You can’t sleep at night on one side because your shoulder hurts, you start carrying things differently to avoid discomfort, you need help to reach for things on high shelves. These are all signs of rotator cuff problems.
The shoulder is a very dynamic joint, able to move in all directions and with that comes rather lacking stability if the muscles are weakened. The shoulder is held onto the body by really only one joint, the acromioclavicluar joint (A.C.) as we refer to it sometimes. The upper arm bone (humerus) attaches to the shoulder blade (scapula) at a place we call the glenohumeral joint. (G.H. joint for short. There are many problems that can occur in this very complex and flexible structure.
There are a few issues that come up commonly with the shoulder; labrum tears, (the GH joint), AC separations, rotator cuff injuries, strains, sprains, and even dislocations… not to mention fractures.
The rotator cuff comprises four muscles we like to call the “SITS” muscles. Just a fancy acronym for the names (Supraspnatus, Infraspinatus, Teres, and Subscapularis) Now, for you anatomy buffs out there you have noticed I put ‘teres’ rather than more specific Teres minor… well, I have good reason for that … I will get into that later.
So what can you do?
The first thing we have to do is determine if the injury is acute or chronic. An acute injury is generally new, less than a week say. A chronic one is obviously more than a week old. Muscles and the connective tissues act differently in each stage of an injury. For example, acute swelling can be controlled by a simple cold pack and reduce the amount of activity you are doing with your arms. A chronic injury to muscle and ligament will have scar tissue, adhesions, changes in the fibers of muscle, which will cause weakness and pain.
The first thing that I check is the alignment of the shoulder; how the shoulder joint is set in place, how the shoulder blade rides on the back etc. With that we can get a good idea of which muscles are to blame for the trouble. Next we need to test each muscle for its relative strength. No, you don’t have to lift weights or anything, I just want to see that the muscle is working. if it is not holding up to its job, we have to look at the possibility of nerve problems in the shoulder girdle or neck. The neck is a common start of shoulder problems because of the nerves and attached muscles to the shoulder.
Once we have discovered what the problem is related to, we can decide on the most appropriate treatment.
Some techniques that I have found to work on these types of injures. Many therapists and doctors may try one or two here.
1. Gentle manipulations and adjustments to help realign the joint so that the muscles can relax and do the job they were intended to do.
2. Cross fiber massage helps to reduce adhesions and scar tissue giving each muscle better range and healing ability.
3. Triggerpoint therapy helps reduce toxins in over tight muscles and allows fresh blood in to clean and nourish the area. (This is generally part of medical massage)
4. Electrical stimulation Therapy helps improve blood flow, reduce pain, and relax muscle.
Differential diagnosis, means to consider and look into the different possibilities of cause. Could it be a heart condition that is referring to the left shoulder? Could it be a gall bladder if it is the right shoulder referring? These are important to consider, anyone that is working on you should know enough to check. The treatment that is best is sometimes something entirely different.
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