The most common shoulder problem that people experience is known as “Impingement Syndrome”. This problem is often also referred to as painful arc syndrome, swimmers shoulder, supraspinatus syndrome and/or thrower’s shoulder. The pain that occurs is usually felt on the front (anterior) aspect of the shoulder and is the result of inflammation of the tendons and/or bursa that lie between the ball and socket of the shoulder, better known as the humeral head and the glenoid fossa. This problem can occur at any age and usually occurs due to overuse of the biceps and/or supraspinatus tendon (rotator cuff muscle responsible for lifting the arm away from the body at the front and side). The typical presentation will be pain in the shoulder region with overhead activity (movements occurring at 90 degrees or greater). The pain is deep, achy, tender and may come and go depending on the severity of the issue and how long the problem has been occurring.
To put it simply try to imagine a ball and socket with “elastics” (muscles) that attach and/or traverse the area where the ball and socket interact. If the “elastics” are being repeatedly used this will cause inflammation at the area where the “elastic” is anchored to the bone. This inflammation (swelling of the tendons or bursa) will then cause pinching of the injured “elastics” whenever the arm is lifted greater than 90 degrees. People often complain of pain when sleeping with their arm under their pillow, while brushing their hair, exercising and will all activity that is repetitive and involves holding the arms away from or above the body.
This problem can progress from simple inflammation of the tendons and/or bursa to chronic scarring and permanent thickening of the involved tissues, thus making the problem more frequent and difficult to treat/ control. In some cases this will also lead to tears in the tendons that add additional frustration to the healing process.
Before treatment can begin a proper diagnosis of the problem and determination of severity needs to be established. Often times this means simply seeing Dr. Gloin (chiropractor) for an evaluation. He will ask a series of questions and do a variety of orthopedic tests to determine what type of shoulder issue you may have. In some cases he may request that you receive an MRI to better examine the tendons and bursa to look for possible tears or scarring. All care is done in conjunction with a conversation with the patient about their goals for coming to see Dr. Gloin. Some patients simply want the pain to stop, others want full function in the shoulder. Either way it is important for you to understand what has caused the problem and the variety of ways to fix it!
Treatment involves rehabilitation of the injured tendons and/or bursa and improved biomechanics of the shoulder. Treatment is broken down into three parts: 1) Improved flexibility of all shoulder muscles by doing specific stretches (some at home and others at the office) on a regular basis, receiving cross friction massage for the injured tendons, and applying heat/ice (depending on the severity and chronicity of the injury), 2) Improved strength and overall balance to the shoulder muscles (all shoulder muscles must act together to stabilize the shoulder joint as strength imbalances will hinder the recovery process) and 3) Improved joint mobility.
When the muscles are flexible and healthy, the strength is balanced and full plus the joints are able to move as they were intended then the symptoms will improve and the problem will resolve. This all of course assumes that the aggravating activities are addressed and alternatives are considered ie. altering swim technique or way of sleeping.
To better understand any shoulder problem that you may have please make an appointment to meet with Dr. Gloin ((323) 930-9355), so that he may evaluate and help you as soon as possible.