A Functional Perspective
ACA News 2013 (Aug): 34–35
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.”
Manipulative Therapy for Shoulder Pain and Disorders:
Expansion of a Systematic Review
J Manipulative Physiol Ther 2011 (Jun); 34 (5): 314–346
This study found a level of B or fair evidence for manual and manipulative therapy (MMT) of the shoulder, shoulder girdle, and/or full kinetic chain (FKC) combined with multimodal or exercise therapy for rotator cuff injuries disease or disorders (RCIDs). 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 (SCDP). There is a fair (B) level of evidence for MMT with exercise that included proprioceptive retraining as helpful for frozen shoulder (FS) or adhesive capsulitis. There was a fair level of evidence (B) for MMT using soft tissue or myofascial treatments for soft tissue disorders (ST) of the shoulder. There is a limited level of evidence (C) for cervical lateral glide mobilization (CLGM) and/or HVLA manipulation with soft tissue release and exercise in the treatment of minor neurogenic shoulder pain (NSP). There is an insufficient level of evidence (I) for MMT with or without exercise or multimodal therapy in the treatment of OA of the shoulder. In particular, MMT must be combined, when safe, appropriate, and including no contraindications, with commonly indicated exercise or rehabilitative therapy, as it remains the standard care. For clinicians, however, this study is intended to guide them in the appropriate use of MMT, soft tissue technique, exercise, and/or multimodal therapy for the treatment of a variety of shoulder complaints in the context of the entire hierarchy of available evidence.
Manipulative Therapy in Addition to Usual Care for Patients With
Shoulder Complaints: Results of Physical Examination Outcomes in a
Randomized Controlled Trial
J Manipulative Physiol Ther 2010 (Feb); 33 (2): 96–101
The factor analysis resulted in 4 factors: “shoulder pain,” “neck pain,” “shoulder mobility,” and “neck mobility.” At 6 weeks, no significant differences between groups were found. At 12 weeks, the mean changes of all 4 factors favored the intervention group; the factors “shoulder pain” and “neck pain” reached statistical significance (95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors “shoulder pain” (95% CI, 0.0-2.6), “shoulder mobility” (95% CI, 0.2-1.7), and “mobility neck” (95% CI, 0.2-1.3) statistically favored the intervention group. 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.
A Multi-modal Treatment Approach for the Shoulder:
A Four Patient Case Series
Chiropractic & Osteopathy 2005 (Sep 16); 13 (1): 20 ~ FULL TEXT
The patient underwent a multimodal treatment protocol including soft tissue therapy, phonophoresis, diversified manipulation; and rotator cuff and shoulder girdle muscle exercises. Outcomes included pain measurement; range of motion of the shoulder, and return to normal daily, work, and sporting activities. At the end of the treatment protocol the patient was symptom free with all outcome measures normal. The patient was followed up at 4 and 12 weeks and continued to be symptom free with full range of motion and complete return to normal daily and pre-treatment activities.
Identifying and Managing Shoulder Pain in Competitive Swimmers
PHYSICIAN AND SPORTSMEDICINE 2005 (Sep); 33 (9)
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.
Shoulder Pain and Weakness
PHYSICIAN AND SPORTSMEDICINE 2004 (Nov); 32 (11)
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.
Rotator Cuff Impingement
J Manipulative Physiol Ther 2004 (Nov); 27 (9): 580-590
Outcomes included pain measurement; range of motion of the shoulder, and return to normal daily, work, and sporting activities. At the end of the treatment protocol the patient was symptom free with all outcome measures normal. The patient was followed up at 4 and 12 weeks and continued to be symptom free with full range of motion and complete return to normal daily and pre-treatment activities.
Manipulative Therapy in Addition to Usual Medical Care for Patients
with Shoulder Dysfunction and Pain: A Randomized, Controlled Trial
Ann Intern Med 2004 (Sep 21); 141 (6): 432-439
Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.
Predictive Factors for Neck and Shoulder Pain:
A Longitudinal Study in Young Adults
SPINE (Phila Pa 1976) 2004 (Aug 1); 29 (15): 1662–1669
This random sample of 826 high school students was investigated when they were 15 to 18 years old, and again at 22 to 25 years of age, to estimate the prevalence and incidence of neck and shoulder pain in young adults, and to identify the associated and predictive factors of neck and shoulder pain based on a 7-year follow-up. In 7 years, the prevalence of weekly neck and shoulder pain increased from 17% to 28%. Among those who were asymptomatic at baseline, 6-month incidence of occasional or weekly neck and shoulder pain was 59% 7 years later. 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.
