Shoulder pain is a common complaint we see in our clinic.  In fact, 2 out of every 10 patients in the US come in complaining of shoulder pain. Many patients immediate go to Dr. Google and tell us their diagnosis, such as bursitis, biceps pain or rotator cuff tear or an impingement…but today let’s dive in to see how and what causes the “why does my shoulder hurt when I lift my arm”.

Why Shoulder Pain Occurs When Arms Are Lifted

What most patients consider their “shoulder” is actually 2 different joints:

1. Acromioclavicular joint (AC Joint) – which is where the clavicle meets the shoulder bone (scapula)

1. Glenohumeral joint (GH joint)– which is where your arm bone (humerus) meets the shoulder bone (scapula), this is the main ball and socket joint of the shoulder.

The AC joint is held together by a network of ligaments and your GH joint is much more complex: it has a capsule that holds the bones together keeping the ball and socket together, a labrum that cushions between the ball and socket.  The rotator cuff muscles envelop the humeral head (ball part of the ball and socket joint) to allow motion and stability. Then you have all the other muscles such as the pectoralis, biceps, deltoid, serratus, latissimus, rhomboids, levator scapula and more that attach to various aspects of the shoulder to allow multiple degrees of motion.

Symptoms Of Shoulder Pain When Moving The Arms

Shoulder pain when moving the arm can come in various forms and associated symptoms such as:

• Intense Pain When Lifting The Arm. Pain described as multiple different sensations such as:
  • Burning
  • Sharp
  • Shooting
  • Stabbing
  • Achy
  • Pulling
  • Tearing sensation
  • Catching
  • Weakness
  • Unstable
• Limited Range Of Shoulder Motion
• Excessive range of motion

Possible Conditions That May Cause The Shoulder Pain

Shoulder pain can be very non-specific, meaning that multiple structures and issues can cause identical pain in the shoulder. Most shoulder examination maneuvers are very limited in their ability to assess exactly what the problem is.  With pain when lifting your shoulder, it is critical to take a detailed history, good examination, coupled with imaging to fully understand what is causing the shoulder pain.  Many conditions can present with these symptoms ..let’s discuss.

Shoulder Impingement

• Shoulder impingement occurs when the top outer edge of your shoulder blade, called the acromion, rubs against (“impinges on”) or pinches your rotator cuff beneath it, causing pain and irritation.
• While pain when active movement, there should be no pain while at rest of in any other direction.
• Now, if have impingement, we still need to understand the underlying mechanism such as shoulder instability of the capsular ligaments that allow the shoulder to move improperly to impinge
• Location of pain typically on the outer area of the shoulder around where the deltoid muscles are.

Osteoarthritis

• Shoulder arthritis is common as we age and with any history of trauma or previously surgery can increase the risk for developing arthritis.
• Arthritis can be in either the main glenohumeral joint or the AC joint.
• Both can cause pain with raising your arm but there is typically an association with a “grinding” or crepitus (bone crutching) sensation that accompanies the pain with movement.
• AC joint pain can be more on the top of the shoulder where glenohumeral joint can be more in the front or back of the shoulder

Rotator Cuff And Bursa Injuries

• Rotator cuff is a collection of 4 main muscles and tendons that envelope the shoulder joint and they can get damaged causing pain with lifting the shoulder.
• There are multiple terminologies that typically all mean the same thing such as tendonitis, tendinosis and bursitis – all typically describe pain and damage coming from the rotator cuff areas.
• Pain from rotator cuff tendons typically located outside of the shoulder around the deltoid area but can also present with front of the shoulder pain.
• Also associate with pain while laying on the shoulder and night pain.

Frozen Shoulder Syndrome

• Frozen shoulder can cause pain while trying to lift your arm BUT the movement of the arm is extremely limited and unable to go through all the normal range of motion
• Both active and passive (meaning with patient not using their muscle and the physician moving the shoulder) not able to get full range of motion.

SLAP Tears And Bankart Lesions

• Labral injuries all can present similar to other injuries such as rotator cuff tears and biceps injuries
• Location of pain can also vary from back, front and top of the shoulder
• Can be an association with crepitus, popping or clicking of the shoulder

 Biceps Tendon Rupture

• Biceps tendon runs in the front of the shoulder and can also create pain with lifting shoulder.
• It also attaches to the labrum as well

Important to understand as well, there is extensive amount of research also showing many of these pathologies exist in perfectly normal shoulders with ZERO shoulder pain!  This is why it is critical to have extensive history information and a physical examination along with imaging findings to understand what the source of the pain is!

AC Joint Impingement

AC joint Impingement is a painful condition that occurs when the space beneath the acromion bone is narrowed.   This narrowing can result in irritation of the rotator cuff tendons and bursa.  A bursa is a fluid-filled sac that reduces the friction on tendons and muscles as they cross bony surfaces.  A tendon is thick collagen tissue that connects muscles to bones.  The rotator cuff tendons provide important support and enable movement in the shoulder.   If severe,  impingement can cause tears in the rotator cuff tendons.  Patients with AC joint impingement typically have pain with elevation of the arm and or while lying on the shoulder.

Arthritis in Shoulder

The shoulder is a truly remarkable joint.  It allows you to reach out into virtually all directions: overhead, forward, and backwards. Unfortunately, like other joints in the body the shoulder is susceptible to irritation and injury. Osteoarthritis is the most common cause of disability in the United States, affecting up to 32.8% of patients over sixty years of age (1). Shoulder arthritis is a common condition estimated to be as high as 16-20% in the middle aged and elderly population (2).  Shoulder arthritis can compromise range of motion, strength and be a source of debilitating pain. This blog will review the shoulder.

