Shoulder Impingement Syndrome Causes and Treatment Options

Impingement syndrome is a painful condition that affects the shoulder, and is often seen in adults over the age of 50. It may also affect those who engage in activities that require them to repeatedly raise their arms over their heads, such as playing tennis, swimming, or working in careers that require them to reach up to retrieve or lift items above their heads.

It is caused by wear or injury to the rotator cuff muscles that surround and support the shoulder joint. When the muscles and tendons of the shoulder become worn, they respond by swelling, which (because they are surrounded by bone) causes compression and a loss of blood flow to the entire area. This in turn causes the muscle tissue of the shoulder to begin to degrade, in effect to fray like a rope. As a result, movements such as reaching up behind the back or lifting the arm over the head become painful, and shoulder motion becomes restricted. This may be accompanied by an increasing weakness of the shoulder muscles.

The pain of shoulder impingement syndrome is most often experienced as a sharp burning sensation when you move your arms and shoulder. One test performed by chiropractors to detect this syndrome is to have you raise your arm to the side, similar to performing “jumping jacks.” If pain occurs, that may be an indication of impingement. The pain is often felt on the outer side of the shoulder and upper arm. Another key symptom of this condition is waking up with pain after sleeping on your side, regardless of which side you sleep on.

Shoulder impingement syndrome is treated by medical doctors with painkillers and anti-inflammatory medications (and in severe cases with surgery), but there are more conservative, non-invasive treatments available. Several studies have shown that chiropractic manipulation, in conjunction with standard medical treatments, produces much faster and more complete relief from impingement syndrome pain than medical treatment alone.

A Doctor of Chiropractic, after performing a thorough examination to make sure that the condition is in fact shoulder impingement syndrome and not a more serious injury or condition, can prescribe a series of treatments aimed at achieving several goals. First, because the shoulder and arm are connected to the spine, the chiropractor may perform spinal adjustments to eliminate structural abnormalities that are causing or perpetuating the wear and tear on the shoulder joints. At the same time, your chiropractor may treat the muscles of the shoulder and arm with cross friction massage or with electro-stimulation therapy to relax them, and thus to improve mobility of the shoulder joints and arms. Chiropractors can also recommend home care activities and exercises to strengthen the shoulder girdle muscles and prevent further pain as the result of upward movements of the arm.

Anatomy of the Shoulder

The shoulder is the part of the human body in which the upper arm attaches to the axial skeleton of the torso. The bones that form the pectoral (shoulder) girdle on each side of the body are the scapula (also known as the shoulder blade) and clavicle (collar bone) whereas the glenohumeral (shoulder) joint is formed by the intersection of the head of the humerus and glenoid cavity of the scapula. This coming together of the humerus and scapula is assisted by a narrow rim of cartilage known as the glenoid labrum, which slightly enlarges the glenoid cavity in order to better receive the humeral head. The clavicle and scapula articulate at the top of the shoulder at the acromioclavicular joint (so named because the acromion of the scapula meets the acromial extremity of the clavicle).

The shoulder joint is a ball-and-socket joint that allows the upper arm to exhibit a whole range of movement including flexion (bending up), extension (straightening out), abduction (movement away from the body), adduction (movement towards the body), lateral rotation (rotation of the arm at the shoulder joint itself) and circumduction (making circles with the arm). The shoulder joint allows a greater range of movement than any other joint in the body, and is encapsulated by a loose sac called the articular capsule that covers the area from the glenoid cavity to the neck of the upper humerus. Three sets of ligaments hold the scapula and humerus together. These are made up of the coracohumeral ligament, glenohumeral ligaments and transverse humeral ligament. Although the ligaments lend some degree of support to the shoulder joint, the majority of its strength actually comes from the associated muscles and tendons.

Muscles of the shoulder and their tendons encircle the shoulder joint and form what is known as the rotator cuff. The rotator cuff (comprised of the supraspinatus, infraspinatus, teres minor and subscapularis muscles and their tendons) joins to the articular capsule and, together with the shoulder ligaments, holds the scapula and humerus in place. Four strategically located bursae (the subscapular, subdeltoid, subacromial and subcoracoid) prevent friction between the shoulder bones as they are moved by muscular contractions.

Although part of the axial skeleton of the torso, the shoulder girdle is not physically connected to the vertebral column but held in place by a series of muscles that include the trapezius, deltoid, serratus, rhomboid, subclavius, pectoralis and latissimus dorsi.

