SHOULDER TREATMENT FOR EACH CONDITION

Referred pain and tenderness

"Shoulder treatment" very often means treatment of joints in the neck and upper back.

It’s very often possible to cure shoulder and arm pain only by including this, even if a possible cause is found in the area of the pain.

It is common for us to feel just one pain when there are multiple places contributing to it.

I retest for the painful arc immediately after treating any stiff joints in the cervical and thoracic spine.

If this is reduced (over a smaller angle of arc, less painful) the spine was contributing to the shoulder pain. Sometimes this is all that is needed. More commonly scapular muscle stretches need to be included in your shoulder therapy.

Shoulder treatment of the rotator cuff mechanism

Cortisone is a dirty word. Many people will refuse this treatment because of the perception that toxic effects will be dangerous.

This is not the case here, however. The cortisone injected will have precious little effect on your body generally.

It will speedily relieve your shoulder joint pain by reducing shoulder tendonitis. I recommend it often, even though I lean towards natural remedies.

Acupuncture is very effective in shoulder treatment, regardless of the actual state of the tendons.

Glyceryl trinitrate can be applied to the skin over the affected part of the rotator cuff.

This is to improve repair mechanisms, so should work well with any nutritional support for repair, such as zinc and vitamin C.

Unlike its use in angina, no nitrate-free interval is needed. It should be applied over the full 24 hours each day.

In angina, the blood vessel dilating effect is wanted. Our body becomes resistant to this effect with continuous application. Workers in munitions factories during the second world war got headaches only for their first week, from the nitro glycerine.

The effect being used for tendon injury repair, is stimulation of the fibroblast cells which do this job.

One little known cause of rotator cuff pain is vitamin B 12 deficiency. This is described in Dr. Jonathan Wright’s “Book of Nutritional therapy” and I have seen it occasionally.

This is a possibility when the X-ray shows calcification of the rotator cuff.

Treatment is with vitamin B12 injections, daily initially for about ten days, then progressively less often over a period of months.

The pain is relieved within days, and the calcium deposits eventually are removed by this treatment.

Surgery can relieve pain well. The edge of the acromion is often trimmed back and torn tendons can be reattached.

Recovery is quicker with keyhole surgery, but still takes months. It does not give one a normal shoulder.

Treatment of causes in the scapulo humeral joint - the shoulder joint proper

Recurrent dislocation is also very well treated by the surgeons.

Adhesive capsulitis (frozen shoulder,) is covered on the next page.

TESTING AND STRETCHING YOUR RIGHT SIDE SCAPULAR MUSCLES

Any of the three main muscles may be tight and sore, and need stretching as part of your shoulder treatment.

This may be so even if imaging has shown a tear. I figure that if there is enough tendon intact to allow testing to hurt, there is enough to contribute to your pain.

These tendons tear because of attrition and pathological weakness, so there is a theoretical risk that stretching may increase or cause a new tear.

I have not seen this happen. Presumably most times any potential tear has already happened from day to day activities. I can't remember right now, anyone knowing exactly when a tear occurred.

Subscapularis

Sit facing along the side of a table. Hold the table edge. Hold your elbow closely to your side, then shift forward so that your hand is left behind.

As this swings your forearm backwards, note any pain. You could turn around and do the same test on the other arm, to compare both discomfort and range of movement.

This comparing of your two sides is a basic principle to use for most examinations.

Supraspinatus

This may already be painful, but if not, use your other hand to push the wrist away from you. Do not shift the elbow, and keep it bent at a right angle (90 degrees.) Your forearm is being used as a lever to cause your upper arm to rotate.

Infraspinatus

An alternative is to lean your raised elbow against a wall and push against the wall to force your hand over the shoulder.

These tests of pain on stretch and range of movement, are done with the arm passive, not resisting the movement.

Exactly the same actions are used to stretch the muscles in treatment.

Keep any sore muscle stretched, only enough to cause minimal pain, and just wait. The muscle is likely to take a couple of minutes before even the tightest fibers relax. More on this.



PLEASE ASK YOUR HEALTH CARE PROFESSIONAL BEFORE DOING THIS SHOULDER TREATMENT.

You can use the same actions for testing isometric (not shortening) contraction and also for strengthening.

Here you get into position, and use your arm to resist the movement described above.

Shoulder treatment for frozen shoulder

Back to shouldeer anatomy from this shoulder treatment page