Manipulative Therapy in Addition to Usual Care for Patients With Shoulder Complaints: Results of Physical Examination Outcomes in a Randomized Controlled Trial
In clinical trials concerning treatment of shoulder complaints, factor analysis is useful for the reduction of multiple outcomes of physical examination data and therefore increases statistical power. On the basis of the factors derived from physical examination tests of the shoulder and the cervicothoracic spine, we conclude that manipulative therapy, in addition to usual care by the general practitioner, diminishes the severity of the pain in the shoulder and neck and improves the mobility of the shoulder and the cervicothoracic spine. Results were most prominent at 26 weeks after initiation of treatment.
Adhesive capsulitis, also called frozen shoulder, is a painful condition. It results in a severe loss of motion in the shoulder. It may follow an injury, or it may arise gradually with no injury or warning.
The rotator cuff tendons are key to the healthy functioning of the shoulder. They are subject to a lot of wear and tear, or degeneration, as we use our arms. Tearing of the rotator cuff tendons is an especially painful injury. A torn rotator cuff creates a very weak shoulder. Most of the time patients with torn rotator cuffs are in late middle age. But rotator cuffs tears can happen at any age.
Many people refer to any pain in the shoulder as bursitis. The term bursitis really only means that the part of the shoulder called the bursa is inflamed. Tendonitis is when a tendon gets inflamed. This can be another source of pain in the shoulder. Many different problems can cause inflammation of the bursa or tendons. Impingement syndrome is one of those problems. Impingement syndrome occurs when the rotator cuff tendons rub against the roof of the shoulder, the acromion.
Biceps tendonitis, also called bicipital tendonitis, is inflammation in the main tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is overuse from certain types of work or sports activities. Biceps tendonitis may develop gradually from the effects of wear and tear, or it can happen suddenly from a direct injury. The tendon may also become inflamed in response to other problems in the shoulder, such as rotator cuff tears, impingement, or instability (described below).
A shoulder separation is a fairly common injury, especially in certain sports. Most shoulder separations are actually injuries to the acromioclavicular (AC) joint. The AC joint is the connection between the scapula (shoulder blade) and the clavicle (collarbone). Shoulder dislocations and AC joint separations are often mistaken for each other. But they are very different injuries.
The shoulder is an elegant piece of machinery. It has the greatest range of motion of any joint in the body. However, this large range of motion can lead to joint problems. Understanding how the different layers of the shoulder are built and connected can help you understand how the shoulder works, how it can be injured, and how challenging recovery can be when the shoulder is injured. The deepest layer of the shoulder includes the bones and the joints. The next layer is made up of the ligaments of the joint capsule. The tendons and the muscles come next.
There has been an explosion of new tests for labrum tears of the shoulder. Among those developed and studied over the last few years have included the Crank test, O’Brien’s sign (active compression test) and the anterior slide test. The new biceps load test was designed and tested on patients with recurrent anterior dislocations. This subpopulation may respond differently than patients without a history of dislocation; therefore, extrapolation beyond this population is not recommended.
While watching the golf swing, it’s obvious that shoulder muscles are used to create a powerful swing. Not so obvious are the details of shoulder muscle activity during the swing. Fortunately, a handful of electromyographic studies have given us a better understanding of shoulder muscle function during the golf swing. [3, 4, 5] These studies demonstrate that rotator cuff muscles (particularly the subscapularis), the latissimus dorsi and pectoralis major are highly active during the golf swing.
Chiropractic Treatment of Frozen Shoulder Syndrome (Adhesive Capsulitis) Utilizing Mechanical Force, Manually Assisted Short Lever Adjusting Procedures
Chiropractic care may be able to provide an effective mode of therapeutic treatment for certain types of these difficult cases. Low force instrumental adjustments, in particular, may present certain benefits in these cases that the more forceful manipulations and/or mobilizations cannot. As such, further formal investigation of this type of therapeutic intervention for treatment of frozen shoulder may be warranted on a larger scale.
This case demonstrates how an athlete with recurrent shoulder instability had a successful outcome after receiving multimodal treatment of soft tissue mobilization, manipulation, proprioceptive training and taping, nutritional counseling, and conditioning exercises. It further demonstrates that achieving functional and sport-specific activities after musculoskeletal trauma can be enhanced significantly if proprioception is addressed in the treatment program. The decreased frequency of instability occurrences in this case combined with the perceived improvement on the shoulder instability index suggest a gradual stabilization of the proprioceptive function of the shoulder. This would suggest that rehabilitation exercises should focus on the importance of incorporating joint position sensibility and reflexive-type contractions into the therapy program. Future directions for proprioception research should consider the effects of upper extremity training on proprioception in both normal and unstable shoulders. Future studies should also examine the effectiveness of proprioceptive training in nonoperative treatment of shoulder instability. Further research to better understand and use chiropractic management strategies and interventions for athletes with shoulder instability appears warranted.
Faulty movement patterns cannot be ignored in the treatment of functional pathology of the motor system. Modern society overstresses the postural function of muscles, thus creating an ideal terrain for muscle imbalance to develop. Mobility is reduced and movements in constrained postures are performed repetitively, leading to static overstrain and cumulative trauma. The motor program for good quality movement and posture is thus compromised leading to poorer static and dynamic function of the locomotor system.
An appropriate and progressive rehab program should be started early in the treatment of elderly patients with upper extremity problems.10 Simple, effective rehab techniques are available, none of which requires expensive equipment or great time commitments. A closely monitored home exercise program is recommended, since this allows the doctor of chiropractic to provide cost-efficient, effective rehabilitative care.