Consult your Fremont Chiropractor, Dr. Hans Freericks, to find out how you can achieve a good posture. Call Fremont Chiropractic at (510) 797-4796 today.

 

Chiropractic Care For Treating and Preventing Injuries

Professional football teams recognize the value that having regular chiropractic care affords their players. All of the 32 teams in the National Football League (NFL) use the services of a chiropractor for treating and preventing injuries to team members.

Dr. Spencer H. Baron, a team chiropractor for the Miami Dolphins and past president of the Professional Football Chiropractic Society, said, “The robust need for chiropractic care in the NFL has been deeply driven by the players’ desire for peak physical conditioning and not simply for injuries. From the earliest years of full contact football, their bodies are subject to structural stress that doctors of chiropractic are specially trained to care for. Many DCs who provide their services to professional athletes travel with their respective teams throughout the season, treating players up until game time, during the game and sometimes immediately following.”

Professional Football Players Advocating Chiropractic Care

A number of professional football players are staunch advocates for chiropractic care and the ability it gives them to perform at their peak.

Emmitt Smith, a former NFL player for the Dallas Cowboys and Arizona Cardinals and NFL all-time record holder for rushing, dealt with a lot of hamstring problems during a tough season in 1994. He related how he had some difficult questions to answer: “‘Do I need to get more rest? Do I need to eat better? Do I need a little more training? How can I take care of my body better? Do I need to find a Chiropractor?’ It was time for me to invest in me.” Smith added, “I found a specialist that’s really good in balancing out my body to make sure my hips are rotated right, and my body is functioning properly.”

Smith continued, “I remember somebody telling me that what I put myself in during the games is like having a car wreck every Sunday. It’s against the norm. You can find yourself in awkward positions. That stuff takes its toll. But if you take advantage of the health care, balance your body back out, put it back where it’s supposed to be, you function better, and you recover faster.” He said about chiropractic, “You can have a Ferrari body, but your wheels need balancing. I felt if I took care of my body, I could still function when I got older.”

Chiropractic apparently served Smith well in helping him maintain function and flexibility, because after his retirement in 2004 he went on to win the third season of Dancing With the Stars, teamed with professional dancer Cheryl Burke.

Other professional footballers have expressed their appreciation for chiropractic care as well. Joe Montana, who possesses three Super Bowl MVPs and was named Player of the Year in 1990, was so appreciative of chiropractic that he agreed to become the spokesperson for chiropractic in the state of California, saying “Chiropractic has been a big part of my game. Chiropractic care works for me.”

New Orleans Saints wide receiver Lance Moore is another chiropractic devotee. He said, “Not only did my chiropractor get me back on the field, but he helped me to stay on the field. My body just feels much better overall because of the care I’ve gotten.”

Three-time Super Bowl champion Jerry Rice, a former wide receiver with the San Francisco 49ers said, “I believe in chiropractic, and I know that it works. You probably know about my long and successful career in football. I’m flattered by the testimonials to my durability. Football is a very rough and vigorous sport. Chiropractic was the key to keeping me in the game.”

Discover Chiropractic also serves patients in Oakland, CA. For ways to find a good Oakland chiropractors, follow this link.

Treatment Options for Shoulder Arthritis

While we generally think of arthritis as being associated with old age, shoulder arthritis is not uncommon among younger people as well. Any injury to the shoulder, such as a dislocation or a fracture, can eventually lead to shoulder arthritis.

The shoulder consists of two main joints. The first is the glenohumoral joint. This is a ball-and-socket joint in which the head of the upper arm (humerus) fits into the glenoid cavity of the scapula (shoulder blade). The second is the acromioclavicular. This joint is formed by the meeting of the collarbone (clavicle) with the top of the scapula (acromion).

Hyaline cartilage located on the ends of these bones generally allows for movement of the arm in the socket without friction, but a loss of cartilage here can cause the bones to rub against each other. Although not as common as arthritis in other parts of the body, shoulder arthritis can be extremely uncomfortable and debilitating. The principal symptom of shoulder arthritis is steadily worsening pain, especially when the arm is moved.  However, patients with this condition are also likely to experience considerable stiffness in the joint and weakness at the shoulder. Sleeping may become difficult as the condition worsens, especially on the most affected side.

Shoulder Arthritis – Causes

Shoulder arthritis may be caused by any of the following:

1. Osteoarthritis.  This is the degenerative wearing of cartilage, especially at the acromioclavicular joint.
2. Loss of cartilage through acute traumatic injury to the shoulder, such as from a car accident, particularly when there has been a tear to the rotator cuff.
3. Rheumatoid arthritis, an inflammatory autoimmune disease in which the body attacks its own cartilage.

