The shoulder joint is one of the most complex body joints. It has a wide range of motion and receives the attachments of many muscles. Rotator cuff tears, bursitis, tendonitis, arthritis and frozen shoulder syndrome may develop. Such problems are often due to direct injury. Similarly faulty body mechanics form poor posture or old injuries may also produce chronically tightened back, shoulder and neck muscles, which decrease flexibility and strain the shoulder.
People don't have repeated strains of a body part for no reason. Something about the mechanics of the area creates strain. If we find and correct the strain we stop the pain. If we don't correct the problem, we wear that part of the body out at a very early age. Since many muscles surround and attach to the shoulder, shoulder blade and upper arm from the neck, upper back, arm and chest wall, one can see that the area of damage and irritation can involve multiple structures.
Additionally as nerves from the neck directly supply the shoulder muscles, irritated or pinched nerves from the spine often affect the functioning of these muscles as well. In all conditions of the shoulder the surrounding tissues of the neck, upper back and chest must be evaluated to see if they may be to a varying degree responsible for pain and dysfunction. We have much success in dealing with conditions of the neck, shoulder, arm and hand.
ROTATOR CUFF INJURIES
Multiple muscles comprise the rotator cuff and move the shoulder. These include the supraspinatus, infraspinatus, teres minor, teres major or subscapularis muscle. Any one or more of these muscles can be torn in conjunction with chest, neck and arm muscles to give a complex pattern of pain and poor function. Due to the complexity of the area expert diagnosis and treatment is essential for quick healing and minimizing shoulder damage from scaring. Many therapies are appropriate for reconditioning and rehabilitating such injuries. Caution must be exercised as some therapies are harmful. (Often, very aggressive massage and stretching may actually produce more injury or delay proper healing.) We have found a high degree of success in treating such conditions by using combined therapies to the neck and shoulder; light massage and stretching, range of motion for the shoulder joint muscles, rehabilitational exercise, ultrasound and ice pack application among others. Very often a shoulder brace must be worn as well. Strict attention to doctor's orders is a must and biomechanics of the area must be checked.
There are many bursas in the body. Depending on the location these can cause pain wherever they are found. Bursitis of the shoulder is usually a condition of inflammation or swelling of the subacromial bursa. This bursa is a small sac located just underneath the most overhanging or lateral part of the shoulder blade and the upper arm bone. When inflamed, the bursa can become sticky and swollen leading to entrapment of the supraspinatus tendon and tissues surrounding the area. A decrease in range of shoulder motion and exquisite pain in the shoulder joint is seen. This may lead to a condition known as frozen shoulder. Bursitis can usually be treated successfully with a combination of therapy, exercise and strict avoidance of activities that stress the joint. Mechanics of the head, neck, shoulder and torso must be accessed for biomechanical problems to ensure rapid healing without flair-ups.
Frozen shoulder is often the result when subacromial bursitis or shoulder strain is treated inadequately. The condition is produced by scarring or contracture of shoulder joint tissue. Frozen shoulder can be treated successfully by using a combination of heating therapy, ultrasound, friction massage, stretching, bracing and other maneuvers. One must use caution to make sure that these maneuvers are not overly aggressive or stressing to the area of treatment. Knowledge as to home care, supportive postures and what to do and avoid is equally important. A close look at the biomechanics of the entire region is important.
Tendonitis of the shoulder, elbow, knee, hip or in fact any area of the body is due to overstrain or recurrent injury of the tendon insertion of the muscles as they enter the bone. Tendons are the interconnecting fibers that attach muscle to joint and bone. If one strains the joint badly or receives smaller repetitive stresses or injuries over time the tendon may tear. Because a tendon is comprised of thousands of fibers tears may be small or large and are graded using the numbers 1,2 and 3. In a small grade 1 tear perhaps only 5-10% of the fibers may actually separate. With continued use and overuse, more fibers can separate and the tendon may become highly inflamed. Tendonitis can become chronic. The successful intervention and treatment of tendonitis, requires decreased physical activity and appropriate treatment. Treatment for tendonitis usually entails rehabilitational exercise, mild friction massage, stretching, hot packs, ice packs and ultrasound at various times throughout the treatment period and given in specific sequence. Vigorous and inappropriate therapy can produce permanent tendon scarring, weakness and shortening. Certain maneuvers and stretches must be avoided at all costs. NorthStar Chiropractic's experience and success in the treatment of tendon injuries indicates that biomechanical assessment is a must.
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