An appropriate and progressive rehab program should be started early in the treatment of patients with shoulder sprain and strain injuries, generally after ligaments and connective tissues have repaired sufficiently. Simple, yet effective rehab techniques are available, none of which require expensive equipment or great time commitments. A closely monitored home exercise program using exercise tubing is recommended, since this allows the doctor of chiropractic to provide cost-efficient, yet very effective and specific rehabilitative care.
The most important aspect is to recognize and address the biomechanical alignment problems and postural factors that are frequently associated with shoulder injuries. This entails screening the patient for forward head and flexed (kyphotic) torso postures. In addition, protracted (forward) shoulders change the angle of the scapula and compress the rotator cuff further. Failure to recognize these complicating factors will result in a patient with recurring shoulder complaints. When the shoulder girdle is properly aligned on the torso, the complex mechanism of the shoulder will be more likely to function optimally.
Athletes at risk include weight lifters, baseball players, softball players, and those who play racket sports such as tennis, racquetball, and squash. Glenohumeral osteoarthritis (GHOA) seems to result from pure instability, rotator cuff arthropathy, fracture, or postsurgical trauma and predominately affects older men. GHOA generally involves the glenoid rather than the humeral side of the joint,3 which will influence rehabilitation.
Comparison of Physiotherapy, Manipulation, and Corticosteroid Injection for Treating Shoulder Complaints in General Practice: Randomised, Single Blind Study
For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.
Acute soft-tissue injuries such as muscle-tendon strains, ligament sprains, and ligament or tendon ruptures occur frequently in sports and exercise. Without correct diagnosis and proper treatment, they may result in long-term breaks in training and competition. Far too often, injuries become chronic and end careers of competitive athletes or force recreational athletes to abandon their favorite activity. For these reasons, an increased focus has been on finding ways to ensure optimal healing. In this regard, the question has centered on immobilization or early mobilization in treatment.
A fall onto an outstretched arm or a collision on the playing field often leads to an acute anterior shoulder dislocation for high school- and college-age athletes. The diagnosis is usually made by history and physical exam. The angle of impact is an important diagnostic clue. If no neurologic contraindications or signs of acute fracture are seen, radiographs are unnecessary, and early reduction before the onset of muscle spasm is essential. Recent advances in arthroscopic techniques have dramatically reduced the high incidence of recurrent instability in young elite athletes, though nonoperative management with immobilization is still an excellent option.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for musculoskeletal injuries because the conditions are believed to be inflammatory in nature. However, because inflammation is a necessary component in the healing process, decreasing inflammation may prove counterproductive. Also, many tendon injuries called ‘tendinitis’ are, in fact, degenerative and not inflammatory conditions. An analysis of the pathophysiology and healing of musculoskeletal injuries questions the use of NSAIDs in many treatment protocols. Because NSAIDs have profound side effects, they should not automatically be the first choice for treating musculoskeletal injuries.
This article reviews the biomechanical structure and function of the glenohumeral joint, the typical mechanisms of injury, and then reviews injury prevention, exercises, and rehabilitative strategies.
In young adults, the incidence of neck and shoulder pain is high, and the associated factors of neck and shoulder pain are already multifactorial in a young population.
Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain: A Randomized, Controlled Trial
Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.
This article highlights a successful outcome for a patient with shoulder impingement syndrome after receiving a multimodal treatment approach combining soft tissue techniques (ischemic compression, friction), electromodalites (ultrasound), manipulation, and rehabilitation (exercises). In managing the shoulder and shoulder pain syndromes, a detailed knowledge of the anatomy of the shoulder and associated structures including the scapulohumeral, scapulothoracic articulations, the cervical, and the thoracic spine is important to develop an appropriate treatment plan. The practitioner is therefore well placed to manage both shoulder and spinal pain syndromes. Recent evidence suggests that this may be the future direction in managing pain of musculoskeletal origin,  particularly of the shoulder.  To determine the true effectiveness of a multimodal chiropractic treatment approach, further research should be initiated.
An otherwise healthy 47-year-old man reported a history of right shoulder pain subsequent to an injury he sustained several months earlier while boating. The patient recalled trying to lift a heavy object out of the water when his right arm was forcibly externally rotated. The patient related that his arm was sore for several days after the injury, but his pain receded and became manageable. He did not seek medical care acutely. Months later, when he did seek care, he said that he had lost overall power in his shoulder and had generalized shoulder pain with activity. Furthermore, he could not tuck his shirt into his pants with his right arm.
Shoulder pain resulting from glenohumeral instability is common among competitive swimmers. The biomechanics inherent to swimming promote muscular imbalances that stress the capsuloligamentous structures and contribute to shoulder instability. Most swimmers respond favorably to conservative treatment of rest and rehabilitation, while a small percentage may ultimately require surgical intervention. Swimmers who respond well to rehabilitation have a better prognosis for a successful return to swimming than those who require surgery. Overall, education in proper stroke and training techniques can minimize the likelihood that a competitive swimmer will experience disabling shoulder pain.
This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.
This study found a level of B or fair evidence for MMT of the shoulder, shoulder girdle, and/or the FKC combined with multimodal or exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction. There is a fair or B level of evidence for MMT of the shoulder/shoulder girdle and FKC combined with a multimodal treatment approach for shoulder complaints, dysfunction, disorders, and/or pain.
The rotator cuff, as all doctors of chiropractic know, is actually composed of four separate muscles: the supraspinatus, the infraspinatus, the teres minor and the subscapularis. Most of the approximately 2 million people who seek care for rotator cuff injuries in the United States every year have injured the supraspinatus, but the involvement of at least one of the other muscles is more common than was previously thought, says Dale Huntington, DC, owner of the Huntington Chiropractic Clinic in Springdale, Ark. “We used to think these tears were just in the super-spinatus 90 percent of the time. Now we’re realizing that, in the converging of these tendons, the infraspinatus is often being torn as well.”