Common Causes of Shoulder Pain

Imagine your life for a few seconds without a functional shoulder.
Imagine a scenario where simple joys of life like lifting your grandson into your arms appears impossible or painfully difficult because of an ongoing chronic condition.

Picture yourself popping analgesics and prescription pain killers to get rid of the chronic ache while also fighting the horror of drug dependence, dose tolerance and other adverse side effects.

This is definitely not a pleasant picture, but believe it a not, a lot of people suffer from chronic, agonizing shoulder pain and discomfort. According to a study reported in the peer-reviewed BMC Musculoskeletal Disorders (1), the annul incidence of shoulder pain is as high as 14.7 cases per 1000 of the general population. The lifetime prevalence of shoulder joint pain is as high as 70% (suggesting 7 of every 10 individuals develop at least one episode of disabling shoulder joint pain during their lifetime).

What are some common causes of shoulder pain?

Shoulder joint is invariably the most useful and multidimensional joint of the human body. Unfortunately, shoulder pain and chronic discomfort is one of the most frequently reported musculoskeletal issue in the primary care clinics. Optimal management of shoulder pain is dependent on several factors; such as:

Site and onset of pain
Severity of pain
Co-existing health issues
Origin of shoulder pain
Cause of shoulder pain
Healthcare professionals and holistic care providers utilize several classification criteria to understand the pathophysiology of shoulder pain in order to devise functional treatment regimens.

Causes of Shoulder Joint pain based on the origin:

1. Joint related causes of Shoulder Pain: Shoulder joint is a ball and socket joint (formed by the ball of humerus and socket of glenoid cavity) to offer multi-dimensional motion. The shoulder joint is well-supported by antagonizing (opposing) group of muscles, powerful tendons and tough connective tissue components (such as tendons, ligaments and joint capsule).

Most frequently reported causes of shoulder pain due to joint dysfunction are:

Arthritis: Due to extensive wear and tear related damage (as a result of aging or other inflammatory disorders) the joint capsule may undergo degenerative changes that may presents with pain, joint stiffness, loss of joint flexibility and limited range of motion. According to latest estimates, approximately 53 million Americans are currently living with some form of arthritis (2)
Shoulder joint fracture or dislocation: Direct or severe impact of force can also lead to dislocation or fracture of the shoulder joint.
2. Muscle related causes of Shoulder Pain:

Muscle sprain/ strain: Damage or degeneration of muscle fibers as a result of inflammation or chronic repetitive motion is referred to as sprain/ strain. Most cases of muscle sprain resolves spontaneously.

Tendon rupture: Rupturing of muscle tendons (especially biceps and triceps) as a result of vigorous or repetitive joint activity can also elicit severe pain and loss of joint function.

Rotator cuff lesions or injuries are implicated in 60 to 64% cases of all shoulder pain (3)

3. Shoulder pain due to connective tissue damage:

Shoulder joint is supported and stabilized by tough connective tissue elements such as ligaments, shoulder capsule, bursa etc. However, due to sudden, strong impact of force, the connective tissue matrix may undergo damage or injury leading to sprain, torn ligaments and inflammatory degeneration. Weak and vulnerable connective tissue components can aggravate the risk of recurrent injuries and chronic shoulder pain. It is estimated that 2% of all the chronic cases of non-specific shoulder pain are due to adhesive capsulitis (3).

4. Pain referred from internal organs

Some medical conditions such as gall bladder and pancreatic pain can also present as shoulder pain (or discomfort). Additionally, pain of angina and myocardial infarction (heart attack) is also referred to chest and shoulder region. Other common secondary sources of shoulder pain are; liver cancer, lung cancer (especially small cell carcinoma of lungs), fibromyalgia and sub-arachnoid hemorrhage.

According to a latest report released by American Academy of Family Physicians (4), about 5% of all the cases of non-specific shoulder pain are due to pain referred from other organs and organ systems.

What are popular treatment modalities to manage shoulder pain?

Analgesics: Acute injuries and painful recurring episodes of shoulder pain are managed by analgesics that may range from over-the-counter non-steroidal anti-inflammatory drugs to more potent prescription analgesics, nerve blocking agents and muscle relaxants. Although, most patients achieve transient relief, almost all analgesics are associated with some degree of adverse effects/ side effects.
Corticosteroids injections: Steroid injections offers maximal and almost instant relief to the shoulder joint in episodes of acute aggravation. But keep in mind that long term steroid abuse can lead to cartilage degeneration and destruction of bone matrix (due to osteoporosis).
Surgery: Surgical intervention is mainly reserved for advanced cases that are refractory to conventional methods of care.
How chiropractic care help shoulder pain?

Non-specific and chronic shoulder pain is a fairly common cause of patient visits to the primary care clinics and chiropractic settings.According to a study reported in the Journal of Manipulative and Physiological Therapeutics (3), investigators suggested that 12% of all the patients who reports to chiropractic clinics complaints of persistent and gnawing shoulder pain. About 82% patients are managed by joint manipulation or other diversified techniques with a primary focus of rehabilitation exercises and remedies.

Chiropractic interventions are superior to other modalities of care because:

Most medical practitioners identify the ailment and advise treatments to mask/ manage the symptoms. Chiropractors on the other hand, identifies the inciting agents and risk factors to treat the cause and minimize the risk of recurrence of symptoms.
The chiropractic treatment plan is customized according to the patient’s demand and musculoskeletal health. Most medical regimens, on the other hand are generic.
Medical or surgical interventions are hazardous in the long term. Chiropractic interventions on the other hand are effective and safe. It has been observed that chiropractic treatment reduces the risk of recurrence of symptoms, while also improving the overall health and wellness in patients.
Chiropractors advise help regarding lifestyle modification, weight adjustment, occupational counseling and ergonomics and nutritional counseling besides devising a multi-nodal treatment plan comprising of:

Therapeutic stretching and strengthening exercises
Massage therapies
Chiropractic manipulation and soft tissue mobilization
Rehabilitation and training
If you or your loved-ones are experiencing chronic and disabling shoulder joint pain, book an appointment with us to see if we can help resolve your symptoms.

References:

1. Cadogan, A., Laslett, M., Hing, W. A., McNair, P. J., & Coates, M. H. (2011). A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC musculoskeletal disorders, 12(1), 119.

2. Centers for Disease Control and Prevention (CDC. (2013). Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation-United States, 2010-2012. MMWR. Morbidity and mortality weekly report, 62(44), 869.

3. Pribicevic, M., Pollard, H., & Bonello, R. (2009). An epidemiologic survey of shoulder pain in chiropractic practice in Australia. Journal of manipulative and physiological therapeutics, 32(2), 107-117.

4. Virta, L., Joranger, P., Brox, J. I., & Eriksson, R. (2012). Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC musculoskeletal disorders, 13(1), 17.

5.

http://www.aafp.org/afp/2011/0115/p137.html

6. Hill, C. L., Lester, S., Taylor, A. W., Shanahan, M. E., & Gill, T. K. (2011). Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms. BMC musculoskeletal disorders, 12(1), 8.