Biomechanical Factors That Contribute To Rotator Cuff Function And Injury:
A Focus on Chiropractic Sports Care
Today's Chiropractic 2004 (May)
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.
NSAIDs and Musculoskeletal Treatment: What Is the Clinical Evidence?
PHYSICIAN AND SPORTSMEDICINE 2003 (Jan); 31 (1) ~ FULL TEXT
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.
Shoulder Dislocation in Young Athletes
PHYSICIAN AND SPORTSMEDICINE 2002 (Dec); 30 (12)
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.
Comparison of Physiotherapy, Manipulation, and Corticosteroid Injection for Treating Shoulder Complaints
in General Practice: Randomised, Single Blind Study
British Medical Journal 1997 (May 3); 314 (7090): 1320–1325 ~ FULL TEXT
In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P < 0.001). Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy (P < 0.001). Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%). CONCLUSIONS: For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.
Osteoarthritis of the Glenohumeral Joint
Nonsurgical Treatment Options
PHYSICIAN AND SPORTSMEDICINE 2002 (Apr); 30 (4) ~ FULL TEXT
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.
Managing Shoulder Sprain/Strain Injuries
Many of the shoulder problems that chiropractors see involve one or more forms of rotator mechanism dysfunction. This chronic biomechanical continuum usually begins with dysfunction of the rotator cuff muscles and progresses to rotator cuff syndrome; supraspinatus tendinitis; impingement syndrome; subdeltoid and subacromial bursitis; calcific shoulder bursitis; and even most cases of frozen shoulder and bicipital tendinitis. In such cases, there is no direct, acute injury.
Upper Extremity Rehab in the Elderly
There is now a wealth of data that supports the value of resistance exercise in the geriatric population. Improvements are seen in weight and body composition, decreased falls/improved balance, better psychological health, less frailty, and improved function. With exercise, the resting blood pressure lowers and there is a reduction in the risk of all-cause mortality.3 These benefits overwhelm the few detrimental concerns, and encourage us to recommend resistance exercise to older patients who need upper extremity rehab.
Faulty Movement Patterns as a Cause of Articular Dysfunction
Craig Liebenson, DC
During activities involving lifting of the arms, fixation of the scapulae is the key. Upper trapezius and levator scapulae fix the scapulae from above, while the lower trapezius and serratus anterior do so from below. The upper fixators attach to the cervical spine while the lower ones attach to the thoracic spine. Since the upper fixators are usually overactive and the lower fixators inhibited, overstrain of the cervical spine during carrying or reaching activities is common.
Chiropractic Management of a Professional Hockey Player
with Recurrent Shoulder Instability
J Manipulative Physiol Ther 2001 (Jul); 24 (6): 425–430
The patient had undergone strength training for rehabilitation after each of the previous two shoulder operations and had very strong rotator cuff and scapular musculature. Proprioceptive testing revealed a poor response in the left shoulder compared with the right shoulder. Two subjective outcome measures were used to determine the effectiveness of the treatment protocol in reducing the symptoms of recurrent shoulder instability. Much of the treatment focused on proprioceptive training, soft tissue mobilization, and improving joint function.
Chiropractic Treatment of Frozen Shoulder Syndrome (Adhesive Capsulitis)
Utilizing Mechanical Force, Manually Assisted Short Lever Adjusting Procedures
J Manipulative Physiol Ther 1995 (Feb); 18 (2): 105–115
The patient's shoulder was conservatively managed with chiropractic adjustments to the affected shoulder joint, as well as to the cervicothoracic spine. Treatment consisted of mechanical force, manually assisted short lever chiropractic adjustments, delivered via an Activator Adjusting Instrument. Successful resolution of the presenting symptomatology was achieved.
Shoulder Muscle Dysfunction and the Golf Swing:
Important Treatment and Educational Considerations
David Seaman, DC, MS, DABCN and George DeFranca, DC
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.
Rotator Cuff Exercises
The exercises described below are to help you strengthen the muscles in your shoulder (especially the muscles of the rotator cuff--the part that helps circular motion). These exercises should not cause you pain. If the exercise hurts, stop exercising. Start again with a lighter weight.
Sports Update: Evaluation of the Unstable Shoulder
Thomas Souza,DC, DACBSP
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.