Shoulder pain has been subjectively rated as one of the worst pains to experience. You may know shoulder pain is an uncomfortable inconvenience and can be quite severe. Not only does it hurt, but it also limits just about everything in your daily life. Trying to avoid the use of your arm can be extremely frustrating. It affects little things like washing your hair, brushing your teeth, walking your dog or flipping a pancake.
Shoulder pain can be caused by a myriad of contributing factors. This means that a thorough understanding of the nature of what causes this pain is important and getting the correct diagnosis is key.
Today, we're going to be exploring shoulder impingements. Shoulder impingement is usually the "pinching" of bone, muscle, tendon or joint structures against one another. In some instances, it closely resembles "frozen shoulder," but in all cases, the person affected with the pain can move the arm. Most notably, pain and cracking could accompany motion from chest height and up toward overhead motion.
The pinching of structures over time leads to inflammation, swelling and eventual deterioration of the joints, nerves and healthy muscle tissue/tendons. Yes, this will eventually lead to a torn rotator cuff muscle (which are small stabilizing muscles that help keep your shoulder in its socket).
How does this happen?
1. Disuse/Misuse -- "Use it or lose it"
Disuse: Normal everyday full range movement lubricates the shoulder joint and keeps the capsule healthy. If you don't utilize your arm's full range or motion, it can get tight. As a result, the next time you try to move your arm the tightened structures get pinches and don't move out of the way.
Misuse: When using your shoulder for lifting and throwing, it is likely that the muscles will overdevelop too quickly. If this happens it becomes the bigger movement muscles in the shoulder get strong than the small joint stabilizing muscles underneath. The end result s the bigger muscles change the axis of rotation at the joint. The poor axis of rotation causes the bone to bump into the other parts of your shoulder, creating grinding, popping and/or pain. This is one of those things that will later be called "wear and tear" on the joint and will eventually cause a tear if not corrected.
2. Poor shoulder blade mechanics
Did you know your shoulder blade accounts for on third of your overhead shoulder motion? If you are slouching while lifting your arms, you won't be using your shoulder blade correctly because it will be blocked by your ribs. If the muscles are weak, the extra resistance that the shoulder provides will make your shoulder muscles work harder and lead to eventual breakdown.
3. Poor posture
This is a wake-up call for all of your desk jockeys out there. Often, poor posture can set you up for a forward shoulder and head position. Poor posture means any position that doesn't have your head stacked on top of your rib cage on top of your pelvis. It includes, if you cross your legs, sit on your wallet or slouch sideways. DO DON'T DO IT. THis will create problems as you lift the arm above your shoulder height and cause the bones and joints not to mechanically glide properly.
4. Other causes such as arthritis
THere's no way to tell if you have arthritis unless you have it checked out by an orthopedic doctor. A simple x-ray will tell you this. Arthritis can cause inflammation and boy is it painful. This will also cause the pinching of structures in the shoulder.
So what should you do?
You can always try resting your shoulder. But if you've rested it for more than a week and you feel like it isn't getting better or it's getting worse, then it's probably something that will require intervention. If it's getting worse and your range of motion is progressively less than it was a few days prior, you may have some sort of inflammation in the joint.
ICE IT!
Try postural corrections: Get your posture better at the gym or just by being more aware of it. Work out those rhomboids and deep shoulder blade stabilizing muscles.
KTape: Taping may assist in decreasing symptoms. There are a lot of different taping techniques depending on where you're feeling your pain.
Acupuncture is also known to help reduce inflammation and symptoms
Don't forget to seek a Doctor of Physical Therapy who has treated this injury before. You'll often find out that what you think is a shoulder impingement may be a different pathology at the shoulder like a muscle tear or muscle strain.
Remember, we can and we will get better together.
Dr. Justin C. Lin