Archives for posts with tag: shoulder pain

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this afternoon to review a topic known as Little Leaguer’s Shoulder.  This is something that concerns me a lot because both of my older boys are playing baseball, and the oldest has just reached the level where the boys start pitching to each other.  Furthermore, I am certain that he will be doing some pitching.

little leaguer's shoulder

In the image above by RelayHealth, we can see the damage that is done with Little Leaguer’s Shoulder.  Rotational stresses on the growth plate of the humerus up near the shoulder results in a Salter-Harris Type 1 fracture in pitchers who over-pitch or pitch to frequently.  More rarely, this may cause a Salter-Harris Type 2 fracture.  The different types of Salter-Harris fractures can be seen in the image below.

Salter-Harris

These individuals come into my office complaining of shoulder pain that occurs mainly when throwing hard.  The pain began as a very minor pain, but over time it progresses to a substantial amount of pain.  They are able to point directly to the point of pain in the arm near the shoulder.

With this condition there is no agreed upon course of treatment; however, it is recommended that the arm be rested for a minimum of three months, and it made need up to a year.  Once it has healed, gradual return to throwing is needed with pain be a limiting factor.  Complications of Little Leaguer’s Shoulder include avascular necrosis, loose bodies, and early closure of the growth plate.

If you are struggling with Shoulder Pain, call my office today (480) 366-4041.  We can Help!

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Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this afternoon to quickly receive a condition that I see quite often in my office, and that is the Shoulder Separation also known as Acromioclavicular Separation or AC Separation, not to be confused with a Shoulder Dislocation.  We often hear people say that they separated their shoulder, but what does that mean?  Today, I will answer that question.

Shoulder Separation

In the image above by Healthwise, Incorporated, we can easily see the three different grades of an AC Separation.  The grades of the AC Separation are based on the severity of the injury.  There are also six different types of AC Separations based on the directionality of the collar bone after separation.  Grade I (first degree) indicates some tearing of the AC ligament, but there is no instability.  Grade II (second degree) indicates a rupture of the AC ligament, and Grade III (third degree) involves tearing of the coracoclavicular ligaments.  Both the Grade II and the Grade III separations are unstable.

These patients usually come into my office with shoulder pain following either a fall on an outstretched arm or a fall  onto the top of the shoulder.  I see the fall onto the top of the shoulder mainly in football players, mostly quarterbacks, and we see the fall on the outstretched arm in football players; however, I see it a lot in my extreme sports patients such as skateboarders, BMX riders, motocross, cyclocross, and so forth.

All AC Separations can be treated conservatively; however, Grade III separations will leave a permanent bump as depicted in the image below, and for some patients may be a site for minor persistent discomfort.  Surgery is an option for those that require cosmetic perfection, or for those that attempted conservative care and are not back to full function.  Standard care for an AC Separation includes some time in a Kinney-Howard sling followed by mild isometric and on to isotonic exercises with the focus being the deltoid and upper trapezius muscles followed by biceps and pectoral exercises.  This is also couple with soft-tissue therapies such as Active Release Techique (ART) and Graston Technique to encourage healing and prevent scar tissue formation.

ac_joint3

If you are struggling with Shoulder Pain contact my office today (480) 366-4041.  We can Help!

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this afternoon trying to catch up on all the things that got pushed aside during the holiday season.  Today I want to address a condition known as a Rotator Cuff Tear or a Strained Rotator Cuff.  This is something that I see quite often because I have come to be known in the community here as somewhat of a shoulder guru.

rotator_cuff_tear

The rotator cuff is made up of four different muscles known as the supraspinatus, infraspinatus, teres minor, and subscapularis, also known as the SITS muscles.  The most common tears occur in the supraspinatus.  There is typically two different areas where the tears occur in the supraspinatus.  One occurs where the arm and shoulder blade form a joint known as the articular sided tear, and the other occurs next the fluid-filled sac known as bursa, which would make it the bursal sided tear.  Most partial tears are articular sided and may be related to poor blood flow to the area.  Tears can be due to trauma, but most often they are due to chronic degenerative changes to the tendon.  Thus, leading to patients complaining of shoulder pain, but they do not know why they have shoulder pain because they have not experienced any trauma.