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a painful loss of shoulder movement and range in motion.  The incidence of frozen shoulder is 3-5% in the general population and up to 20% in those with diabetes.  The peak incidence is between 40-60 years of age.  The exact mechanism is poorly understood.  In general, the capsule becomes inflamed, thickened, and contracted with pain and significant restriction in range of motion. causes are poorly understood but risk factors include trauma, prolonged immobility, systematic diseases such as diabetes, stroke, connective tissue disease, and heart disease.  Other causes include post-surgery, chronic inflammation causing stimulation of myofibroblasts

Rotator Cuff Tear

Are you plagued by shoulder pain that has now transitioned from intermittent to constant and keeps you up at night? Are daily shoulder movements, such as dressing and reaching for objects in the kitchen cabinets, painful? Is your range of motion decreasing as your pain is increasing? You may have a full- or partial-thickness rotator cuff tear. Has conservative therapy in the form of heat, ice, stretching, rest, and acupuncture failed to provide significant relief? Has an MRI demonstrated a full-thickness or partial-thickness tear of the rotator cuff? What to do? If left untreated, full-thickness and 26% of partial-thickness tears will progress.

Shoulder Impingement Syndrome

Pain is the most common symptom.  It typically occurs with the elevation of the arm, forced movement overhead, and when lying on the shoulder.  Impingement can also cause shoulder pain when reaching across the body. Narrowing of the subacromial space is the most common cause of shoulder impingement syndrome (6).  The subacromial space is the area between the top of the arm bone (humerus) and the AC joint.   This narrowing compresses or pinches the rotator cuff tendons and bursa.  If left untreated the rotator cuff tendons can become inflamed, damaged, and or torn.Bursa and tendons can not be seen on x-ray.  An x-ray may demonstrate…

Shoulder Labral Tears

The labrum is a cartilaginous cup that circles the shallow shoulder socket (the glenoid) to make the socket deeper. The labrum supports and stabilizes the shoulder joint. Causes of Shoulder Labral Tears Injury to the labrum typically occurs from repetitive trauma in overhead throwers, such as in baseball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground or getting your arm jerked. Symptoms of Shoulder Labral Tears. Typical symptoms include pain in the front of the shoulder or deep inside the joint. Treatment options initially include physical therapy which is designed to restore range of motion and strength to the shoulder.

Most of us often don’t think twice about our shoulders until they are in pain. Once in pain we immediately realize we use our shoulders for many daily activities such as extending our arms, driving, carrying objects and many more activities. The shoulder is the most mobile joint in the human body so it is more easily injured than many of the more stable joints. That’s why most people upon noticing shoulder pain immediately begin looking for chiropractic care in Jacksonville for relief of their shoulder pain.

If you are suffering from a shoulder problem and wait too long to get it corrected it may lead to permanent range of motion loss and lifelong issues. Since the shoulder is so important for so many movements and daily activities it is important to identify what is causing the shoulder issue. This article will help you get an understanding of what could be causing your shoulder pain as well as what Thrive Chiropractic Health Center can do to help you get well again.

Common Causes of Shoulder Pain

If you search the causes of shoulder pain the list seems to never end, but let’s go over some of the causes for shoulder pan that are the most common:

• Foreword Head Posture
• Spinal Misalignments
• Neck and upper back tightness
• Sports or automobile injuries
• Arthritis
• Rotator Cuff tear

What most people do not recognize is that shoulder problems most commonly stem from the spine and often are directly related to spinal misalignments and foreword head posture. Every inch of forward head posture that you develop adds an extra ten pounds of weight force coming down on the base of your neck. As a result, the upper back and shoulder muscles must work overtime and eventually become tired. As this happens the shoulders begin to round foreword creating shoulder instability leading to shoulder injury and decreased range of motion. The extra force also compresses the vertebra and discs at the base of the neck irritating the nerves that go straight to your shoulders causing pain. Even slight foreword head posture and spinal misalignments can cause shoulder issues and pain over time if left untreated.

Common Symptoms

Shoulder pain can develop two primary ways, gradually over a period of time or rapidly from some sort of injury. When the pain develops slowly symptoms are often minor at first and don’t seem to be a big issue. However, if left unchecked these minor problems can become a major issue. That’s why it’s important to seek out evaluation of you shoulder if you experience the following symptoms:

• Difficulty raising your arm
• Pain while carrying objects
• Shoulder pain lasting more than one week
• Shoulder pain that goes and goes frequently
• Shoulder pain that is worse in the evening
• Popping, clicking or grinding sounds during shoulder movement.
• Any swelling or bruising

How we can help

Chiropractic care for shoulder injuries is effective, gentle and non-invasive. Chiropractic is a great alternative to surgery and typically produces fast results. A study by the Journal of Manipulative Physical Therapy even showed that manipulations of the spine (adjustments) to the upper back alone were more beneficial than shoulder surgery for rotator cuff tears. At Thrive Chiropractic Health Center our doctors are expertly trained in finding out what the root cause is of your shoulder pain and efficiently treating it to get you back on the right path. We will begin with a thorough consultation and examination to pinpoint the location and issue and then we will make a custom-tailored plan designed specifically for you to maximize results and speed up recovery time. Whether your problem is stemming from your spine or the shoulder itself we have a wide variety of options and treatments available to get you well.