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Chiropractic and Shoulder Problems Part 3

© Dr. David L. Phillips

In the first 2 parts of this series of articles on shoulder pain and dysfunction, we discussed the basic anatomy and motions of the shoulder. I related why it is that one muscle in particular is the one that causes problems often. If you recall, I said that when you raise your arm, the ball part of the joint at the upper part of your arm is rotating upwards, while at the same time, it is sliding down over the joint surface of the scapula.

I also told you that it was the muscles of the rotator cuff that create this downward sliding action, and for a very good reason, too. As you raise your arm, without the action of the 4 rotator cuff muscles, the top of the ball would strike the bony overhang of the scapula and collar bone or acromioclavicular arch, as it is called. In the space between the ball and that acromioclavicular arch we talked about are several tendons and bursa. Bursae serve to reduce the friction of the tendons as they rub together with movement. So perhaps you can see what's coming here.

Weakness in the rotator cuff muscles causes reduced downward sliding of the arm, and the various tendons and bursae are caught between the bones. As the upward moving arm comes closer to the acromial arch, the space for the tendons and bursa get progressively smaller and tighter. A squeezing or crushing action occurs as the tendinous space disappears. This crushing action causes pain, inflammation and ultimately, spasm. Inflammation of a body part is described with the suffix "-itis" added to the name of the part. Therefore, we get tendon-itis and burs-itis from this crushing action.

This action of the bones coming together can be sudden and dramatic, but is more often, slight and barely noticed, at first. Over time, however, the condition gets more and more chronic and painful. The repeated crushing action dries and frays the tendons and causes a low-grade inflammation in the bursae.

So-called "rotator cuff surgery" is frequently nothing more than a surgeon taking a burr and grinding away some bone of the overhanging arch to allow more space for the tendons. This type of surgery not only doesn't address the cause of the trouble but also is rather crude. However, it does give adequate relief to a shoulder that is almost beyond help. Like most medical procedures, it should be considered a last option. In most cases, it is done far sooner than is necessary.

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