Chronic Shoulder Pain

Chronic shoulder pain has the ability to take over someones life. The shoulder, as seen in the shoulder pain page ,is a very unstable ball-n-socket joint. Yet, it has the ability to withstand tremendous force generation. If you have shoulder pain the best time is now to seek treatment.

What you don't want is the pain to become chronic. As a health care provider we are constantly trying to understand shoulder pain syndromes and better treatment methods for patients. Chronic shoulder pain is very clinically misunderstood by practitioners because pain gets referred to the shoulder in many conditions by various parts of the human anatomy.

Chronic shoulder pain is usually amassed by many years of overuse to the shoulder joints as well as poor posture syndromes. When I say poor posture syndromes I am usually talking about the normal seated posture (slumped over a desk at a computer). Along with this seated posture comes overuse of the dominant arm with repeated mouse use.

Acromio-clavicular (AC) joint osteoarthritis is often related to rotator cuff degeneration. The patient will usually have pinpoint pain over the AC joint. There will be crepitus in the joint and the distal clavicle could be enlarged. The patient has pain during the last 30-40 degrees of abduction or flexion which is called the painful arc. The patient will also experience a positive O’brien test.

The bench and military presses have been strongly implicated as causes of isolated destruction of the joint. To explain this a little further...when the barbell is loaded with weight and lowered down towards the chest the scapulae (shoulder blades) lose their normal biomechanical function due to being blocked by the bench under the lifter. This places tremendous force upon the AC and other joints in the shoulder.

The labrum is often injured with falling on an outstretched hand or overhand throwing athletes. When torn an audible “clunk” can be heard and is reproducible. Aside from the “clunk” many patients do not have a sense of pain due to lack of nerve innervations.

Problems worsen with the arm above 90 degrees of flexion/abduction with combined rotation. Generally, the labrum tears off the rim during dislocation which is a Bankart or reverse Bankart lesion. The labrum usually requires surgery for complete healing.

The long head of the biceps inserts onto the superior portion of the glenoid labrum. This structure is often injured in athletes and is called a “SLAP” tear. The biceps tendon exerts large tensile forces on the superior labrum. Biceps tension sets the stage for the labrum to “peel back,” off the glenoid.

Throwers can complain of a “catching,” or “popping,” sensation with overhead activity. O’brien and Andrew supine test are usually positive in this injury. Surgery is almost an absolute measure. Posterior capsule tightness is sometimes responsible for the “peel back."

Adhesive capsulitis is also known as "frozen shoulder" this condition is usually caused by injury with lack of movement of the shoulder joint. Inflammation, adhesions (bands of scar tissue), and lack of synovial fluid can give the shoulder an immovable feeling.

Patients will be unable to move the shoulder in normal motion patterns due to these changes. The motions will feel restricted. After a patient has surgery to the shoulder, frozen shoulder can set in when proper rehabilitation has not been taken seriously. Treatment should be centered around restoring lost motion and treating the muscles for normal function.

SBI!