This region, where the arm joins the trunk of the body, is formed by the meeting of three bones -the clavicle, scapula and humerus – that create several joints, all and any of which can cause shoulder pain and varying degrees of immobility.
The shoulder is a complex area and its ball-and-socket joint between the upper arm bone (humerus) and the scapula is the most flexible in the body.
Fractures of any part of the shoulder joint are painful but specifically difficult to heal if the joint surfaces are involved.
Any shoulder injury should be examined by a doctor or osteopath. An X-ray is usually recommended.
Immobility for a minimum of six weeks is recommended in most fractures, or longer if the articular surface has been compromised. Do not shirk on this or try to do too much too soon because long-term arthritis is the usual outcome.
Fractures of the scapula cannot be splinted and severe breaks in this area or anywhere in the shoulder joint may require surgical pinning.
The clavicle is more commonly fractured in contact sports and events like skiing. It may often be left to heal even though the bones may be considerably malaligned.
Dislocation of the shoulder
Dislocation of the shoulder generally refers to the misalignment between the head of the humerus and the socket aspect of the scapula. If the dislocation occurs forward it is known as an anterior dislocation, and backwards as a posterior dislocation. The dislocation may repair spontaneously or may stay out of place, in which case it needs manipulating.
To dislocate usually requires a considerable amount of force because of the strength of the ligaments and muscles surrounding the shoulder joint. Falling on an outstretched arm is the usual cause. Because of the anatomy of the shoulder the head of the humerus tears through the anterior synovial capsule four times more frequently than the posterior aspect. Damage to the nerves and arteries running through the armpit is not uncommon and when replacing a dislocated shoulder this needs to be borne in mind. A relocation must be done swiftly if the pulse is compromised at the wrist. If numbness or paralysis of the fingers has ensued then replacement should be done by medically-trained personnel for fear of risking further nerve damage.
Emergency replacement or relocation of the humerus when no complications are observed should proceed as follows, but only if the joint cannot be stabilized until a professional can do the job: (a) The arm will be flexed at the elbow because of the shortening of the biceps tendons and will automatically be across the chest in an anterior dislocation. Hold the forearm as close to the elbow as possible and apply gentle downward traction. (b) Move the hand of the dislocated arm outwards, continuing to apply strong but gentle traction downwards at the elbow as in (a) above. (c) If the shoulder has not re-aligned, gently pull the elbow towards the other shoulder whilst continuing the downward traction and keeping the hand rotated away from the body. (d) This is a painful process and should preferably only be done if analgesia is available.
A frozen shoulder is a chronic or longstanding inflammation of the tendons and synovial capsule around the shoulder joint. It is characterized by pain that gets worse on moving the shoulder. Any motion is limited by this pain.
This lay-term has passed into medical parlance and represents a painful tightening of the muscles around the shoulder joint. It is most commonly created by an initial pain causing a lack of movement on a persistent basis, leading to a profound stiffness and worsening of the pain in these muscles.
The causes are generally unknown but there is increased vascularity, degeneration and scarring of the fibres within the tendons and synovial capsule. Arthritic conditions and trauma are often associated.
Several meridians or energy channels travel across the shoulder joint or are indirectly connected. These include the large and small intestine, heart, lung and reproductive organs. The triple heater (arguably the energy line that ‘ controls the heat of the body via its influence on the adrenal and thyroid glands) is very much associated with ‘shoulder problems. The triple heater is often weakened in stress situations. Problems such as frozen shoulder that have no obvious causative factor need to be reviewed from this point of view.
Osteopathic or chiropractic assessment is necessary for a firm diagnosis.
Manipulative treatment, including work on the neck and spine, is mandatory.
Acupuncture may be instantly relieving and should be used in combination with osteopathy.
Shiatsu may take the place of both of the above.
The application of heat may pull blood to the surface, reducing inflammation; or holding an ice bag over the area for a period of time may cool the area down. Both techniques may be soothing but neither are particularly relevant in long-term care.
Ensure good hydration because persistent cramps may be indicative of dehydration: three pints of water on top of current intake (up to a maximum of six pints per day) is necessary.
Ensure that calcium and magnesium supplements are being taken at three times the daily recommended dose on a chelated product.
Homeopathic remedies should be reviewed in your preferred manual and specific attention paid to Arnica, Rhus toxicodendron and Ruta.
Arnica 6 can be used every hour if pain and limitation of movement is being noticed.
Avoid orthodox practitioners because the treatments of choice are anti-inflammatory drugs and steroid injections, which may give temporary relief and a full sense of well-being that will allow further movement but longer-term injury and recurrence are not uncommon.