Shoulder pain can be debilitating – shoulder pain diagnosis is critical to insure proper, effective treatment. Common diagnosis for shoulder pain includes; radiating pain from the neck (pinched nerves), muscle strains, arthritis, tendinitis, impingement and ligament tears. In most cases, physical examination can pinpoint the cause of shoulder pain but sometimes x-ray and/or MRI is necessary for correct diagnosis. Many patients with shoulder pain also have some idea of how the pain began. Common causes of shoulder pain include falls, bad posture, car accidents, sports injuries and work injuries. The way in which the shoulder was injured can help point to the source of the pain.
Severe shoulder pain is often due to an impingement in the shoulder or due to a pinched nerve in the neck. These two different types of shoulder pain present differently making correct diagnosis easier.
Impingement in the shoulder occurs when one of your rotator cuff tendons – the supraspinatus – becomes compressed between three bones in your shoulder. When this tendon is compressed it becomes extremely painful and is often associated with severely limited range of motion – especially when trying to lift your arm off the side of your body. Patients usually describe the pain as sharp and stabbing and they guard their shoulder at all times. In less severe cases of impingement, patients will have a painful arc of motion in which moving their arm is fine until they get to a certain point at which time it becomes painful – if they continue on, however, the pain subsides and their movement is normal again. Treatment for shoulder impingement will help you recover from this condition much faster than if it is left to run its course.
Pinched nerves can also cause severe shoulder pain. The shoulder gets its nerve supply from the neck. The neck, upper back and shoulder also use the same major muscle groups for both movement and stabilization. If joints in the neck are irritated and inflamed or if a disc in the neck is putting pressure on one of the nerves that supplies the shoulder, the patient can experience severe shoulder pain. In most cases, this pain is associated with neck pain and stiffness as well and it can include numbness, tingling and achiness in addition to the sharp / stabbing pain that is common in impingement of the shoulder. Treatment for pinched nerves includes treatment for the neck, upper back and the affected shoulder. Even though treatment is directed at the source of the pinched nerve (usually the neck), the shoulder also needs care to help it recover from its recent lack of adequate nerve supply.
Chronic (pain that has been unchanged for more than 30 days) shoulder pain is often due to arthritis or rotator cuff injuries.
Arthritis of the shoulder can occur in two different areas. The most common site for arthritis in the shoulder is in the AC joint which is the bump on top of your shoulder where the Acromium Process from your scapula hooks over the top of your shoulder and joins the Clavicle. Arthritis in joint causes pain because of the bone spurs that grow around the joint and dig into the top of the ball of the humerus. This type of pain usually begins slowly and with time gets worse. The second are prone to arthritis in the shoulder is the shoulder joint itself. Because the shoulder allows for such a wide range of motion, it tends to be somewhat “sloppy”. This “sloppiness” that is inherent in the joint is magnified by injuries and eventually causes instability within the shoulder. Over time, the instability of the joint unevenly wears the joint surfaces which cause arthritis. Just like with arthritis of the AC joint, arthritis of the shoulder joint results in bone spurs which can dig into other sensitive soft tissues that lie in and around the joint. With time, symptoms related to arthritis of the shoulder worsen if left untreated.
Chronic pain is also common with rotator cuff injuries. The rotator cuff consists of four small muscles that coordinate the rotational movements of the shoulder. Many injuries result in either tendonitis (inflammation of the tendon) or small tears of one of the muscles. If left untreated, which most are, the injury worsens gradually over time and eventually becomes a surgical situation. The most commonly injured rotator cuff muscle is the supraspinatus muscle, which typically causes pain on the front middle portion of the shoulder. The supraspinatus is a small muscle with a thin tendon that can deteriorate fast if not treated.
In some cases, patients with pinched nerves in the neck experience severe shoulder blade pain. The nerves that leave the neck are responsible for innervating the shoulders and the area in and around the shoulder blades. Depending on which part of the nerve is compressed, patients may experience pain that runs down the inner boarder of the shoulder blade – which can be extremely painful. This type of pain can also limit range of motion of the shoulders as well as the neck. Chiropractic treatment for this painful condition includes chiropractic manipulations, therapy to reduce inflammation and speed healing and at home therapies.
Related content: Causes of Shoulder Pains.