doctor with patient

Are you living with shoulder pain?

woman with shoulder pain
May 7, 2019

Are you living with shoulder pain? If so, you are in good company. According to statistics, approximately 26% of the adult population seek care for pain in the shoulder and up to 70% of people will experience clinical shoulder pain in their lifetime.[1] This makes shoulder pain the third most common complaint in musculoskeletal clinical setting.[2] There is a large number of potential causes of shoulder pain and they are diverse; from postural issues to gallbladder inflammation to cardiac issues, a thorough history and physical examination are vital to correctly addressing the root cause of the problem.

Let us briefly discuss the anatomy of the shoulder:

!(https://redtailhealth.com/wp-content/uploads/2019/05/shoulderpain.png)The shoulder joint involves three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).

The shoulder is actually comprised of two separate joints that work together to provide your shoulder with its flexibility and mobility.

The joint that most people think of when describing the shoulder joint is the glenohumeral joint. This is a ball and socket type joint featuring the head of the humerus (ball) and the glenoid fossa (socket). The acromioclavicular joint (AC joint) is formed by the distal end of the clavicle and a part of the scapula called the acromion. This joint is commonly injured with overhead activities.

The glenohumeral joint is home to a layer of cartilage called the labrum. The labrum serves to provide padding between the bones so they can articulate smoothly. Also contributing to this smooth movement are small fluid filled sacs called bursae. The bursae produce fluid that helps lubricate the joint and prevent friction.

!(https://redtailhealth.com/wp-content/uploads/2019/05/shoulderpainboulder.png)There are nine major muscles that act on the shoulder joint, but the four smallest of these muscles account for more than two thirds of cases of shoulder pain. These four muscles are collectively called the rotator cuff. They are supraspinatus, infraspinatus, teres minor, and subscapularis.

All of the muscles of the shoulder, as well as the muscles of the arm and forearm, are controlled by the brachial plexus. The brachial plexus is a network of peripheral nerves that runs from your neck all the way down to your fingers. When people say they ‘hit their funny bone’, they actually mean they hit their ulnar nerve, which is a branch of the brachial plexus.

The primary movers of the shoulder joint are the pectoralis major, latissimus dorsi, and deltoid muscles. As these three muscles move the humerus on the scapula, the rotator cuff muscles work like a seatbelt to make sure the joint stays stable and does not move in a way that would result in injury (i.e. dislocation).

Misalignments in the spine or the shoulder itself can place increased wear and tear on the small muscles and tendons of the rotator cuff. If this persists for long enough, a tear or strain can occur. Once there has been an injury to the rotator cuff, that shoulder becomes prone to damage and degeneration. Repetitive tasks either overhead or with the arm extended back fully should be limited and are consistently linked with damage to the shoulder joint and should be very limited, especially at work.[3]

Rotator cuff injuries themselves are notoriously painful; there are specific scales that have been developed, such as the Western Ontario Rotator Cuff Index, that measure not only physical pain, by the associated psychological factors that can arise with a rotator cuff injury.[4] Research has even shown psychological factors to be a consistent indicator of how well patients recover.[5]

With so many muscles and tendons crossing and attaching to the shoulder joint, it is possible for them to become trapped by other tissues. This is called impingement syndrome. Patients with impingement syndrome have difficulty lifting their arms up overhead or lying on their affected side. They generally complain of consistent pain without any trauma to the region. Inpingement can progress to frozen shoulder or adhesive capsulitis if it is not correctly diagnosed and treated.

Impingement syndrome is often associated with rotator cuff issues. There is somewhat of a chicken or the egg debate in the healthcare community over whether rotator cuff injury causes impingement, or if it is the other way around.[6] Impingement syndrome is also associated with inflammation of the bursa, which further complicates the picture. As the bursa becomes swollen, it encroaches on the space that should be open for the tendons. This also interferes with the bursa providing proper lubrication for the joint, leading to damage to the joint.

Injuries to the shoulder can also damage the brachial plexus. Nerves are more susceptible to damage from physical compression or stretching than muscles, or ligaments (i.e. hitting your funny bone, ulnar nerve). When the brachial plexus is damaged, patients often complain of numbness and tingling in the affected arm. Clinical research has shown a correlation between brachial plexus injuries and issues with the rotator cuff.[7] This correlation further demonstrates the importance of the rotator cuff to shoulder health.

So what can be done for a rotator cuff injury? Well our very own Dr. Ian was faced with this same question when an MRI of his shoulder revealed degeneration as well as a tear in his subscapularis tendon about a year ago. Being a chiropractor requires him to use his arms and be active to be best able to help his patients. He also wanted to avoid the down time associated with recovering from surgery.

Maybe you have heard of corticosteroid injections for joint pain. This is commonly done for these types of injuries. Unfortunately, this type of injection simply reduces the pain, but can accelerate the degenerative process, making the damage happen at a faster rate (surgery is also statistically higher when they are used). It can also lead to side effects such as GI upset, osteoporosis or heart attack.[8]

Surgery was the next option. With the prolonged recovery process, risks associated with going under anesthesia, as well as the wide variance in shoulder surgery success rates, this was quickly ruled out as well.

It was then that a colleague of Dr. Ian’s made a recommendation that changed his life!

Mesenchymal stem cells (MSC’s) have provided doctors with a revolutionary ability to regenerate tissue within the shoulder. Dr. Ian saw positive results within 1 week, and after a few months had regained full range of motion and strength with no pain.

In our office, we use MSC’s derived from healthy (exhaustively screened with 20 tests) umbilical cord tissue. There are several benefits to this as opposed to using stem cells harvested from one’s own body. First off being that stem cells decrease as we age, therefore the concentration in a newborn’s umbilical cord is exponentially higher. Another factor to consider is how active these stem cells are. You are born with all the stem cells you will ever have, and as you age, this declines rapidly. Your stem cells in your body are as old as you are. Stem cells derived from umbilical tissue are still fully charged and have been shown to replicate on a much higher level.

In summary our stem cell product is more potent and easier to use. To find out more, and potentially save $500 or more on your stem cell injections, come out to one of our group consultations or read more of our blog posts.

Our office phone number is (303) 882-8447.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127806/#B2

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729225/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119373/

[4] https://www.ncbi.nlm.nih.gov/pubmed/25801922

[5] https://bjsm.bmj.com/content/52/4/269

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729225/

[7] https://www.ncbi.nlm.nih.gov/pubmed/25143507

[8] https://www.ncbi.nlm.nih.gov/pubmed/10787466

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