Nearly every patient who comes to my office with shoulder pain has the same question: “Do I have a torn rotator cuff tendon?” I understand their concern, but the reality for most patients is that tendon problems are not the cause of their pain.
This idea takes a little getting used to. The terms “shoulder pain” and “rotator cuff tear” almost always are used together. Besides, it just seems logical that if you have a torn tendon, the problem is found — case closed. But it isn’t nearly that simple.
Many patients whose MRIs show torn and damaged tendons respond well with conservative care like acupuncture, physical therapy or chiropractic, despite the fact the treatment does not repair the tendon. Also, it is actually common to have torn tendons without pain in the shoulder. In one study, MRIs were taken of 96 people, ranging in age from 19 to 69, who did not have shoulder pain. The researchers found 34 percent of those tested had rotator cuff tears, and 15 percent had complete, “full thickness” tears.
Of course, these problems were more common in the older subjects. It is amazing how much tissue damage the body can work around and still do its job.
What is the cause of most shoulder pain if it isn’t tendon damage? Joints and muscles that do not work properly. A common comparison is a misalignment of the wheels of a car: There is no structural damage, the wheels still work and the car can drive, but something isn’t right. This problem can start from an injury, but it can also build up over time, often because of work stresses. This dysfunction causes inflammation of the tissues, tension in the muscles and, eventually, pain. It also could contribute to tendon damage, especially if left uncorrected over time.
The shoulder is a complex joint. The simple act of raising your arm requires the coordination of many different muscles. It is very common to find “knots” in the muscles of a patient with shoulder pain. This stored tension interferes with normal muscle dynamics, throwing the shoulder joint’s motion off, stressing the joint and causing inflammation. Releasing these “knots” in the shoulder muscles often improves shoulder pain immediately.
The shoulder is the loosest joint in the body. It also has the largest and most complex motions of any joint. Because of this, it depends on normal alignment in the surrounding joints, especially in the neck and upper back. I have seen shoulder problems disappear by treating the spine only, without touching the shoulder itself at all. This is true even if there is damage to the rotator cuff tendons.
If a patient is concerned about a torn rotator cuff tendon, I tell them it is quite possible they have one but it is not the most likely cause of their pain. The best approach is to start with conservative care. If that doesn’t work, work your way “up the ladder” to more aggressive treatments. Nearly every patient with shoulder pain gets at least some relief with conservative care and some get complete relief, but there is always the option to move on to surgery. The patient who starts with surgery first then works their way backward to conservative care may find the surgery was not necessary and can actually interfere with their recovery.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at email@example.com.