Shoulder injuries are widespread and account for over 6.5 million ER visits per year in the US. That’s not including chronic issues, which are more common in the shoulder than acute injuries. The joint as a whole is very mobile yet often unstable, which helps explain the many injuries. The shoulder complex is actually made up of three joints, from three bones and 17 muscles. The bones are the clavicle (collar bone), scapula (shoulder blade), and humerus (upper arm bone). The three joints are the glenohumeral, the acromioclavicular, and the sternoclavicular. The glenohumeral joint is between the humerus and the scapula, and this is what most of us think of when we talk about the shoulder: the ball-and-socket joint. The acromioclavicular or the AC joint sits right above the glenohumeral. It is formed by the upper end of the clavicle and a portion of the scapula called the acromion process. This is the joint that is injured when you “separate your shoulder”. The last joint is often forgotten, yet it is essential. The sternoclavicular or SC joint is made from the other end of the clavicle and the sternum. When you tuck your chin to your chest, your chin is touching the SC joint. This is the only joint that connects your upper extremity (arm) to the axial skeleton.
We don’t need to go through all of the individual muscles, but understanding a few groups will be helpful. The first is the rotator cuff muscles. The rotator cuff is actually made up of 4 different muscles, the Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis, or the SITS muscles for short. These muscles help keep the humerus in the glenoid fossa, forming the glenohumeral joint. The “ball” is too big for the “socket,” so this joint looks more like a golf ball on a tee. As the humerus rotates, the SITS muscles all keep the “ball” from rolling off the tee or “socket”. The other muscle group we need to know is the scapular stabilizers. This is a group of muscles that all stabilize the scapula. The scapula is almost free-floating on your back, with very few bony attachments. Because of this, many muscles attach and hold it together. In the office, I often refer to the scapular stabilizers as the “core” of the shoulder.
Shoulder injuries are usually very complex and rarely have a simple answer. That’s why we mix multiple treatment types to help patients get the results they deserve. It’s more than just one injection for pain. It’s more than just a “simple” surgery to “clean out” the joint. We will treat the entire joint and the entire person, helping them reach the goals they set. Shoulder injuries can be daunting and scary, but they don’t have to be.
$99 New Patient Special
Includes consultation, exam, doctors report of findings, PosturePro analysis, and first adjustment.
How Our Care Plan Works
1. Better
No matter where you start, we can improve together. The first phase focuses on making progress in your current ailments. Typically, this means alleviating pain and helping you return to your daily activities as smoothly and quickly as possible.
2. Stronger
Now that you’ve made progress, how do we KEEP it? We’ve all experienced improvements, only to regress when our focus shifts. This phase empowers your body to sustain the hard-earned progress you’ve worked so diligently to achieve.
3. Healthier
True HEALTHcare! So often, we are only concerned with our sickness and dysfunction, seeking treatment only when we experience symptoms. This is SICKcare. During the healthier phase, we focus on your overall health and maintaining your well-being.
How We Treat Shoulder Pain in Fuquay-Varina, NC
Since the shoulder is a major joint that is used frequently with day-to-day activities, it is very common to experience pain and discomfort. Untreated shoulder pain will get much worse over time if left alone. Don’t suffer any longer. Book your appointment today to get started with care!
Comprehensive Consultation and Exam
Shoulders are complicated. There’s a laundry list of things that can go wrong with the shoulder. Some are minor issues; others are larger. Our New Patient appointment always starts with an office tour and introduction to our staff. We go through a comprehensive consultation, making sure you give every detail of what’s going on and how it’s affecting your day-to-day life. We guarantee that by the end of this, you will feel heard. We then move into a thorough examination. Ruling in and ruling out everything we can to get to the bottom of what is causing your shoulder issues. We will also work together to set goals. Making sure we have a clear path to what you want out of care.
Following this first appointment, we will have a Report of Findings and a treatment plan in place to help you reach your specific goals. All of this is discussed with you, making sure you have a complete understanding of your condition and how we need to treat your case specifically.
