A/C Joint Injury
ACROMIOCLAVICULAR (A/C) JOINT INJURY
The A/C Joint is located at the tip of the shoulder and is formed between the acromion (part of the shoulder blade or scapula) and clavicle (collar bone). The movement in this joint allows you to bring your arm above your head.
Injury to this joint usually follows trauma, especially a fall onto an outstretched arm or a fall onto the tip of the shoulder. In severe cases this may involve a dislocation known as an A/C Separation Injury, which may require surgery.
In most cases seen by chiropractors the degree of damage is less and these normally respond well to techniques for both the shoulder and the neck, along with stability exercises.
A bursa is a small fluid-filled sac that sits between tendons and bones (or tendons and skin), preventing abrasive rubbing against bones as muscles contract and relax. Bursae can become inflamed in a condition is known as bursitis.
In the shoulder the important bursae are the subacromial and subdeltoid (continuation of subacromial bursa). These occupy a small space under the tip of the shoulder and normally slide through this space with normal shoulder movement. If they become inflamed the bursa can become impinged with shoulder movement, in a condition known as impingement syndrome.
Bursitis usually coincides with mechanical imbalance in the shoulder leading to irritation of muscle tendons – especially the rotator cuff and biceps. Repetitive shoulder movements and altered posture cause a low level, but continuous stress that eventually leads to inflammation.
In the early stages, regular ice on the shoulder and avoiding aggravating activity are important in settling the pain. Chiropractic adjustments to the shoulder and neck along with exercises that draw the shoulders back can be very useful.
Less commonly bursitis may be the result of an underlying arthritic condition, such as rheumatoid arthritis or gout.
In some cases medical management is also required. This may include anti-inflammatory medication, aspiration of fluid from the bursa or cortisone injections.
Frozen Shoulder/Adhesive Capsulitis
FROZEN SHOULDER/ADHESIVE CAPSULITIS
Frozen shoulder (adhesive capsulitis) describes a state in which the shoulder builds up significant scar tissue causing the joint capsule to contract and severely limit shoulder flexibility.
This lack of shoulder movement is both active (when the person tries to move the arm) and passive (when the chiropractor tries to move the arm).
Frozen shoulder can follow any shoulder injury, such as bursitis, tendonitis and rotator cuff syndrome.
There is often no pain at rest, though it can be very painful with attempted movement or if sleeping on the effected side.
The condition is typically diagnosed based on clinical presentation; however, X-ray, ultrasound or MRI may be used to rule out other causes, such as osteoarthritis.
Frozen shoulder is a chronic condition that often takes many months to improve. Without care the condition will mostly resolve, but this can take up to 2 years.
Mobility and stabilization exercisers play an important role in rehabilitation. Chiropractic adjustments to both the spine and shoulder are often useful.
A medical procedure known as hydrodilatation in which saline and cortisone is injected into the joint may be helpful. This addresses both the inflammation and also stretches the joint from the inside.
Rotator Cuff/Impingement Syndrome
ROTATOR CUFF/IMPINGEMENT SYNDROME
The rotator cuff is a group of 4 muscles and their tendons that attach from the shoulder blade (scapula) into the bone of the upper arm (humerus). The role of these muscles is to stabilize the shoulder through movement.
These muscles can become irritated or torn – usually due to chronic ‘wear and tear’ associated with repetitive actions over a long period of time. At other times a fall onto an out stretched arm may cause an acute rotator cuff tear. The supraspinatus is the most common tendon involved with both chronic and acute tears.
Most tears are partial tears that can be managed conservatively. A complete full thickness tear in a young person may require surgery, but in an older person surgical repair is often not recommended.
The supraspinatus sits just under the tip of the shoulder (acromion). If the tendon becomes inflamed, such as in a tendonitis, it can become impinged as the shoulder moves. Typically pain is most obvious when the arm is in the mid-range outward position, but then decreases once the arm completely overhead. This is known as impingement syndrome and is often associated with bursitis.
In the early stages avoiding aggravating activity is essential. Ice for 10-15min after activity can help settle inflammation.
It is common that shoulder and neck posture is compromised in individuals with rotator cuff injury. Chiropractic care and stabilization exercises can therefore be very useful.
Medical co-management may also be required for more severe cases. This may include non-steroidal anti-inflammatory medication or cortisone injections.