The shoulder is not just one joint but rather four: the sternoclavicular (collar bone/breast bone), acromioclavicular (the “roof” of the ball & socket joint), glenohumeral (the ball & socket joint), and scapulothoracic joints (shoulder blade/rib cage joint). There are also many structures in the vicinity that can mimic shoulder pain—namely, the cervical spine (neck), the upper half of the thoracic spine (upper back), and the rib cage.
The most common area that most shoulder pain sufferers point to is the top of the shoulder—between the neck and upper arm/shoulder joint. This may indicate dysfunction in the neck, since it can refer pain to this area. When patients point to their upper arm, the shoulder “could be” the pain generator, but more information is necessary before their doctor can make a firm diagnosis. If raising the arm above the horizontal plane (90°) hurts, it could be an impingement caused by a swollen bursa (“bursitis”), tendon (“tendinitis”), and/or a tear of the rim of the socket (“glenoid labrum tear”).
Specific orthopedic tests exist that help to differentiate between the possible causes or diagnoses but often, an MRI may be necessary to nail down a diagnosis. Unfortunately, an MRI can also show too much information, such as normal age-related changes, “silent” abnormal findings (like tears and frayed tissue that are not pain generators), which can actually make it more difficult to be sure what is causing the patient’s current shoulder pain.
When it comes to treatment, there is evidence to suggest conservative approaches, like exercises, are just as effective as surgical approaches. One review found the following:
• Subacromial impingement syndrome: Exercise is as effective as surgery at one, two-, four-, and five-year follow-ups (at a fraction of the cost of surgery).
• Rotator cuff partial thickness tears (<75%): Exercise is as effective as surgery (at a fraction of the cost).
• Atraumatic full thickness rotator cuff tears: Exercise significantly reduces the need for surgery (75%).
• Subacromial impingement syndrome: Exercise significantly reduces the need for surgery (up to 80%).
So if you suffer from shoulder pain, don’t jump to surgery as your first treatment option. Conservative treatments offered by doctors of chiropractic—such as manual therapies, exercise training, and the use of modalities—can help improve motion in the shoulder and the surrounding structures at a much lower cost and without the risks that come with more invasive procedures. Also, regardless of the treatment option you choose, keep in mind that it can take three, six, nine, or even twelve months to reach a satisfying end-point in treatment for these types of injuries.