Help – I Have a Tear In My Shoulder Tendons!
Maybe it is the answer – but not straight away unless you have had recent severe trauma. See below how strong the muscles can become around your shoulder and they need to have strong tendons to link them to the bones – think about how much weight you can lift or pull or push, over your head or at awkward angles when gardening ….and it is a relatively small joint with small, short tendons that need to react to any movement you make – no wonder we develop problems so often!
Causes of ‘Popping’, ‘Snapping’ or ‘Cracking’ in My Shoulder
The most common cause of popping or snapping is rotator cuff tears, bursitis, labral tears (see below for labral information), biceps tendon problems and arthritis. These can show on either X-rays or MRI’s, however, what you must remember is that MRI’s of patients with no shoulder pain at all, show high rates of tendon and labral tears! The word ‘tear’ sounds as though you need to have it repaired immediately and if you don’t get it repaired then you will be in trouble either sooner or later.
The reality is that if you are in pain due to these tears, most of the time rest and treatment by a chiropractor can work very well to restore correct function and relieve your pain.
At the Avenue Clinic we treat you, the patient, not your X-ray or MRI findings because the recent scientific literature shows that this is the most beneficial approach for patients.
We will take a detailed history of your shoulder problem and then examine you – your shoulder, your neck and your upper back to ascertain if an X-ray or an MRI is necessary.
Recent research showed that in 50 patients between 40 and 60 years of age that underwent MRI scans, superior labral tears were actually normal age-related findings and actually, 70% of shoulders scanned showed a superior labral tear , commonly called a SLAP lesion and furthermore, they were not aware of it!
The bottom line to remember here is that MRI’s of the shoulder will almost always find something wrong!
Why Not MRI ‘Just To See’
So what is the problem with undergoing MRIs performed ‘just to see what is going on in there’? The most important reason is that it can often lead to worry about something that is not serious and to undergo unnecessarily invasive treatment. Of course if you need do not respond to treatment, it may be that you do require surgery but no surgery should be undertaken lightly without trying less invasive treatment first.
Many of the changes we see on a shoulder MRI are simply a consequence of activity and aging. If you do not respond to treatment then we can arrange an MRI but it is better to try less invasive treatment that often helps considerably, before undergoing injections of corticosteroids that can actually cause thinning of the tendon or surgery that can lead to more pain that lasts longer and also don’t forget most surgery does not come with guarantees!
If we tell you we think you have a tendon tear, bear in mind the high number of tears that show up on MRI’s that have been present for maybe years and yet have never given patients pain – just because you have developed pain and we can see on MRI that you have a tear does not necessarily mean that the pain is coming from that tear. A thorough examination will determine where the pain is coming from more accurately.
Treatment may not repair the tear but by treating the tissues that ARE causing the pain, and encouraging better function and increasing strength of the surrounding muscles, you can become pain free without undergoing any expensive and worrying scans.
Shoulders may pop or snap for lots of other reasons too. It is very common and you really shouldn’t worry about it but it would be a good idea to get your shoulder function checked out by one of us so that we can better advise you on the cause.
Shoulder Joints are Made Up Of
The shoulder is a very complex joint composed of bones, cartilage lining those bones, ligaments holding the bones together and tendons that link the muscles to the bones to move them all surrounded by bursae – small sacs of fluid that cut down on friction between ligaments and tendons and the bones as they move. There is also a labrum – thick, rubbery, non elastic tissue that surrounds the shoulder joint and acts to keep the top of the arm ‘cup’ fixed to the ‘saucer’ of the shoulder blade. If you imagine a cup and saucer with sticky glue around the base of the cup allowing the cup to move without falling off the saucer, that is what the labrum does.
Any of those structures can be injured by just everyday repeated movements such as reaching to close a stiff garage door daily or gardening overhead or sports injuries or significant trauma and then the smooth movement of any of those structures can cause that popping, snapping or clicking.
Usually the noises are nothing serious. As we age, we often hear our joints make noises that are not in the least painful but if our shoulders feel as though they might ‘go out of joint’ if we move our arm too far, or we feel any discomfort, you should consider talking to one of the chiropractors at the Clinic.
Treatment at the Clinic
All of these injuries can be improved or healed by physical therapy such as chiropractic care. You should therefore consider consulting one of the chiropractors. They will examine your shoulder and treat what they find and probably give you some exercises.
Treatment may involve manual therapy, ultrasound therapy, dry needling (acupuncture for your musculoskeletal system) to improve blood supply to the area and promote healing and function of the surrounding muscles, ligaments and tendons.
Manipulation of your neck or upper back will improve movement there and take the stress off your shoulder. Imagine if your mid back between your shoulders is stiff and you don’t move in that area very well. If you then repeatedly reach over head when you are gardening or reaching for the garage door or up to high cupboards with your arm outstretched and your mid back does not take part in that stretching activity you can imagine that all the stretch occurs in your shoulder and this can overload it eventually, giving pain. If your mid back and neck are part of that movement then the load is spread over more tissues and that overload is less likely to occur.