My shoulder pain isn’t getting better … That’s because it might no be coming from your shoulder!!

As with so much in life, clinical routine has its seasonal features: the overindulgence accident at Christmas; the gardener’s back in March after a winter of inactivity – most of these problems have an obvious cause an effect but there is one problem that strikes every autumn … and nobody is quite sure why.

Ask a chiropractor how they know when autumn has arrived and they will tell you it’s the sudden influx of patients with ‘shoulder’ pain – instead of half-a-dozen per week, suddenly it’s more than half a dozen every single day. 

Theories as to why range from the ‘cold wintery draught on warm skin’ to the effects of rapidly changing day length on serotonin levels, though no theory has yet been proved (it’s not a well-researched subject). What is, however, seems quite clear from clinical experience is that most of these seasonal symptoms are not shoulder pain at all!

If the pain is across the top of your shoulder or between the shoulder blade and the spine, then the chances are it’s coming from your ribs. Patients often look slightly sceptical on being informed that their ‘shoulder’ pain is coming from their costal joints (the joints between the ribs and the vertebrae) – “surely my ribs are in my chest?” they say.  In fact, the top rib actually joins with the base of the neck and acts as an anchor for some of the big muscles that run up the side and back of the neck (which can often feel as if they’ve been ‘pulled’ or ‘cricked’ if the underlying rib is injured).  You can easily feel your top (first) rib, it’s the bony lump you can feel at the base of your neck just behind your collar bone … that’s how high they go.

By comparison, most pain that arises from the joints and muscle of the shoulder is typically felt at the top of the arm. either whether the rotator muscle pass under the collar bone and attach to the arms or coming directly from the joint between the collar bone and shoulder blade or from the cartilage, ligaments and synovium of the ball and socket joint.

The other things patients often complain of is that – unlike ‘true’ shoulder injuries – they’ve no idea how they’ve done it: it just “came on gradually”, or, more commonly, they “woke up with it”.  That’s because the inflammation in the small joints between the ribs and the spine builds up slowly over several hours, so its not the injury (often from lifting at arm’s length) that hurts, it’s the body’s reaction hours later.

So, if you’ve got a intense ache across the top of your shoulder or feel there's a knife in your back just inside the shoulder blade, then you’re probably suffering from costovertebral syndrome, colloquially known as a ‘popped rib’ … and you may well be suffering: it can be one of the most painful of conditions;  fortunately, it is also one of the easiest and quickest for chiropractors to treat, with recovery often in days. 

There's also something you can do to help yourself if you’re suffering from seasonal shoulder symptoms, use an ice pack (or wrap some frozen peas in a tea towel) and apply for ten minutes or so every hour (that will reduce the inflammation), then pick up the phone and ask one of our chiropractic experts for confirmation that it’s your ribs and not your shoulder that are the source of the trouble.

What does a Chiropractor do … on a Tuesday?

Because I work on Saturdays and have Mondays off, Tuesdays start early at 7:30 and begin with an assault on the in-tray: two days’ post, messages, following up patients, phone calls and making sure the social media for the week is planned and posted (thanks goodness for Hootsuite and ‘autoschedule’).

It’s important that the decks are cleared before patients start, because Tuesdays are invariably fully booked … and often overbooked, as was this particular Tuesday, which kicked off fifteen minutes early with an emergency patient, who had cricked their neck sleeping awkwardly the previous day and was nervous about seeing another chiropractor.

The morning consisted of a typical mix of patients: There were twelve cases of low back pain (including one new patient), one hip pain, one ankle injury (tennis), a couple more cases of cervicalgia, and a couple of headache, a child with poor gait, a cartilage injury in the knee, a rotator cuff tendinitis and a lady with temporomandibular disorder … and one no-show, which is always incredibly frustrating when you’re not only full but have people on the waiting list, desperate for appointments.  Fortunately, everyone was getting better and staying better apart from one of the headache patients, who was referred to our next specialist Headache Clinic so the dental and stress components that were preventing the condition from settling could be addressed.

