When Shoulder Pain Is Not A Shoulder Problem

By Dr. Brian Lanoue

Move By Design

Having a tough time solving your shoulder pain?

It could be the rotator cuff. Maybe it’s the shoulder joint itself?

It could also have nothing to do with the shoulder at all. Hmmm.

Here’s how to know when shoulder pain is not a shoulder problem, what the real culprit could be and how to start fixing it.

ANATOMY

The shoulder joint is formed where the humerus (upper arm bone) fits into the scapula (shoulder blade), like a ball and socket.

The shoulder has several other important structures as well:

  • The rotator cuff is a collection of muscles and tendons that surround the shoulder.
  • The bursa is a small sac of fluid that cushions and protects the tendons of the rotator cuff.
  • The labrum is a cartilaginous cup for the ball-like head of the humerus to fit into.

Intimately connected to the shoulder are the structures of the neck.

The nerves that exit between the cervical vertebra feed and receive input from many of the tissues and structures in and around the shoulder area.

Needless to say, the shoulder is one of the most complex joints in the body.

PAIN

To understand how to solve a problem that is eliciting pain, it’s necessary to understand (somewhat) pain itself.

When it comes to pain, it sure feels like pain is a problem… but pain is actually a subjective experience, it’s a symptom, a signal.

Such as the case in a heart attack.

Damaged heart tissue from a myocardial infarction leads to pain we often associate with the condition. However, it’s common knowledge that an intervention aiming only to reduce pain will not solve the problem that lead to it.

To make matters more complicated, the site of damage is rarely where pain is perceived. This is known as referred pain.

WHEN SHOULDER PAIN IS A SHOULDER PROBLEM

There are times when the main source of shoulder pain is primarily a shoulder problem.

Most often the rotator cuff (tendons and muscles that stabilize the joint) develops wear and tear with age and abuse making it more susceptible to injury.

Some typical signs include:

  • Pain in the shoulder itself or on the outside of your upper arm.
  • Dull and aching pain.
  • Pain occurs when you reach overhead or behind your back, or when lifting.
  • Pain radiates into the upper arm, but not past the elbow.
  • Persists at night.
  • Improves when you rest your arm.

WHEN SHOULDER PAIN IS NOT A SHOULDER PROBLEM

More often than not, a persistent shoulder problem that is not recovering through rehabilitation of structures around the shoulder area or with rest, is in part or in whole… a neck problem!

Some of the more likely signs are:

  • Pain radiates to your shoulder blade, or close to or on the side of your neck.
  • Electric-like, stabbing, burning or tingling pain.
  • Radiates down past your elbow or even into your hand.
  • Persists at rest.
  • Radiates down your arm when you extend or twist your neck.
  • Is relieved when you support your neck.

WHAT TO DO ABOUT IT

Diagnosing shoulder pain and uncovering the contributing factors is difficult for even the most experienced clinician.

Unless a trauma or fall is the obvious cause, a problem within the shoulder itself is much less than common than one would expect.

In looking to the neck as one potential factor, a comprehensive assessment will typically show:

  1. A structural distortion and rounding of the thoracic spine (mid-back) that causes a forward tilt of the shoulder blade.
  2. An Anterior Spinal Distortion of the neck contributing to the tightness of the musculature around the shoulder blades.
  3. Irritation and increased sensitivity of the neck nerves that provide sensation to the shoulder joint and power on the muscles of the shoulder.
  4. Reduced movement of the shoulder blade placing additional movement strain on the shoulder joint.
  5. Immobility of the lower cervical vertebra.
  6. Decrease grip strength unilaterally.

When a clearer picture of a shoulder problem comes to light and it includes a contribution from the cervical spine, the best solution to recovery is a multipronged approach.

  1. Bio-Structural Restoration (schedule a consultation with one of our doctors)
  2. Cervical, Thoracic & Scapular Corrective Exercises
  3. Soft Tissue Therapy
  4. Shoulder Stabilization Training

Whether it’s chronic pain in the shoulder, neck or even both… it’s best to see an expert as soon as possible.

Without addressing the real problem, you run the risk of ongoing deterioration and negatively impacting other body parts and functions you may never have thought could be related.

Have you ever had a shoulder problem that was really a neck problem? What did you do about it?

Dr Brian Lanoue is a Life By Design Chiropractor, blogger and speaker on achieving extraordinary health. It is Brian’s passion and mission to empower you, your family and your community to live extraordinary lives. Brian co-owns The Powerhouse Chiropractic in beautiful Vancouver, BC, Canada with his wife Thea.