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The shoulder is the most mobile joint in the human body. The joint includes four tendons that hold muscle to bone. Together, these four “rotator cuff” tendons stabilize the upper arm bone to the shoulder socket and allow a wide range of motion in the shoulder.
Shoulder pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you are unsure of the cause of your shoulder pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem.
The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff. Bursitis is an inflammation of a fluid-filled sac, or bursa, that lies between tendon and skin or between tendon and bone. Normally a bursa protects the joint and helps make movement more fluid.
Tendonitis is when tendons become compressed under the rigid bony arch of the shoulder. The compressed tendons become inflamed or damaged and cause pain. This can occur from general wear and tear, as you get older, an activity that requires constant shoulder use like baseball pitching, or an injury.
Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery. Arthritis is a gradual narrowing of the joints and loss of protective cartilage in the joints about the shoulder.
A Rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.
Also called ‘adhesive capsuliitis,’ this is a common condition that leads to stiffness of the joint. Physical therapy and stretching are extremely important aspects for treatment.
Calcific tendonitis is a condition of calcium deposits within a tendon — most commonly within the rotator cuff tendons. Treatment of calcific tendonitis depends on the extent of symptoms.
A Bankart lesion is a type of labral tear most commonly due to dislocation of the joint. Bankart lesions cause problems of persistent instability.
Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition.
A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.
Also called an AC separation, these injuries are the result of a disruption of the acromioclavicular joint. This is a very different injury from a dislocation!
The SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand.
A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint.
Shoulder, elbow and wrist pain or pain down the arm will be treated differently depending on what type of doctor you go to. Chiropractors will try treating more of the cause (correcting spinal misalignments, perform myofascial muscle work and strengthening). Medical doctors will usually try medication first, physical therapy second and surgery third. Dr. Widenbaum believes a conservative approach is always best but at times medical co-management is necessary. The cause of the pain can also be for different reasons and it’s sourcing WHY you have the pain that becomes the tricky part. So, in order for you to do what’s in your best interest and what’s right for you, you will need to do some self educating.
There are thirty bones, over forty muscles and fourteen major nerves making your arm more diligent, dexterous and adaptable than any tool mankind can emulate. Arm pain is a warning signal and should not be ignored. Often arm pain is caused by injury to the area of pain but it can also be an indication of a more serious underlying problem.We often find that in cases of arm pain, injuries to muscles, joints and ligaments in the neck are often overlooked. It is very common to have referred pain from these
structures causing pain in the arm. Here we will cover some conditions that are often seen by a chiropractor that also relate directly with the structures of the arm.
Positions that strain muscles repetitively are likely to result in an insidious onset of wrist or forearm pain such as carpal tunnel syndrome or lateral epicondylitis (tennis elbow).
Arthritis is the body’s way of trying to stabilise unstable joints. Joints can become unstable for many reasons from trauma to overuse. If joints are allowed to remain unstable, they start to fuse stopping you from carrying on with everyday activities. The wrist and hands are often the first place arthritis attacks.
Common injuries such as scaphoid fractures (fracture to a small bone between your thumb and your wrist), ligament tears and joint strains often cause immediate pain and swelling around the area of the trauma. Injuries of this kind need immediate consultation from a health professional.
Constant overuse or micro trauma can go unnoticed on a daily basis. If you go to the gym, play racket sports, use a computer, play musical instruments or even text on a mobile phone enough, then overuse is a likely cause of pain.
One of the most common postural distortions is that of forward head and forward shoulders. This shift of posture causes muscular tension in the shoulders and the neck having to cope with the weight of the head (the average head weighs as much as a bowling ball!) Muscular tension can cause pain to be referred into the arm causing a deep ache that often gets worse as the day goes on.
When neck pain is caused by muscle strain, you may have aches and stiffness that spread to the upper arm and forearm. Shooting pain that spreads down the arm into the hand and fingers can be a symptom of a pinch nerve in the neck. When a nerve has been pinched in the neck, numbness and weakness of the hands or arms, as well as pain, may occur.
Heart problems can often cause referred pain in the left arm due to the shared neural pathways in the spinal cord. Information about the heart can be confused in the spinal column leading to apparent pain in the arm. Arm pain accompanied by chest pain or shortness of breath may signal a heart attack.
Doctors can be very busy and make you feel like they are not listening. Dr. Widenbaum listens and investigates what the cause of your pain is. If it’s shoulder pain you have, we will need to find out if the pain is really coming from the shoulder. Since the nerves that go to the shoulder come from the neck, a nerve impingement can refer pain into the shoulder. It would be similar to a heart attack referring pain down your arm. Cervical nerve impingements can mislead you into thinking that the pain is coming from the shoulder when it isn’t. The treatment then becomes misguided and solely focused on the shoulder when that is not the cause of your pain.
A nerve impingement can be from a cervical (neck) vertebra that is misaligned causing a pulling or irritation and inflammation to a nerve root. It can also be from a herniated disc that is protruding onto a nerve root. Another cause can be from severe stenosis (narrowing) of the intervertebral foramen (the little hole where the nerve comes out). This is usually because of arthritic degeneration or osteoarthritis in which bone spurs or calcification is growing into the nerve or spinal cord. You may have had an injury, auto accident, fall, or over-exerted yourself with pre-existing cervical osteoarthritis that was already there. Many people who already have degeneration will not be able to handle an injury nearly as well as someone who hasn’t. Arthritic degeneration can be found with an x-ray, MRI or CT scan.
Above is a disc herniating back into the spinal cord also causing a stenosis (narrowing of the spinal canal that houses the spinal cord). This can cause neurological deficits that can often be picked up in an examination performed by Dr. Widenbaum. In most cases, the majority of the people who see us have vertebral subluxations (misalignments that cause hypomobility or fixations of particular vertebra leading to inflammation in the facet joints or nerve irritation). This responds well to spinal manipulation.
The pain can definitely be coming from the shoulder due to a rotator cuff tear and in that case, shoulder treatment would be warranted. Shoulder pain can also come from weakness of the shoulder muscles or a muscle imbalance which can lead to a bursitis or joint inflammation. You then have to ask why the shoulder muscle is weak or has an imbalance to begin with. This is where a good examination of your shoulder comes in. Our philosophy is to try conservative treatments to include chiropractic, myofascial massage and pilates physical therapy methods first and medical referral if necessary.
Again, elbow and wrist pain can be much like the shoulder. It can be coming from the neck, from surrounding muscle damage or a joint misalignment from over-use or a fall. Dr. Widenbaum has years of experience finding the cause.
It’s simple. Performing a good examination and getting the proper diagnostic tests will give Dr. Widenbaun the answers. At Nephesh, you can rest assured that you will be listened to and examined thoroughly and professionally. Dr. Widenbaum knows that it can be challenging to find an office who spends the time to accurately find your shoulder, elbow or wrist problem. We hear from our patients all the time how other doctors didn’t spend the time or do the tests that we did to find their problem. On top of all of that, the other doctors never really explained what they found to them. We believe education goes a long way and our patients appreciate it.
If you want a caring and professional doctor to walk you through all the steps of accurately assessing your shoulder, elbow or wrist condition then please call us at 925-829-8484 today.