Shoulder pain: the rotator cuff and the joints around it
The shoulder is the most mobile joint in the body and it pays for that freedom with vulnerability. Most of the shoulder pain I see involves the rotator cuff, the group of muscles and tendons that steer the shoulder joint itself or the soft tissues and small joints around it, including the AC joint where the collarbone meets the shoulder blade. Related problems such as shoulder bursitis and biceps tendinopathy often present alongside it.
These complaints usually respond well to hands-on treatment combined with a specific, graded exercise programme. A systematic review in the British Journal of Sports Medicine found specific exercise the best supported approach for this kind of shoulder pain, with manual therapy a reasonable addition. That matches 39 years of experience of knowing what works. I also check for pain referred from the upper back and there is more on how I approach shoulder problems on the blog.
Arm pain often does not start in the arm
Arm pain frequently begins somewhere else. An irritated or trapped nerve in the neck can send pain, pins and needles or numbness down the arm and into the hand, sometimes with very little neck pain to point you to the source. Shoulder problems, by contrast, tend to hurt most when you use the arm: reaching, lifting or lying on that side at night. Part of every assessment here is deciding whether your arm pain is coming from the shoulder itself or from the neck, because treating the wrong one would waste your time and money.
Elbow, wrist and hand
Elbow pain, tennis elbow and golfer’s elbow are usually overuse problems of the tendons where the forearm muscles are anchored. Where elbow pain is connected to problems in the neck and upper back, treatment directed at those areas may help. Where it is an isolated overuse injury, the evidence favours a progressive loading programme for the tendon and if that is what your examination shows, I will explain it rather than give you treatment you do not need. Carpal tunnel syndrome, cubital tunnel syndrome, RSI and desk-related arm pain, De Quervain’s tenosynovitis and thumb arthritis each have their own guide on this page.
Frozen shoulder: being honest about it
Frozen shoulder, properly called adhesive capsulitis, is a condition that tends to run its own course, often over many months and no hands-on treatment has good evidence for shortening it. Where I can help is in getting the diagnosis right, because a fair share of shoulders labelled frozen turn out to be stiff, painful rotator cuff problems and they behave quite differently. In keeping the neck and shoulder blade moving while the joint recovers can help, alongside your GP’s options for pain control.
What happens at an assessment
Everything starts with a proper assessment, whether the problem is arthritis in the shoulder, thumb and hand arthritis or a hand and wrist nerve condition. Every session begins with a thorough case history and an examination of the neck, shoulder and arm together, so treatment is aimed at the precise source of the pain. Our FAQ page is a useful source of information and I have written an article on how many sessions it usually takes.
When to see a doctor first
Most shoulder and arm pain is mechanical, but a few situations need a doctor before they need me. Arm or shoulder pain with chest pain, breathlessness or sweating can signal a heart problem, so call 999. A shoulder that is deformed or unusable after a fall or accident needs A&E. A hot, red, swollen joint with fever, constant pain that is no better with rest or at night or progressive weakness or numbness in the hand all need medical assessment first. If anything in your examination does not belong in a chiropractic clinic, I will tell you and refer you on. I have also written an article on is it safe to see a chiropractor. In fact, the blog, in general, has lots of helpful articles if you enjoy a read.