Both osteo- and rheumatoid arthritis are more prevalent in older people (osteoarthritis in particular tends to occur in those over age 50). It's not surprising that the overall incidence of shoulder arthritis is increasing as the general population ages. Initial management of shoulder arthritis is usually non-surgical.

Shoulder Arthritis – Treatment Options

Possible treatment options include:

• Chiropractic care
• Targeted exercise programs to increase shoulder mobility
• Heat and ice treatment
• Nutritional supplements such as glucosamine and chondroitin, both of which build cartilage and can slow joint degeneration
• Rest and shoulder immobilization
• Modifying shoulder movements to minimize irritation
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroid injections and other medications may be used in the case of rheumatoid arthritis

The National Arthritis Foundation reports that regular chiropractic care can help prevent the damage caused by arthritis. Chiropractic treatment can help reduce pain and restore movement and increase range of motion in the shoulder joint.

In severe cases, surgery for shoulder arthritis can help to reduce pain and improve motion if non-surgical treatments are no longer working. Glenohumeral surgery can consist of either replacing just the head of the humerus with a prosthesis (hemiarthroplasty) or replacing the entire joint (both the humeral head and glenoid cavity, a total shoulder arthroplasty).

Chiropractic Treatment for Neck Pain

Chiropractic More Effective for Neck Pain Than Other Therapies

Neck pain is believed to affect between 10% and 15% of the general population, and is particularly likely in those over 50 years of age. Neck pain is frequently accompanied by headaches, dizziness or other symptoms.  In addition, certain movements or sustained postures of the neck can aggravate the pain and stiffness and add to a limit in range of motion.

Common treatments for neck pain include prescription analgesics along with some type of physical therapy (usually massage, application of heat and/or specialized exercises) to deal with the pain and improve function.  However, the results of a randomized controlled trial published in the Annals of Internal Medicine showed that manual therapy, such as chiropractic care performed by a certified Fremont chiropractor, was more effective than either physical therapy or continued care by a general practitioner.

The study involved 183 patients between 18 and 70 years of age who had reported having non-specific neck pain for two weeks or more. Patients were randomly assigned to one of three groups: manual therapy, physical therapy or continued care by their physician.
Those referred to a manual therapist had a 45-minute treatment once a week for up to six weeks; those who were treated by a physical therapist had a 30-minute treatment twice a week for up to six weeks; and the remaining patients who were under continuing care from their doctor were given medication to treat pain and inflammation, were instructed in the use of hot compresses and were given exercises they could perform at home to treat their neck pain. All patients included in the study were allowed to use exercises at home, non-prescription pain medication and any medication that his or her physician may have prescribed before the beginning of the study in the treatment of their neck pain.

Seven weeks after the beginning of the study, patients were asked to rate their neck pain, from "much worse" to "completely recovered," and the researchers compared the number of patients in each group who had reported feeling at least "much improved." The results indicated that 68.3% of the manual therapy group reported feeling either "much improved" or "completely recovered," compared with 50.8% of patients in the physical therapy group and 35.9% of patients in the physician-treated group.

Despite the fact that the lead author of the study is a physical therapist, the study noted that "the physical therapy patients achieved significantly worse success rates while using twice the number of patient visits as the manual therapy group." The researchers concluded that "in daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner," and that "primary care physicians should consider [referral for] manual therapy when treating patients with neck pain."

Is Your iPad Causing You Neck and Shoulder Pain?

It is estimated that up to 300 million tablet computers such as the iPad may be sold by 2015, which seems entirely possible, given their ubiquitous appearance on trains, in cafes, and even at the supermarket. It has already been shown that frequent texting on your mobile phone can cause problems with neck pain, but those who use their tablet for everything from surfing the internet to watching full-length movies may be in for even more pain. Commonly referred to as “iPad neck,” increasing numbers of people are showing up in their chiropractor’s office with neck pain and stiffness due to the use of this device.

The results of a study published in Work: A Journal of Prevention, Assessment, and Rehabilitation, found that the use of tablet computers was associated with greater head and neck flexion than traditional desktop computers and that placing the tablet higher on a table and using a case to put the tablet at a more optimal angle could help prevent neck and shoulder problems.

Researchers from the Harvard School of Public Health, Brigham and Women’s Hospital and Microsoft Corporation studied 15 volunteers who were regular users of tablet computers. The subjects performed simulated tasks on an Apple iPad2 and a Motorola Xoom, during which the posture of the head and neck, the subjects’ gaze angle and gaze distance were measured by a three-dimensional infrared motion analysis system. They surfed the internet, wrote e-mails, watched movies and played video games.

