Shoulder pain

Is a throbbing shoulder waking you up at night? Do you find yourself wincing when reaching for something in the cupboard or in the back seat? If so, you’re not alone. The shoulder is by far one of the most complex joints in the human body. Shoulder pain is common, can affect anyone at any age, and the severity of the injury can vary significantly.

The shoulder is made up of three bones, two joints, and an intricate assembly of muscles, tendons and ligaments. It is the most flexible joint in your body, and its function is to position your hand in space. It is considered a "ball and socket" joint; however, unlike the hip, which is also a ball and socket joint, the shoulder has far less stability. The head of the humerus, or upper arm bone, sits in a very shallow socket, much like a golf ball on a tee. While this allows for a great deal of freedom and movement, the lack of enclosure predisposes the shoulder to inherent vulnerability and injury.

This vulnerability can result in many scenarios, including impingement, inflammation, instability, tearing, dislocation and even fracture. Additionally as we age, our tissue becomes less compliant, and there is a dramatic decrease in the vascular system’s response to injury, resulting in less optimal tissue healing.

Perhaps one of the most familiar shoulder pathologies involves injury to the rotator cuff muscles. Rotator cuff injuries are the most common causes of shoulder pain in the aging demographic, and left unattended, can become disabling. These injuries are frequently a result of falling on an outstretched arm, sudden ‘jerking’ on the arm, such as when walking a dog, and are particularly common in individuals involved in professions and activities requiring repetitive and excessive demands on the shoulder, such as baseball players and chiropractors)

With persistent injury comes a decreased ability of the tissue to heal in response to normal, everyday use, and even minor tearing can cause substantial pain. Depending upon the gravity of the injury, there is a specific time frame for improvement, before adhesion and fibrosis set in. After that, normal stresses trump the body’s natural ability to heal, resulting in further damage.

The goal of any treatment is to restore the damaged tissue to a functional state as soon as possible. Depending upon the phase and severity of impairment, many rotator cuff injuries can be managed without surgery. For mild to moderate rotator cuff injuries, a multimodal approach including chiropractic manipulation combined with soft-tissue treatment and appropriate exercise therapy can produce highly effective outcomes.

If the injury is chronic, Regenerative Injection Therapies including Prolotherapy (Prolo) or Platelet Rich Plasma Therapy (PRP), as well as conventional steroid injections may be helpful to interrupt the pain sequence, reduce inflammation and allow for rehabilitation. Prolo injections are a natural alternative for treating degenerative or overuse conditions of the tendons, ligaments or cartilage, and may be the treatment of choice if the patient fails to improve with other treatments. PRP is an injection procedure that employs the body’s own blood platelets. The body’s first response to soft tissue injury is to deliver platelet cells, which are rich in growth and healing factors, and initiate repair while attracting critical assistance of stem cells. And, because your own platelets are injected into the area, there’s no risk of transmissible infection.

If surgical intervention is actually required, today’s procedures can generally manage complete repair. Surgical techniques for RTC repair range from minimally invasive procedures which spare damage to healthy tissue and curb pain, to total shoulder replacement.

If you are experiencing shoulder pain, talk to your health care practitioner to ensure an accurate diagnosis. Don’t delay — help is available!

Patricia Holl, D.C., is part of the staff at Yellowstone Naturopathic Clinic. She can be reached at 259-5096.

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