How to manage shoulder pain

By Lee Sung-hun

Today’s Koreans exercise and play sports more often than they ever did before, and among those who enjoy leisure activities, the number of patients with shoulder pains have been increasing especially with those that engage in lots of shoulder movements by doing sports such as golf, baseball, tennis and lifting weights.

Among such shoulder-related complaints is shoulder impingement syndrome (SIS), commonly referred to as swimmer’s shoulder or thrower’s shoulder.

It is a common cause of shoulder pain that, if improperly treated or left untreated, can lead to more severe supraspinatus tendonitis, or subacromial bursitis, calcific tendonitis or in the worst cases to rotator cuff tear.

Some readers who exercise regularly may have at least heard of rotator cuff even if you may not be able to describe exactly what it is.

Contrary to a common misconception, it is not actually a single muscle but a group of muscles and tendons, namely supraspinatus, infraspinatus, teres minor and subscapularis muscles.

The rotator cuff stabilizes the shoulder joint from top, front and back sides of the shoulder and allows for shoulder movements.

Shoulder impingement usually occurs around the supraspinatus muscle of the rotator cuff.

The tendon of supraspinatus is located just below the acromion, which is a bony process on the scapular that laterally covers the rotator cuff like a roof.

Due to its anatomy, congenital malformation or degenerative changes of the acromion resulting in bony spur can lead to the narrowing of the space between the supraspinatus tendon and the acromion and cause impingements.

Other common causes of impingement include imbalance of the muscles around the rotator cuff and shoulder joint, or severe thoracic kyphosis, or round shoulder, all preventing the normal movements of the bones when lifting the arm overhead

Typically, SIS manifests pain in the front and side of the shoulders, and patients may find it difficult to lie on the affected side when lying on a bed.

Most commonly, it is painful to move the shoulders in upward “overhead movements,” like when throwing a ball, or swinging a tennis racket or swimming.

The range of angles from 70 to 130 degrees when lifting the arm is often referred to as the painful arc as there is no pain lower than the said angles.

SIS is different from a rotator cuff tear, where the pain is present from the moment you start lifting the arm.

It is also different from frozen shoulder, another common shoulder problem, in that with a frozen shoulder, both active and passive motion of the shoulder is limited and generally heals itself within 18 to 24 months.

As SIS can lead to damage in the muscles and tendons if left untreated, it requires proper medical treatment.

While treating for the specific areas of pain is a necessity for treatment of SIS, treating the surrounding areas such as the neck, back and shoulders is often beneficial for better prognosis.

The reason for that is because the motion of lifting the arm involves the movement of the scapula.

Lifting the arm upwards to 180 degrees consists of the humerus turning up 120 degrees and the scapula turning the rest.

As the scapula is directly connected to the neck, shoulder and upper back, any issues with them can lead to misalignment of the scapula.

In turn, it can limit the motion of the scapula from its normal range and overextend the range of motion by the humerus, making impingement more likely.

To address such issues holistically, Oriental medicine employs various combinations of Chuna chiropractic, acupuncture, moxibustion, cupping and pharmacopuncture.

To prevent SIS, it is the best practice to minimize the overhead movement of the arms while stretching can help ensure flexibility of the shoulder joints when such movements are necessary.

Strengthening the rotator cuff and surrounding shoulder muscles can also help.

The writer practices Oriental medicine at the UN Oriental Medical Clinic in Hannam-dong, Seoul.