The patients that I see in my office generally give some sort of history of an acute traumatic event such as lifting a heavy object or a fall on an outstretched arm.  Older patients may not even recall any sort of traumatic event.  These individuals usually complain of pain with overhead activities or weakness in lifting the arm.

Partial tears can be treat in my office with great results.  We do this by implementing soft-tissue therapies such as Active Release Technique (ART) and Graston Technique to stimulate the healing process.  Kinesiology Tape is also used to help encourage the muscles to function properly as well as stabilize the shoulder.  Rehabilitation begins with isometric exercises gradually leading to to a strengthening program.  Complete tears usually require surgical repair in younger individuals.

If you are struggling with Shoulder Pain, call my office today (480) 366-4041.  We can Help!

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this morning to review a disorder known as Adhesive Capsulitis or better known as Frozen Shoulder.  This is a very common disorder that I see on a regular basis in my office, and I would say that this is one of my favorite shoulder disorders to treat.

shoulder_adhesive_capsulitis_anat02

In the image above by MMG 2001, we are able to see the changes the occur with the joint capsule with Frozen Shoulder.  The cause of Frozen Shoulder is currently unknown, but the most accepted theory is that adhesions develop within the capsule of the shoulder.  However, this is not always seen at surgery.  Furthermore, the patient often respond favorably to stretching techniques that place very little stretch on the capsule.  There are certain groups of individuals that are predisposed to Frozen Shoulder including those with diabetes, hyperthyroidism, or chronic obstructive or other lung disease, and those who have had a heart attack.  It has been proven, contrary to common logic, this disorder is not due to immobilization of the shoulder.  This process begins as an inflammatory process that progresses to fibrosis.  The three phases include the following:

  • an acute inflammatory phase that causes a presentation that overlaps with some other condition
  • a stiffening phase
  • a thawing phase where some of the range of motion returns

These patients come into my office with varying symptoms based on the their current phase.  These patients are usually over the age of 40.  In the acute phase they complain of moderate to sever pain that limits all shoulder movement.  Usually they cannot recall any specific event that lead to the pain.  The pain interrupts their sleep, and in most cases leads these individuals to seek prescription pain medication.  In the stiffening phase these individuals tell of a history consistent with the acute phase ; however, now the pain is substantially less, but the range of motion in the shoulder is severely limited.  In the final phase there is an increase in the range of motion, but the range is still very limited.

Management for this condition is not the most comfortable thing to go through.  Soft-tissue therapies including Active Release Technique (ART) and Graston Technique are used to increase the range of motion in the shoulder by attempting to break the fibrous adhesions that have developed with the shoulder musculature and joint capsule.  Range of motion and stretching exercises are implemented as soon as possible.  If these conservative measures are not showing improvement after a couple of month, more aggressive procedures are utilized such as Manipulation Under Anesthesia.

If you are struggling with Shoulder Pain or Frozen Shoulder, call my office today (480) 366-4041.  We can Help!

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this afternoon to start writing about some common shoulder injuries.  Today, I wil start with Impingment Syndrome.  This is a very common disorder of the shoulder.  I see this several times each week in my office making it a very important disorder to review.

Shoulder-Impingement-Syndrome

There are several different structures that can become impinged with Impingement Syndrome.  The biceps tendon, supraspinatus tendon, and the subacromial bursa are all susceptible to impingement at the front or outer portions of the shoulder.  There are some structural causes that account for this impingement including variations in the collar bone, degeneration on the under side of the end of the collar bone, and inflammation directly under the collar bone.  Instability in the shoulder is also a coexisting problem, allowing for excessive upward movement of head of the humerus bone.  There may also be some tightness on the backside of the shoulder capsule, which cause migration foward and up of the humerus bone when raising the arm.

Management of Impingement Syndrome is based on the severity of the symptoms; however, stabilization of the shoulder must occur with a progressive rehabilitation program, stretching the posterior capsule, and modification of inciting activities.

If you are struggling with some sort of Shoulder Pain, call my office today (480) 366-4041.  We can Help!