Digital X-Rays
X-rays are a safe and effective way to rule out fractures and dislocations. One of the most significant benefits of X-rays is how quickly they can be performed and read. This can be done on the same day as an examination, and we get results back very quickly. One of the limits to X-rays is that you can’t see soft tissue, meaning muscle and ligaments. Because of this, X-rays are effective for detecting fractures or dislocations. For shoulder issues, you can see a broken bone, a dislocated shoulder, or a separated shoulder (sprained AC joint). Another limitation is that it’s a two-dimensional snapshot of a single moment in time. Meaning there are limits to what we can and cannot see in a set of X-rays. Following our examination, X-rays may be necessary to obtain a precise diagnosis and create an appropriate plan to help a patient meet their goals.
Specific Chiropractic Care in Fuquay-Varina, NC
A significant benefit of chiropractic care is that we look at the whole patient, not just the presenting symptoms. For example, if a patient presents with shoulder pain, we will perform a shoulder examination. But we will also examine their cervical and thoracic spines. This is because changes in their biomechanics in either of those areas can also cause significant issues with the shoulder. So, the patient may present with shoulder pain, but the shoulder may not be the cause; it could be a cervical spine subluxation. A perfect example of this is posture. Many people have poor posture, with their shoulders rounded forward and their heads shifted forward. These patients often present with pain at the top or along the outside of the shoulder. During our examination, we will identify the cause of those symptoms and treat them accordingly.
Subluxations are any change in a joint’s ability to move or function freely and fully as it is intended to. These subluxations can also be called segmental joint restrictions, misalignments, and other synonyms. Adjustments will restore proper motion through these joints and, therefore, regain communication through the nervous system.
Chiropractic will look at the entire patient, unlike most conventional models of shoulder treatment. We are also going to treat the root cause of your shoulder pain, not just play whack-a-mole with the symptoms.
Shockwave Therapy
Shockwave therapy uses both pressure and sound to create a pulsing pressure that penetrates through soft tissue. These shockwaves are used to break up scar tissue and inflammation, thereby promoting blood flow and healing in the muscles, tendons, and ligaments in the area.
Shockwave feels like a mixture between a massage gun and a TENS unit. When using this modality, patients often notice immediate results, such as decreased pain and increased range of motion. Treatments are rapid and usually complete within 5 minutes, but allow the body to work through the healing process for the next 3-5 days. Significant changes from just a few minutes of treatment!
This works exceptionally well for strains or muscular imbalances. Patients with significant trigger points in their upper traps love shockwave therapy because it’s highly effective in that area.
Dry Needling
Soft tissue work is crucial for restoring proper motion and stability with a joint, but especially the shoulder. The shoulder requires many muscles to work together to create stability. Any imbalance in one of these muscles will trigger a cascade, disrupting the rest of the shoulder. We have multiple soft-tissue modalities to break down trigger points and scar tissue, allowing proper range of motion to return. Our top treatments are shockwave therapy, dry needling, and instrument-assisted soft tissue mobilization.
Dry needling is performed with a thin, solid needle inserted directly into the muscle belly. What this needling does is create an inflammatory cycle directly in the muscle and tendon where the needle is inserted. This inflammatory cycle means that for the next two to three days following treatment, your body will work through the healing process, clearing away the inflammation and tension.
Instrument-assisted soft tissue mobilization (IASTM) uses a stainless-steel tool to scrape the muscle and fascia. We often joke that the tool looks like a fancy butter knife and is scraped along the muscle belly, breaking down scar tissue and allowing the body to heal the area properly.
Both of these modalities are used to treat muscular imbalances around the shoulder; the specific treatment is patient-dependent.
Custom Therapeutic Exercise Plan
Motion is lotion. Training the muscles and joints around the shoulder is invaluable in diminishing and eventually eliminating shoulder pain. As part of every patient’s treatment plan, we include a list of stretches and exercises. There must be proper mobility and stability in the thoracic spine, cervical spine, and around the shoulders. The stabilizing muscles around the shoulder blade have a specific group name: the scapular stabilizers. Most of us know that core stability is crucial for low back stability. Well, I refer to the scapular stabilizers as the “core” of the shoulder and arm. If there’s no stability there, then you drastically increase the risk of injury in the entire upper extremity. Having proper stretches to target the tight muscles, as well as simple at-home exercises to strengthen the weak muscles, helps create that stability. Muscle imbalances are often created by or made worse by Subluxations. Adjustments and the removal of these subluxations increase the proprioception (communication between the brain and body) to each of these joints. Each care plan we create includes diagnostic-specific corrective exercises designed to help improve the stability that each patient needs.
