Conditions
Shoulder pain
Reviewed by Dr Voula Roumel, Chiropractor , registered since 1987, AHPRA CHI0000942872
Last updated
The shoulder trades stability for range. It moves further than any other joint in the body, and it does that by being held in position largely by muscle and tendon rather than by bony architecture, which is why so much shoulder pain is tendon-related.
How it behaves at night is one of the most useful things you can report. Rotator cuff presentations typically hurt lying on that side. Frozen shoulder wakes people regardless of position. Pain that is severe at night, unrelated to position and not eased by anything is a different matter and needs medical assessment.
What causes it
- Rotator cuff presentations, the most common. Pain with overhead movement, reaching behind, or lying on that side
- Subacromial pain, where tissue is compressed in the space beneath the tip of the shoulder blade
- Frozen shoulder (adhesive capsulitis), progressive stiffness in every direction, including when someone else moves the arm for you
- Referred pain from the neck, felt over the top of the shoulder, often with neck stiffness or pins and needles into the arm
- Shoulder blade control problems, where the blade is not positioning the socket well for the arm to move on
- Acromioclavicular joint irritation, right at the point of the shoulder, common after a fall onto it
When to see a chiropractor
Early, because shoulders stiffen fast and a stiff shoulder takes considerably longer to work with than a sore one.
Go to an emergency department now for shoulder pain with chest tightness, breathlessness, sweating or nausea, that can be cardiac. Also for shoulder pain after significant trauma with obvious deformity, or where you cannot lift the arm at all.
What the assessment covers
- A full history, where it is, what provokes it, how it behaves at night, and whether there was a specific incident
- Shoulder range, both what you can move and what the chiropractor can move for you, the difference between the two is diagnostic
- Strength and specific tendon testing
- The neck and upper back, because referral from there is common
- Shoulder blade position and control
- An explanation of what was found, before any treatment
What treatment involves
- Chiropractic adjustment of the shoulder, upper back and neck where restriction is contributing
- Massage therapy through the rotator cuff, upper back and neck musculature
- Dry needling, where trigger points are part of the picture
- Shockwave therapy for long-standing rotator cuff tendon presentations, including calcific ones
- Rehabilitation exercises, progressive loading, which is the mainstay for cuff presentations
Between appointments
Keep it moving within tolerance. Shoulders that get protected stiffen, and the stiffness then becomes the problem.
The chiropractor will tell you which movements to keep and which to park for now, and how to sleep, usually with the affected side up and a pillow supporting the arm.
Where imaging or specialist care is the next step, you will get a detailed letter outlining the findings and recommendations, including the specialist we believe is best suited to your needs.
Frequently asked questions
Why does my shoulder hurt more at night?
Night pain is a genuinely useful piece of information. Rotator cuff presentations commonly hurt lying on the affected side because the tissue is compressed against the surface. Frozen shoulder characteristically wakes people regardless of position. Pain that is severe at night, unrelated to position and not eased by anything is the pattern that warrants prompt medical assessment rather than a chiropractic appointment.
What is frozen shoulder?
Adhesive capsulitis, where the capsule surrounding the shoulder joint thickens and tightens, progressively restricting movement in every direction, including when someone else moves the arm for you. That last detail is what separates it from a rotator cuff problem, where you can usually be moved further than you can move yourself. It runs in stages over many months and the treatment approach differs by stage.
Can shoulder pain come from the neck?
Frequently. Pain over the top of the shoulder and towards the neck often refers from the neck rather than arising in the shoulder joint, particularly where it comes with stiffness turning the head or any pins and needles into the arm. The assessment tests both, which is why it takes longer than examining the shoulder alone.
Should I rest it or move it?
Almost always keep moving within what you can tolerate, because shoulders stiffen quickly and a stiff shoulder is a considerably harder problem than a sore one. What to avoid for now depends on the presentation. The chiropractor will tell you which movements to keep and which to leave.
When is shoulder pain urgent?
Shoulder pain with chest tightness, breathlessness, sweating or nausea needs emergency assessment now, that can be cardiac and it can present in the left shoulder or jaw. So does shoulder pain after significant trauma with obvious deformity or an inability to lift the arm at all.
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