain exists in the shoulder region in situations like these, the cause is further up in the body.
Check out this article by the Mayo Clinic to read more about the complexities of shoulder conditions: https://www.mayoclinic.org/symptoms/shoulder-pain/basics/causes/sym-20050696
What are the most common shoulder conditions?
According to a 2019 review, about 18 million Americans per year are affected by shoulder pain. Rotator cuff tears are the most frequent cause of shoulder pain, but not the only one. A thorough exam by a chiropractor or doctor is necessary if your pain is severe or is worsening.
Shoulder muscle injuries can result from:
- Traumas: a fall, blow to the shoulder, or a car accident
- Age-related degeneration
- Repetitive overuse
- Repeated overhead use of the shoulder in sports
- Occupations that include vibration
- Constant computer or phone use
- Poor posture
Some other causes of shoulder pain include:
- Autoimmune disease
- Bone spurs
- Broken arm
- Broken collarbone
- Cervical radiculopathy
- Dislocated shoulder
- Frozen shoulder
- Impingement (nerve)
- Impingement (tendon)
- Muscle strain
- Muscle tears
- Myocardial infarction (heart attack)
- Referred pain from gallbladder or heart disease
- Rotator cuff injury
- Thoracic outlet syndrome
- Torn cartilage
Does your office take care of shoulder pain?
Absolutely. If you’re unsure what step is appropriate to take, call our office for an evaluation to determine the extent of muscle injury and if further intervention is required. The doctor can also determine if you need to restrict activities, take days off work, or, depending on the severity, undergo physical therapy and rehabilitation.
Proper treatment and time usually relieve mild to moderate discomfort associated with shoulder pain. Additionally, changes in movement, activity level, performance, and ergonomics may be part of an effective recovery plan. We can help provide alternate instructions and give stretches and exercises to help alleviate discomfort. Ultimately, conservative care options will depend on the severity, duration, and frequency of your pain, as well as the activities impacted by your condition. Thankfully, mild to moderate shoulder pain usually responds well to conservative care!
For severe cases and injuries, we may need to co-manage your care with a specialist or another doctor. This is okay, too. Our office strives to help you feel and move better and make sure you get to the right place for your care.
How we address shoulder pain
Our goal is to not only provide you with the correct diagnosis of your injury but also determine the underlying root cause of your injury and create an individualized treatment plan specifically for you. We have many tools in our toolbox to conduct an effective evaluation and create an appropriate treatment.
Conservative care is a keystone for our Boca Raton Sports Chiropractic practice. Treatment options may include specific stretches for muscles and tendons of the affected muscle, joint mobilization, tendon loading and specific exercises to strengthen the surrounding muscles and tendons, hands-on soft tissue work into the muscles and fascia, changes in exercise routine or modifications at work or home, home exercise, and stretching programs, and more.
Your treatment plan is unique to you and your condition. Some approaches we may use to help your condition consists of sports rehabilitation exercises to perform at home or in the office, as well as targeted soft tissue therapies including Active Release Techniques (Muscle Work), chiropractic, Graston Technique®, and deep tissue laser therapy.
Frequently Asked Questions (FAQ)
What are the most common forms of shoulder pain?
Great question! Because of the complex nature of the shoulder, shoulder pain can feel different from person to person and cause to cause. Pain in the shoulder can be diffuse or specific, sharp or dull, and better or worse with movement and activity. Shoulder pain may also be associated with numbness and tingling in the arm and hand.
You may notice pain with certain movements, or even all movements, of your shoulder. Maybe it hurts randomly, with certain activities, or the pain is difficult to recreate. People with shoulder pain sometimes can’t move their arm through its full range of motion, or pain is experienced in only certain directions. You may not be able to lie on your shoulder when sleeping, or you may have trouble with tasks like dressing, reaching overhead, and even typing or lifting.
Why would shoulder pain develop?
Risk factors include repetitive movement and overhead overuse, poor ergonomics, prolonged posture, an illness or infection affecting the shoulder, trauma, accidents such as a fall on an outstretched hand, or even disease to an organ (like the heart) referring pain into the shoulder.
Is surgery needed for shoulder pain?
Sometimes. The extent of your injury and the nature of the condition may or may not relate to surgical need. Our office has successfully rehabilitated and helped multiple cases of shoulder pain without the need for surgical intervention!
Shoulder pain is not always an indicator for surgery, but it can be. Pain accompanying failure to respond to conservative measures, serious injuries and/or damage to the shoulder, diminished sports performance or significantly impacted activities of daily living, or an inability to change activities and routines (for your job or lifestyle, for example) to avoid reinjury are indicators for when surgery may be needed.
Although our office does not perform surgery, if your shoulder condition is severe and requires advanced medical intervention, we will get you to the right doctor for that, too.
If you are dealing with shoulder pain and want a same-day examination and treatment for your injury, call our Boca Raton or Miami chiropractic and sports injury office at 561-997-8898 or schedule online!