John (who is in his 50’s) started coming to the clinic suffering from shoulder pain and weakness that has been bothering him for years. He noticed that his left shoulder was getting progressively weaker and he was beginning to feel some pain traveling down his arm. He works in an office, spending hours at a computer, but he is also very active outside of work, going to the gym everyday, running, biking and volunteering his time coaching High School wrestling.
He was beginning to fear that his shoulder pain was not going to get better without surgery and that he was going to have to stop coaching the High School wrestling team. He was worried about the weakness in his arm and was performing extra bicep curls and push ups while at the gym to try to help make his left arm stronger. All that extra work seemed to make his shoulder pain and weakness worse.
He came into the Tidewater clinic and was given a full exam by Dr. Garcia. Here are a few things that were noted from the exam:
Poor posture of his head and shoulders while sitting and standing
Reduced range of motion and pain in the left shoulder and neck
Full strength was noted in all extremities
Spasms and trigger points in the neck and upper back musculature
No neurological findings or red flags were found during the exam
After the exam, we discussed the findings from the evaluation and prognosis for his condition. We addressed some of John’s concerns, which included his desire to avoid surgery and his goal to continue to volunteer as a coach. Since he lived an active lifestyle, his condition was troubling for him physically and mentally. Not being able to participate in the activities he loved and seeing the decline in his overall fitness was very stressful.
The shoulder is a large joint and many things can happen and cause pain in this joint. Here are a few conditions we typically see in the shoulder:
Impingement syndrome: Many different structures in the shoulder can be involved in impingement syndrome of the shoulder and can affect exactly where you feel the pain. Often these patients participate in a sport or work activity that requires a lot of reaching overhead (for example, house painting or wrestling). (Sousa, 235)
Glenohumeral Labral tears: This condition may occur from a traumatic incident such as falling forward onto your arm or an anterior dislocation of the shoulder, but this is not always the case. This is usually pain that is felt deep in the shoulder joint. (Sousa, 218)
Cervical radiculopathy: Believe it or not, the pain in your shoulder or arm may be coming from your neck. Many things can cause this condition and they can range from the traumatic (like a car accident), to the gradual ( such as poor posture). This condition can cause pain that travels all the way down your arm and into your fingertips, depending on the severity of the case. (Sousa, 75)
Adhesive capsulitis (frozen shoulder): This condition usually occurs in older individuals and can be very painful, leading to the lack of use of that shoulder. As the pain begins to subside, the patient might notice that the motion in their shoulder is very limited. (Sousa, 242)
John was diagnosed with an impingement syndrome, though there were a few other issues we wanted to work on with him. While discussing the treatment plan with John, we talked about how we could help him achieve his goals by employing chiropractic care, Myofascial Release Techniques, Trigger Point therapies and at home rehab exercises.
We got John treated that day, adjusting his neck and mid back. We performed muscle work on some of the neck and shoulder muscles to help reduce the trigger points and muscle adhesions that had formed. Before John left the office, he was given a few doorway stretches for the pectoral muscles and given postural corrections to work on at home. He was also advised to avoid pushing exercises and bicep curls at the gym.
In a week, John noticed that he was feeling less pain in his shoulder and bicep. He was able to work at his desk for longer periods at a time without experiencing the same level of shoulder pain he did before.
After John’s first week of treatment, we began to introduce some postural exercises and back strengthening work. He was asked to perform rowing exercises and Brugger's postural exercises.
After less than 3 weeks, John has noticed that his shoulder pain has been greatly reduced. He has returned to coaching and has noticed that he is able to work without any shoulder pain. John continues to perform the stretching and posture exercises to help prevent his shoulder pain from returning. He has kept up with wellness visits to help insure he is functioning at peak performance.
John says, “ My shoulder has never felt better. I could tell after the first visit that the pain was getting better and after sticking with the exercises and chiropractic treatments, I feel like I am more active than I was before and my performance is better. Thank you Tidewater.”
SOUZA, THOMAS A. Differential Diagnosis and Management for the Chiropractor. fourth ed., JONES & BARTLETT LEARNING, 2009.