Deep Tissue Laser
Deep Tissue laser, or the more specific term photobiomodulation, uses infrared light to penetrate 2-3 inches into the patient. This light does three things: it increases ATP production, improves oxygenation, and increases circulation. Our bodies naturally heal themselves through the inflammatory cycle. Once our body experiences trauma or an injury, it responds by recruiting more blood cells to the area to deliver more oxygen, as well as specific cell types, such as macrophages and leukocytes, to remove the debris. It takes a significant amount of energy to cycle through this process. So what the laser does is take the same healing process our body already has and supercharge it. So, areas that experience trauma or injury can heal significantly more quickly. Areas that don’t heal well due to a lack of natural blood flow, such as ligaments and discs, respond well to deep tissue laser therapy, enabling them to recover more effectively and efficiently.
Deep Tissue laser applied to the skin and muscles of the shoulder will create a deep, warming sensation. This warming feeling may last for a few hours following treatment. Some patients notice an immediate decrease in pain, but most patients report more lasting improvement following three to four treatments. Shoulder injuries, such as labrum tears and sprains, are notoriously difficult to heal due to decreased blood flow to these tissues. This is why Deep Tissue Laser works so well for shoulder injuries.
Common Causes of Shoulder Pain in Fuquay-Varina, NC
Bursitis
What is a bursa? A bursa is a fluid-filled sac that is made to help a tendon and/or joint move more easily. Their purpose is to reduce friction with movement. -Itis is a suffix that means inflammation or inflamed. So, Bursitis is simply an inflamed bursa sac. Because the shoulder is such a mobile joint, it has five primary bursae that aid in proper movement. Any of these bursae can become inflamed, leading to bursitis. Most patients describe bursitis as dull or aching pain, occasionally burning. This pain is typically worsened by movement and can sometimes cause tenderness, swelling, or a warm feeling in the joint.
To treat bursitis, you first need to decrease the inflammation around the irritated bursa. We do this through laser and shockwave therapy. Once this inflammation is under control, you need to correct what first irritated. This is usually some sort of muscular imbalance. This could be a tight or weak muscle, or a combination of both. This is addressed through a personalized rehabilitation program to correct any imbalances.
And throughout this treatment, we will be adjusting the shoulder, thoracic spine, and cervical spine. Any changes in the range of motion of these joints will create further issues, either continued bursitis symptoms or something more sinister. Adjustments will correct this range of motion and proprioception through these joints.
Frozen Shoulder
Frozen shoulder is technically known as adhesive capsulitis. It feels exactly like it sounds, where the shoulder becomes “frozen”. Suppose we break down the technical name, adhesive- meaning stuck together, capsule- the muscles, tendons, and ligaments that make up the joint capsule or casing around the muscle, and itis means inflamed. Patients will have a minimal range of motion, which is usually very painful when attempted.
Frozen shoulder usually starts as another joint injury, such as tendonitis, bursitis, or a rotator cuff injury, that isn’t adequately treated, and the patient stops moving the joint more and more to try to protect the injury. The joint attempts to defend itself, and it slowly starts to lock up or freeze, forming adhesions around the joint. These often progress until the patient seeks treatment for the frozen shoulder. It can also be a metabolic disorder, meaning your body is struggling to break down what you consume and responds with an inflammatory response, like a frozen shoulder. There are other causes, but these are the most common.
Treatment is often a long process, but keep in mind that this disorder has taken a long time to progress to the point of frozen shoulder. The best treatments use shockwave and laser, both of which help break down adhesions and “melt” away the frozen shoulder. Adding in adjustments to the shoulder and thoracic spine is crucial for re-establishing proper mobility. We also send patients home with a specific rehabilitation program to work through mobility and then stability exercises.
