There is no universal definition of shoulder pain and Shoulder pain treatment. Shoulder refers to the articulations of the scapula, clavicle and humerus together with the ligaments, tendons, muscles and other soft tissues with a functional relationship to these structures. An expert chiropractor can treat you and relieve you from shoulder pain. There are quite a lot of chiropractors in Dubai, UAE who have come up with great facilities recently. Nightingale Health Services is one of them.
It has to be determined whether the disorder causing pain arises from within the shoulder structures or from other sources such as the cervical spine, the acromioclavicular joint or diseased organs, especially heart, lungs and subdiaphragmatic structures.
What are the common causes of Shoulder pain?
- myofascial pain syndrome
- cervical dysfunction with referred pain
- cervical radiculopathy
- supraspinatus tendinosis
- adhesive capsulitis
- subacromial impingement syndrome
- supraspinatus tendon tear or rupture
- acute bursitis
- calcific tendinitis
- glenohumeral arthrosis
- thoracic outlet syndrome
- acromioclavicular joint osteoarthrosis
- biceps tendinitis
- visceral referred pain
How to evaluate the patient with Shoulder pain complaint and do a Shoulder pain treatment?
The initial evaluation of a patient with a shoulder complaint should begin with a thorough history of the problem, including description of each of the following:
- duration
- onset – acute or chronic
- activity or mechanism at time of onset
- activities that relieve or exacerbate
- patient’s age
- past history of trauma or injury
- past history of shoulder/arm surgery
- treatment attempted
- other medical conditions (especially diabetes, thyroid disease, coronary artery disease, alcohol abuse and use of corticosteroids)
DIAGNOSTIC HISTORY CLUES FOR SHOULDER PAIN
| History | Associated condition |
| Age | Less than 40 years: instability, rotator cuff tendinopathy Greater than 40 years: rotator cuff tears, adhesive capsulitis, glenohumeral OA |
| Diabetes or thyroid disorders | Adhesive casulitis |
| History of trauma | Less than 40 years: shoulder dislocation/subluxation Greater than 40 years: rotator cuff tears |
| Loss of ROM | Adhesive capsulitis, glenohumeral OA |
| Night pain | Rotator cuff disorders, adhesive capsulitis |
| Paraesthesia and arm pain past elbow | Cervical spine etiology |
| Pain location | Anterior-superior shoulder pain associated with AC joint pathology Diffuse shoulder pain in deltoid region assoc with rotator cuff disorders, adhesive capsulitis or glenohumeral OA |
| Pain with overhead activity | Rotator cuff disorders |
| Sports participation | Instability associated with overhead sports and collision sports |
| Weakness | Rotator cuff disorders, glenohumeral OA |
Key history questions:
- Did you have any injury, even very minor, before your pain started?
- Does the pain keep you awake at night?
- Do you have pain or stiffness in your neck?
- Do you have pain or restriction when clipping or handling your bra or touching your shoulder blades? (Suggests limited and/or painful internal rotation)
- Do you have trouble combing or attending to your hair? (Suggests limited and/or painful external rotation and also a disorder of the capsule)
- Do you get pain on walking or with some stressful activity?
- Is the pain worse when you wake in the morning? (Indicates inflammation)
- Do you have aching in both your shoulders or around your hips? (Could suggest PMR).
- Do you get pain associated with sporting activity, including weight training, or with
- housework, dressing or other activities?
SHOULDER PAIN IN CHILDREN
Shoulder pain is not a common presenting problem in children, but the following require consideration:
- Septic arthritis/osteomyelitis
- Swimmer’s shoulder
SHOULDER PAIN IN THE ELDERLY
Most of the more common shoulder problems increase with increasing age. Particular disorders to consider in the elderly are:
- Polymyalgia rheumatica
- Supraspinatus tears and persistent ‘tendinitis’
- Other rotator cuff disorders
- Stiff shoulder due to adhesive capsulitis
- Osteoarthritis of acromioclavicular and glenohumeral joints
- Cervical manipulable lesion with referred pain
- Avascular necrosis of the humeral head