Shoulder Pain: Is Surgery Your Only Option?

In my experience, besides back pain, shoulder injuries and pain are some of the most common reasons a patient presents to our chiropractic office.  In fact, I have observed that most of my patients who suffer from chronic neck and upper back issues have at least a minor shoulder condition complicating their case.  The biggest fear with our shoulder pain patients is the dreaded ‘rotator cuff’ injury.  Why dreaded?  Because so many people have been trained to think that he only solution for rotator cuff problems is an invasive procedure.  Generally, the race to expensive, invasive interventions, in my opinion, is largely unnecessary overkill but can include pain management injections, which are generally only temporary and don’t really fix the cause of the pain, and surgery, which has a potential for risk, and recurrence of the condition. Surgery also limits additional future conservative care options in the likely event that the surgery fails.

Your shoulder can experience pain and dysfunction just like your back can.  Acute traumas and chronic stresses can lead to wear and tear on the joint just like they would in the low back.  It reasons then, if a patient can experience an excellent recovery with conservative care of their low back, conservative care of the shoulder is also a viable method of improvement.  So why, when you go to your doctor, do they so often immediately refer you to an orthopedic surgeon?  There are several reasons for this:

1.        Your doctor may not know or understand the nature of a shoulder injury.  The shoulder joint is a complex one with multiple muscular, tendonous, and neurological involvements that can affect areas other than the shoulder.

2.       A lack of understanding of how the body heals if the obstructions to the healing process are removed.

3.       A lack of understanding of the role conservative intervention can play, including chiropractic adjusting of the extremities, in helping the patient to heal themselves.

4.       Surgery is a perceived quick fix (despite the fact that surgery is not without its potential complications and failure rates).

So, you have shoulder pain…now what?  Shoulder pain is not as simple as just ‘rotator cuff damage.’  You have to understand what the mechanism of injury is, what tissues are involved, and whether there are other areas that may be contributing to or aggravating the shoulder region.  There are countless reasons a person can develop pain in the shoulder and rarely is the pain ‘just a shoulder problem.’

Your shoulder joint mechanism is an extremely complex one.  It allows for the largest range of motion of any joint complex of the body.  It has muscular attachments not only to the shoulder joint, but to the neck, rib cage, elbow, and even the low back.  The rotator cuff musculature represents only 4 of approximately 2 dozen muscles that affect shoulder function.  Did you know that the collar bone is the only one that directly attaches the bones of the entire arm to the rest of the skeleton?

In order to adequately diagnose a shoulder problem with the greatest level of accuracy, an MRI of the shoulder may be required.  While many will rely on plain film x-rays to diagnose a shoulder condition, x-rays alone don’t generally reveal the information necessary, especially for a chronic shoulder issue.  An MRI on the other hand will reveal information about all the soft tissues in and around the joint, including the cartilage.  It can even offer information as to whether the injury is acute and whether there is an active inflammatory response currently progressing.

Understanding how the shoulder functions is a key to helping it resolve.  Most injuries to the shoulder are either acute sprains or chronic overexertion injuries.  Either way, most shoulder conditions will improve with conservative care.  Now, many will argue that physical therapy is the best solution for a shoulder issue and I would agree to an extent.  Physical therapy is extremely effective at helping a shoulder condition to resolve.  However, to limit conservative care to only pain management and exercising the shoulder joint may prevent the patient from reaching full resolution of their condition.

Ideally, these factors need to be addressed when caring for a person with a shoulder injury:

1.       Misalignments of the shoulder joints need to be identified and corrected manually.  This requires the expertise of a chiropractor.  There are 3 true joints and 1 potential joint in the shoulder that must be corrected to restore full function before additional care can be rendered.  Exercising or stressing a deranged joint may actually aggravated it and slow your recovery.  The muscles, ligaments, and tendons of the joint rely on proper alignment for their proper function. Your soft tissues cannot function correctly if the skeleton is functioning incorrectly.    Only a chiropractor or, arguably, an osteopathic physician has the training and expertise to identify and correct misalignments in the shoulder with precision.

2.       Pain must be controlled.  While rendering care, there is the temptation to jump right into exercise to rehabilitate the area.  True, studies have shown that the earlier you introduce exercise, the better the long term recovery, but this has to be done within reason.  Applying stress to a guarded and deranged joint experiencing debilitating pain may aggravate the condition.  Additionally, the person is most likely not using the damaged tissue when they are in exercising the area and are, instead, recruiting other tissues to compensate for the loss.  Getting your pain under control is a critical step to rehabilitation.

3.       Exercise is critical.  Ultimately, you will have to add active exercise to strengthen the affected soft tissue damage.  Because your body lays down new tissue and builds up existing tissue according to the stress you place upon it, stressing the joints and soft tissues within reason is a critical component to resolving a shoulder issue.  It will be very difficult to expereince a full recovery without eventually adding a structured exercise regimen.

4.       Don’t ignore other associated areas.  Often, when you feel shoulder pain, you think it is necessarily only a shoulder problem.  In fact, it may not even be a shoulder problem at all.  Neck issues, upper back problems, postural issues, elbow dysfunction, and even low back pain can contribute to derangement in the shoulder.  They can both cause pin in the shoulder and aggravate a shoulder condition.  So, it’s critical that ALL these areas that interact with the shoulder also be addressed when helping you recover.

Conservative care for most mild to moderate shoulder conditions can be extremely effective.  When cared fro properly, I generally see a 90% recovery in our office in 90-120 days, depending on the type and nature of the shoulder injury.  The biggest detriment to a person’s improvement with conservative care, though, is their own impatience.  Healing takes time.  Conservative intervention for these types of shoulder injuries should at least be attempted before any invasive medical intervention is considered.

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