There are medical treatments for frozen shoulder, but these usually start with procedures such as cortisone injections, aimed at reducing inflammation and improving the patient’s range of motion. This has very low success rates, requires the patient to be very diligent with their home stretching, and it is usually excruciating. The most extreme version of medical treatments includes the patient being put under general anesthesia, then the provider forces the shoulder to move, ripping the adhesions. If you watch videos of this procedure, it sounds like Velcro ripping. This usually leaves the patient very sore and still needing to go through a complete rehabilitation program afterwards to retrain the muscles to move after the trauma they went through during the surgery.
Frozen shoulder is an excruciating condition and leaves the patient with limited ability to use that arm. It is essential to treat shoulder conditions before they progress; if they do, treat them promptly. Proper care can help return the patient to everyday life.
Osteoarthritis
Osteoarthritis is the type of arthritis that is usually acquired. Meaning the patient spent enough time overworking that joint, which creates signs of osteoarthritis (OA). The good news is that OA is rarely a pain generator. It is more common to present in conjunction with another cause of pain. So, the best treatments for OA are those that identify the true pain generators and the muscular and movement imbalances that lead to OA, and correct them.
Times that OA is the true pain generator usually lead to some sort of shoulder impingement. Meaning the arthritis has progressed to a point that limits the movement of either the muscles/tendons or the joint itself. Conservative treatment for this usually includes reducing surrounding inflammation and hoping that it relieves symptoms. If that doesn’t work, it is common to progress to medical intervention. This may mean injections or surgery. But even with these avenues, it is essential to correct the imbalances post-surgically to prevent the issue from returning. The surgery may remove the osteophytes that are causing the impingement, but it doesn’t correct the movement pattern that created the osteophytes in the first place.
Rotator Cuff Injuries
Rotator cuff injuries are prevalent, with most research showing that over 25% of Americans will have a rotator cuff injury at some point in their lifetime. The rotator cuff is a group of muscles, known as the SITS muscles. SITS stands for Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. The primary shoulder joint, the glenohumeral joint, is a ball-and-socket joint. But if we were to describe it more accurately, it’s more like a golf ball sitting on a tee. The “ball” is much bigger than the “socket”. The SITS muscles help keep the golf ball from rolling off the tee. These are all small muscles primarily used for stabilization, not for movement. A large majority of rotator cuff injuries happen in patients who demonstrate poor scapular stabilizers. Previously, we discussed how the scapular stabilizers are the “core” for the shoulder. Weakness in the scapular stabilizers will force the rotator cuff muscles to engage more in movement than in stability, placing greater load on them than intended, and eventually leading to injury.
Conservative treatment is more successful at treating rotator cuff injuries than primary medicine. This means injections and surgery have very low success rates, while the treatments we provide in the office continue to prove their effectiveness. The first step when treating rotator cuff injuries is to decrease inflammation in the injured tissues. Laser therapy works well at reducing inflammation, while shockwave therapy is excellent at breaking down scar tissue over time and breaking down hypertonic or tight muscles. Once we reduce pain and inflammation, we move on to loading the SITS muscles and strengthening the scapular stabilizers. Creating a specific rehabilitation program for each patient will provide the tools needed to help them progress toward their goals. Throughout the entire treatment, we will adjust both the shoulder and the thoracic spine. These joints work synergistically to maintain proper mobility and stability, and having adequate motion and proprioception is crucial for achieving long-term results.
Sprain
What is the difference between a sprain and a strain? Simply put, a sprain is a damaged ligament, while a strain is an injured muscle. The most common type of shoulder sprain, the Acromioclavicular (AC) sprain, is also known as a separated shoulder. These are usually diagnosed by orthopedic examination and confirmed on X-ray.
Most treatments for a separated shoulder are palliative, meaning they are just trying to decrease the pain and eventually the inflammation. The severity of the sprain is graded 1-6, with Grade 1 being the least severe and Grade 6 the most severe. Once inflammation has decreased, it is essential to strengthen the surrounding muscles to support the joint, as the ligaments will not be able to stabilize as they were designed to. This is done by increasing strength in both the rotator cuff muscles and the scapular stabilizers. In extreme cases, surgery may be performed, and a screw or plate may be placed across the AC joint to provide stability.