Each tablet came with its own proprietary case that enabled users to set the tablet at different angles. The Apple case allowed for 15° and 73° tilt angles, while the Motorola case allowed angles of 45° and 63°. Greater flexion of the neck was found with the iPad2 when used in its case. Not surprisingly, tablets set at the least perpendicular angle caused greater neck and head flexion than when the subjects used a desktop or laptop computer. Head and neck posture only began to approach a neutral position when the tablets were set in their cases at the Table-Movie angle in which they were closest to perpendicular.

The researchers recommended that tablet users place the devices on a table and at the steepest viewing angle possible to avoid neck and shoulder pain. However, they cautioned that this configuration might cause problems for the arms and wrists, which in this configuration are not optimally placed for input and can lead to problems of their own. If you just cannot conceive of giving up your iPad, in addition to reducing the amount of time you spend using it, consider seeing your chiropractor on a regular basis.

Chiropractic care has been shown to be more effective in treating neck pain than using pain medication. A chiropractic adjustment can realign neck vertebrae and take the pressure off compressed nerves, bringing relief in a gentle, natural manner and allowing you to use your tablet more comfortably.

Seven Causes of Shoulder Pain and Cures

Shoulder pain can be a problem not only because of the discomfort it causes, but also because it may limit an individual’s mobility and ability to perform everyday tasks. Actions such as putting on a coat, lifting a gallon of milk or other simple, routine things suddenly become an exercise in pain each time they are performed because of shoulder pain.

Yet, shoulder pain doesn’t have to prevent an individual from enjoying life and chiropractic care is a way to quickly and effectively deal with the problem. Chiropractic care is a preferable option not only because it is effective but also because it avoids the possibility of painful surgery or pain-killers which may produce harmful side-effects.

What’s important to remember for individuals suffering from shoulder pain is to be patient. Shoulder problems can be resistant to even the best care, but over time chiropractic can help. Correcting the problem begins with an examination of the neck, upper back and shoulder to determine if spinal nerve irritation could be causing pain. A shoulder injury may also result from a weakness due to an underlying nerve irritation. Spinal and shoulder joint adjustments will be needed to stop the progression of joint deterioration and help the soft tissue heal. A chiropractor will also lead a patient in strengthening or stretching exercises to help restore the full range of motion to their shoulder.

In medical terminology, a shoulder is known as a “suspension” joint. This type of joint makes an individual’s shoulders very mobile and flexible. But a “suspension” joint also limits the strength of an individual’s shoulder because it has a shallow socket and very little support, thus the anatomy of the shoulder makes it vulnerable to injury.

The result is that both young and old may be susceptible to shoulder injuries for different reasons and at different times of life. Possible causes of shoulder pain include:

• Sports injury (as a result of pitching, throwing, tackling, swinging)

• Car accidents (especially those resulting in whiplash)

• Overuse and/or repetitive motions such as lifting and reaching

• Arthritis related to aging and/or normal wear and tear

• Previous injuries such as those from childhood

• Sleeping in an awkward position

• Long-standing spinal or emotional stress

While shoulder pain is frequently dismissed as bursitis or arthritis, it should never be neglected. This is because it may be a sign of a larger problem that could worsen if left untreated. There are several reasons shoulder injuries should be dealt with immediately to assure even the simplest of problems do not worsen and present difficulties years later. Among them:

• Strains and sprains can result in continued injury to joints even longer after the pain is gone

• Overuse of poorly conditioned tissues can leave shoulder joints susceptible to future injuries

• Assuming that pampering a hurt shoulder simply by not using it can cause more harm than good. Left alone for too long your shoulder can freeze up, a condition known as “frozen shoulder syndrome.”

Here is a successful home remedy that you can try for a stiff or painful shoulder. Fill an empty gallon milk container with two inches of water. Swing the partially filled gallon around with one arm like a windmill – ten times in one direction and then ten times in the other direction. If this is too painful at first, go as far as you can in one direction and then as far in the other direction. Do this with both arms so you don’t create problems that can arise with asymmetric muscle development. Leave the milk container on the counter so you remember to do this twice a day – in the morning and in the evening.

Chiropractic care should always be considered when dealing with shoulder pain because of its ability to restore the strength and integrity of shoulder’s supporting soft tissues, along with keeping joints flexible and working free of pain.