SHOULDER PROBLEMS

COMMON SHOULDER PROBLEMS
WHAT TO DO ABOUT THEM

DEEP SHOULDER: FRONT VIEW

SUPERFICIAL SHOULDER: FRONT VIEW

DEEP SHOULDER: BACK VIEW

"One of the largest and earliest population-based studies that used a self-administered questionnaire was conducted by Hasvold...  The prevalence of shoulder pain was estimated to be 15.4 % in men and 24.9% in women who reported weekly episodes of pain...    Similar prevalence estimations of shoulder pain were also determined by Pope, with the total level of suffering in the community from shoulder pain to be as great as 20% of the population...  A large European-based survey from 15 countries measured chronic pain prevalence, intensity of pain and duration of pain symptoms.  In addition to these basic variables the survey also attempted to determine the impact of chronic pain on psychological wellbeing of participants, effect on work and daily living, and methods of management of the pain.  According to the authors, 19% of adult Europeans suffer from moderate to severe pain including the shoulder, which has a detrimental effect on their working and daily lives."  From Dr. Mario Pribicivic's chapter (Chapter 7 --- The Epidemiology of Shoulder Pain: A Narrative Review of the Literature) of Dr. Subhamay Ghosh's October, 2012 text, Pain in Perspective.

When you begin to understand just a little bit of shoulder anatomy, you'll begin to truly appreciate why shoulder problems are so ridiculously common, both in America and around the world.  It all starts with the fact that the shoulder is the most unstable joint in the body.  And although we refer to it as a "Ball & Socket" joint, this is not really true.  When we think of a ball and socket, we think of the hip ---- the ball of the leg bone (femur) sitting inside the hip socket (acetabulum).  The shoulder is not like this. 

In the picture below and left, you will notice that the "socket" made by the collar bone (clavicle) and shoulder blade (scapula) is not very deep.  The head of the humerus (the "ball") is held in place by lots of ligaments.  These ligaments make up what is referred to as the "Shoulder Capsule".  An intact Shoulder Capsule keeps the lubricating fluid around the joint.  And as many of you already know, all of the nerves from the lower neck run through the shoulder area, through the arm, and down to the hand.  Because of this, neck problems have the ability to closely mimic certain shoulder problems (RADICULOPATHY and TOS are a couple that come immediately to mind).

The second thing that makes shoulder problems common is the incredible numbers of LIGAMENTS, TENDONS, and MUSCLES that cross the shoulder joint.  Some of these include the four Rotator Cuff muscles, the deltoids, the biceps, the triceps, the trapezius, the pectorals, as well as many of the neck muscles.  In other words, shoulder problems are often the result of problems in tissues that you may not always associate with your shoulder.

How good is diagnostic imaging at telling us what is wrong with the shoulder?  For certain things, it is excellent.  For other things, it does not give us a lot of pertinent information.  In fact, tests like MRI will often times throw us off the trail.  Case in point is an informal study that was done a few years ago by the most famous orthopedic surgeon in the history of modern sports, Dr. James Andrews.  Dr. Andrews had a hunch that MRI's were not telling the whole story as far as his shoulder patients were concerned.  How did he test this hypothesis?  He did MRI scans on the pitching shoulders of 31 professional baseball pitchers that were visiting him for other reasons.  In other words, these guys had no known throwing problems or pain in their throwing shoulders. 

Amazingly, he found that 90% of these "healthy" big league pitchers had cartilage problems and Rotator Cuff tendon issues that showed up on MRI.  He concluded the study by making a shocking observation (I am quoting loosley here) ----- the only excuse a doctor really needs to operate on a shoulder is an MRI.  And interestingly enough, the scientific medical literature bears out what he is saying.  In fact, there are a number of studies saying that it is almost impossible to correlate many of the most commonly seen MRI shoulder findings with how much or how little pain / shoulder dysfunction a person is dealing with (HERE are some posts on the limitations of advanced diagnostic imaging).  This is probably why we have been able to help lots of people with "torn" Rotator Cuffs --- as well as more than a few people who had already been through Rotator Cuff Surgery (this one four decades previous to treatment --- HERE).

WHAT ARE SOME OF THE SHOULDER PROBLEMS THAT I CAN OFTEN HELP?

Let me go on record to say that while there are lots of shoulder issues I can help with, there are lots that I cannot.  Although I have diagnosed my share of Collar Bone Fractures (the most commonly broken bone in the body), I do not treat these.  I cannot help you with a shoulder dislocation (ball out of "socket" aka the Glenohumeral Joint).  Nor can I help with a shoulder separation (stretching out the tissue that attaches the clavicle or "collar bone" to the point of bone coming over from the shoulder blade or "scapula" called the acromian --- see above).  Shoulder dislocations usually require a visit to the ER, and shoulder separations (unless they are a Grade III --- very severe) will have to heal on their own (COLD LASER would probably be of help).  More information on these two common problems can be found HERE.

Rotator Cuff tears are something that I can often help.  This is because in so many cases, the tears are incidental findings.  In other words, just like many cases of HERNIATED SPINAL DISCS, even though there is a Rotator Cuff tear that is present on the MRI, it may have nothing whatsoever to do with a person's pain.  Because 50-70% of the adult American population has asymptomatic Disc Herniations in their low back (Disc Herniations that no not cause pain), many people who have lumbar spine MRI's are erroneously told that this is the cause of their pain.  The problem is that study after study after study says that there is little correlation to MRI findings and low back pain.  Unfortunately, the same thing is true with the shoulder. 

Just like we saw earlier in Dr. Andrews' informal study, it is extremely common for shoulder "findings" to show up on an MRI.  Be warned.  These MRI findings may have nothing whatsoever to do with your pain.  This is probably one of the biggest reasons that SPINAL SURGERY and Shoulder Surgery both seem to be a crap shoot.   Some people do great with the surgeries.  Many do not.   In virtually all cases of shoulder surgery, the rehab and recovery is long and painful.  What do I tell people about our Scar Tissue Remodeling treatment and Rotator Cuff problems?   Although it is unlikely that a single treatment is going to completely resolve the problem, you will know after a single treatment if it is going to help or not. 


COMMON SHOULDER PROBLEMS
The three most common shoulder problems I deal with are........

• FASCIAL ADHESIONS

• TENDINOSIS

• BURSITIS

I cannot even begin to tell you how many shoulder problems that I see on a day-to-day basis are caused by FASCIAL ADHESIONS and / or TENDINOSIS.  And interestingly enough, not only has most of the general population never heard of these two common problems, hardly anyone within the Medical Profession seems to be aware of them either --- especially the former.  This is because microscopic injury and scarring of the Fascia does not ever show up on an MRI.  And Tendinosis shows up so rarely we may as well use the word, "never".  It's like I've said before.  Out of sight; out of mind. 

I have written about both of these topics extensively.  Just click on the links above to read them.  You may learn something you weren't aware of ---- like the fact that the medical "powers-that-be" declared over two decades ago that there is no such thing as tendinitis ---- it does not even exist!  And as for BURSITIS; it exists alright.  But is is so over-diagnosed / misdiagnosed that you would think it were a common problem.  Again, click on the link and start reading.

If you are wondering if your shoulder problem might be helped by what I do here in my clinic, just call us at (417) 934-6337.  We are in Mountain View, Missouri about a half hour drive from West Plains.  We are centrally located about an hour and a half drive from Springfield, Poplar Bluff, Rolla, and Mountain Home, Arkansas.  For those of you traveling to see us, our contact information can be found HERE.