Conservative treatment is focused on laser therapy to decrease the inflammation around the injury, followed by specific rehabilitation programs.
Tendonitis
Tendonitis is inflammation of a tendon. With 17 different muscles that move the hip, 17 different tendons could become inflamed, leading to shoulder tendonitis. It is usually described as a dull aching feeling, soreness, or even a sharp pain directly in the tendon. Tendonitis is generally caused by overuse. This may happen when there is a quick or sharp increase in training or use.
Treatment is initiated with modalities to reduce pain and allow the patient to continue loading the tendon. Tendons love load. Starting with a mixture of shockwave and laser, both relieve pain and let healing begin. Then loading the tendons through some isometric exercises and progressing to eccentric loads will increase tendon strength, preventing it from returning or becoming chronic.
Tendonitis can be prevented by creating training programs that progress appropriately and by continuing to incorporate stabilization exercises into programming.
Check Out Our Location Near You
609 Attain St #141, Fuquay-Varina, NC 27526
Frequently Asked Questions
Can chiropractors help with shoulder pain?
Yes. Chiropractors are musculoskeletal specialists. Shoulder pain is the fourth most common reason patients visit a chiropractor.
Should I see a doctor or chiropractor for shoulder pain?
A chiropractor is a better entry-level provider for shoulder injuries than most medical doctors. Chiropractors specialize in musculoskeletal conditions, whereas medical doctors have a broader scope of practice and do not focus on musculoskeletal injuries as chiropractors do.
Why is my shoulder pain not going away?
There are many causes of shoulder pain, and failing to treat it properly may prevent it from improving. So your shoulder pain may not be going away simply because you aren’t treating it properly.
How do I stop severe shoulder pain?
Stop severe shoulder pain by getting it treated. Many people hope that if they rest or ignore it, the pain will go away, but that is rarely true. If you have severe pain, see a professional to find ways to decrease the pain and then treat it appropriately.
What does a pinched nerve in the shoulder feel like?
Pinched nerve pain is usually described as sharp or electric. Also, if the pain is referred elsewhere, it is often due to a pinched nerve. So if you have shoulder pain radiating into the hand, it may be a pinched nerve.
How should I sleep with shoulder pain?
Sleeping with shoulder pain is often challenging. The best answer is whatever position you can be comfortable in. For most shoulder patients, sleeping on their side is painful and exacerbates symptoms. For those patients, we suggest sleeping on your back. But for another patient, resting on their back stretches the shoulder backward, and it is painful. So, the simple answer is to sleep in whatever position you’re comfortable.
What is the best exercise for shoulder pain?
With the shoulder being a complex joint, there isn’t one or two exercises that are guaranteed to fix shoulder pain. But if we were to try and simplify it, I’d suggest working on the scapular stabilizers. There are many ways to do this, but start with small, simple movements and progress to more difficult movements.
Can I adjust my shoulders by myself?
There is no way to adjust your own shoulder. You may be able to mobilize your shoulder and make it pop, but this is less effective and, if done too often or improperly, can make the injury worse.
Can a chiropractor help with a rotator cuff?
Yes, chiropractors have multiple ways to treat rotator cuff injuries. Conservative treatment has better success rates than injections or surgery.
How do I get rid of a pinched nerve in my shoulder?
Chiropractic care is the most effective treatment for relieving a pinched nerve in the shoulder. We integrate multiple treatment modalities, including adjustments, shockwave therapy, laser therapy, dry needling, and rehabilitation exercises.
What pressure points relieve shoulder pain?
The specific pressure point that relieves shoulder pain varies from patient to patient. Finding an active trigger point and working this trigger point out will often decrease the shoulder pain.
What can cause shoulder pain without an injury?
Shoulder injuries are more often the result of multiple factors rather than a single significant injury. Chronic and degenerative changes cause a large majority of shoulder issues.
$99 New Patient Special
Includes consultation, exam, doctors report of findings, PosturePro analysis, and first adjustment.
