Shoulder & Arm Pain
Shoulder pain is a very common condition that affects many people and has a variety of causes. Some of these causes directly originate in the shoulder and some develop in other areas of the body, which eventually affect the shoulder. These causes include:
Physical Causes: The shoulder joint is a complex joint that has a large degree of mobility, but relatively a small degree of stability. This fact creates a situation, in which the shoulder is very prone to physical stress and injury. Muscular weakness and imbalance, ligament injury and tendon injury, abnormal postural misalignment and neurological stress emanating from the neck will all cause shoulder pain and dysfunction.
- Muscular weakness and imbalance – The main muscles affecting the shoulder are the rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis), the bicep brachi and the pectoral major. The muscles affecting the scapula (wing bone) will also affect the shoulder. These include the upper trapezuis, levator scapulae, rhomboids, teres major, serratus anterior, pectoral minor and lattismus dorsi. Weakness and imbalance of these muscles will misalign and create stress to the shoulder joint that can lead to osteoarthritis and tendon and ligament injuries.
- Tendon Injuries – When the tendons undergo a large degree of stress or injury, they will develop tendonitis, which is inflammation of the tendons that causes pain with movement.
- Ligament Injuries – Ligaments connect bone to bone, and ensure stability of the joint. The main ligament of the shoulder joint is called the glenoid labrum. This surrounds the cavity with which the head of the humerus (main arm bone) inserts into. Physical stress and injury can damage the labrum creating tears and inflammation. Another common ligament of the shoulder which is commonly injured is the ligamentous posterior capsule.
- Abnormal Postural Misalignment – A common abnormal postural presentation is forward head posture and forward rounded shoulders. This posture will place the shoulder joint and associated muscles and tendons in weaken position which makes it prone to injury and stress. This is a very common underlying cause of shoulder pain and dysfunction.
- Neurological Stress from the Neck – The nerves coming out of the neck control the muscles affecting the shoulder joint. Compression and irritation of these nerves from osteoarthritis and disc injuries can negatively affect these nerves. Misalignment of the mid to lower portion of the neck can irritate the long thoracic nerve which will cause dysfunction to the serratus anterior muscle, which is an important stabilizer of the scapula. Misalignment of the upper neck can irritate the spinal accessory nerve which controls the upper trapezuis muscle which is also an important stabilizer of the scapula and clavicle (collar bone).
Vascular Causes: Any type of blockage or restriction of blood flow to the shoulder can cause pain, weakness, heaviness, fatigue and sensation changes. Some common conditions are:
- Thoracic Outlet Syndrome – This occurs when there is compression of the blood vessels in the region where the shoulder meets the neck. This can be caused by muscle tightness, misalignments of the bones in the neck and clavicle, and congential (born with) abnormalities such as cervical ribs.
- Avascular Necrosis (AVN) – Traumas and certain conditions can cause a lack of blood supply to the shoulder, which if left untreated will lead to bone loss and bone cell death.
Digestive Causes: Some common digestive problems can cause referred pain to the shoulder. Gall bladder problems, such as improper digestion of fats and proteins, can cause referred pain to the shoulder, which more commonly affects the right side. Liver dysfunction can also create similar symptoms. Stomach dysfunction and general digestive stress can create a situation in which the muscles of the mid to upper back with tighten misaligning the spine. This will negatively affect the muscles of the shoulder and the overall postural alignment which can lead to shoulder problems.
Hormonal Imbalances: Hormonal imbalances can create a variety of changes in the body which can, over time, affect the shoulder.
Common conditions of the shoulder:
- Shoulder Impingement – Shoulder dysfunction can create a situation in which the supraspinatis tendon becomes impinged or pinched. This commonly creates pain when a person brings their arm out to the side and toward the head. This occurs because the tendon has little room at its attachment site on the head of the humerus under the acromion portion of the scapula at the tip of the shoulder.
- Bursitis – The most common type of bursitis in the shoulder is subacromial bursits. This bursa is a fluid filled sac, that sits underneath the acromion of the scapula.
- Bicipital Tendonitis – This is inflammation of the tendon that connects the bicep brachi muscle to the shoulder.
- Sprain/Strain of the Shoulder – Sprains are injuries to the muscles of the shoulder. Strains are injuries to the ligaments of the shoulder.
- Rotator Cuff Tear – If left untreated, injury, pain and dysfunction can eventually progress to tears in the rotator cuff muscles. When severe, it can require surgery to correct.
- Adhesive Capsulitis (Frozen Shoulder) – Inflammation to the glenoid labrum can become so severe that any movement of the shoulder and upper arm causes severe pain. This condition has many causes, and is commonly associated with hormonal imbalances and repetitive injuries. This condition can take many months to over year to heal, and occasionally will require surgery. If left untreated it can result in permanent pain and disability.
If you are continuing to have problems and symptoms and you are not getting answers, then stop being frustrated! Help is available!
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