Chiropractic Treatment For Shoulder Pain
After lower back pain, shoulder pain is by far the next most common complaint that we see in our office. The assessment of a shoulder complaint begins with simple observation of the patient. The upper extremity should move evenly and in harmony with the opposite lower extremity. Normal shoulder motion has a smooth, natural quality. Abnormal motion is jerky or distorted, and often represents the patient’s attempt to substitute an inefficient motion to reduce pain. One of the most effective ways to identify the presence of abnormality is to simply compare one shoulder to the opposite side.
Examination proceeds to palpation of the bony elements of the collar bone, sternum, shoulder blade and the upper arm (humerus). Examination of the soft tissue elements includes the rotator cuff, the bursa, and the prominent muscles of the shoulder girdle. Completing the soft tissue assessment, the examination proceeds to active and passive range of motion. Active range of motion is what the patient can do on his/her own. Passive range of motion is achieved with assistance of the examiner.
The neurological portion of the examination permits assessment of the strength of each group of muscles that moves the shoulder joint. It may also indicate the degree of muscular weakness that could restrict range of motion. In addition to muscle testing reflex and sensation tests allow for further determination of the integrity of the nerve supply to the shoulder. Other special tests pertain to the anatomy and pathologic condition of each joint. These tests are designed to uncover certain pathologic conditions.
X-ray examination of the shoulder is based on the suspected underlying pathology. Depending on the structures or suspected conditions specialized x-ray views may be necessary. MRI can be a valuable tool when patients are unresponsive to conservative care. However, many patients have been found to have rotator cuff tears that have remained without symptoms. Therefore, caution should be used when using MRI as the only indicator for need of operative repair. Cat Scan and diagnostic ultrasound can be excellent tools for detecting rotator cuff tears.
Our chiropractors can play a valuable role in the conservative management of many non-pathological conditions for shoulder pain. In the event of a dislocation, it will require a specific maneuver to relocate the shoulder. Relocation may be difficult and will require and emergency department referral. If x-ray reveal signs of infection, fracture, or tumor, orthopedic consultation is indicated. All other problems can be addressed conservatively unless the patient’s pain threshold does not allow a nonmedicated course.