Although I always try to run to time, the last couple of patients proved slightly more complicated than expected and that made lunchtime a bot of a scramble – Tuesday’s morning session is at Yeovil and the afternoon session is at Crewkerne … which gives me the opportunity to stop at home en route and quickly eat a rather belated lunch.

As ever, when time is tight, the traffic on East Street is backed up to Mount Pleasant (someone build a bypass for Crewkerne PLEASE!!) and clinic starts seven minutes late!  This, of course is the immediate cue for patients to be complicated, refactory, or to present with unexpected new conditions.

The first patient was typical of this, a lady with a recovering sacroiliac joint causing buttock pain who had been feeling so much better that she decided to move some furniture and now had raging sciatica and all the signs of a prolapsed lumbar disc.  The next three patients also all had sacroiliac joint problems; however, these were all recovering as per prognosis – improved after three treatments, better after six and two of the patients were ready to start some gentle home-based exercises to stretch out tight, fibrotic muscles and rebuild core stability.

The next case is a tough one – a whiplash injury that has been referred via a solicitor having previously failed to recover.  The delays involved in processing the claim has allowed the injury to become chronic and it’s not just neck pain, like a lot of whiplash there is also a jaw problem (which is preventing the neck from settling), back pain and a shoulder injury … all made worse by the stress of dealing with solicitors and the whole compensation process. Today, at last, there is some sign of improvement: everything is moving better and hurting less – but with so many areas to treat, there is no chance of catching up and now I’m running almost quarter of an hour late.There is, however, no point in worrying about that … most patients understand that sometimes you need to spend longer with a patient – next time, it could be them! 

Fortunately, the next lady in is a new patient: at last a chance to sit down for a few minutes and to take a case history. Fortunately too, her case is relatively straightforward: a long history of migraines, which sound like they’re coming from the neck with no evidence of anything sinister or untoward going on – the physical examination confirms the diagnosis and there’s time to start a course of treatment which turns out to solve fifteen years of weekly misery in just  couple of weeks!

The rest of the evening is full of complicated patients: a knee riddled with osteoarthritis that would probably do better with surgery but the lady’s determined to avoid the kind at all costs; neck pain in an eighty-four-year old lady with osteoporosis who needs particularly careful handling; another case of low back pain following not one but two car accidents (the neck and jaw had already responded to treatment); a lady with back hip and knee pain; a cervical disc injury causing arm pain and, to finish the day, a disc problem which is stubbornly refusing to respond to treatment and needs referral for magnetic resonance imaging in Bridgwater, where we have a special arrangement … all of which means that clinic finishes fifteen minutes late – which is still quarter of an hour earlier than the rest of the week (for historical reasons, Tuesday’s Crewkerne clinic ends at 6:30 rather than 7).

Home at 7pm having left at 7am. Although there is stuff to be done (when isn’t there?), the lure of an early night proves irresistible: tomorrow is going to be another early start with budgets, cashflow forecasts and marketing analysis all to do before another 36-patient day and a fresh brain will be required.

My Shoulder is Frozen!

Have you ever had a shoulder joint that’s painful and restricted?  The chances are you probably thought it was a ‘frozen shoulder’ – and the chances are you were probably wrong!

As with some of the previous terms we’ve discussed, such as sciatica and migraines, the problem lies in part with the difference between what you might mean by ‘frozen shoulder’ (it hurts and I can’t move it properly) and what a musculoskeletal specialist means by ‘frozen shoulder’ (very specifically, adhesive capsulitis) … and differentiating between the two is very important as they can have very different treatments and outcomes.

The shoulder is the most complicated joint in the body – in fact, it’s not one joint at all, it’s three joints plus the articulation between the shoulder blade and the top seven ribs.  If it’s going to work properly, there are over 100 joints, muscles, ligaments and bursae that have to we working normally and integrate smoothly.  Fortunately, of all the things that can go wrong, frozen shoulder (or adhesive capsulitis as we should call it from now on) is one of the less common.