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Shoulder Pain - Heart Attack or Rotator Cuff Injury?

The great TV classic ER helps teach armchair physicians to become amateur diagnosticians. He's in shock! She's got kidney stones! Rule-out pheochromocytoma!

But sometimes a little knowledge can be a dangerous thing.

You've learned somewhere - on the network news, in the Science section of The New York Times, or in a CPR class at your job - that shoulder pain can mean you're having a heart attack. Now, seemingly out of the blue, your shoulder begins to ache and throb. Very concerned, you rush to the local emergency room.

The resident's first question, of course, is "where does it hurt"? You point to your right shoulder and blurt out, "Am I having a heart attack?" The resident smiles, gently reassuring. "A heart attack might give you pain in your left shoulder," she says. "Have you been to the gym lately? This might be a rotator cuff strain."

The resident knows that heart attack symptoms usually involve chest pain (in two-thirds of cases), and may include faintness, shortness of breath, sweating, and a feeling of impending doom.1 Chest pain may spread to the back, jaw, and arms. Left arm pain may radiate to the inside of the forearm and the ring and little fingers. So, shoulder pain by itself probably doesn't suggest a heart attack.

She orders an MRI which shows mild damage to the right rotator cuff. What's going on? What exactly is the rotator cuff?

The rotator cuff is a muscular sheath that surrounds the head of the arm bone (the humerus) and the entire shoulder joint (really, two joints - the acromioclavicular and glenohumeral joints). The four muscles that comprise the rotator cuff help raise the arm to the front and the side and help turn the shoulder inward and outward.

If you're a sports fan, you know that rotator cuff injuries affect baseball pitchers, tennis players, swimmers, and football players. Such injuries are due to repetitive motion, and may also result from falling on the shoulder or arm or lifting heavy weights.

Rotator cuff injuries may also be slowly developing and chronic, related to arthritic and degenerative changes in the rotator cuff tendon and the two shoulder joints. Low-grade pain may develop, and the pain may become aching, throbbing, and chronic. Raising the arm may cause pain, and there may be loss of mobility.2

In the above-40 population, lack of exercise and chronically poor posture may contribute to rotator cuff problems. Sitting at a desk all day, with the neck jutting forward and slumped shoulders, places long-term mechanical stress on the rotator cuff.

Chiropractic treatment may be very useful in helping to rehabilitate chronic rotator cuff injuries. The chiropractic physician is expert in evaluating postural problems and associated spinal conditions. By providing effective treatment, postural corrections, and rehabilitative exercise, chiropractors offer a comprehensive therapeutic program to reduce pain, improve shoulder mobility, and regain function.

1Source: Cedars-Sinai www.cedars-sinai.edu
2Baring T, et al: Management of rotator cuff disease. Best Pract Res Clin Rheumatol 21(2):279-294, 2007.

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  • "A few months ago I started going to see Dr. Christie. She is amazing she did not make me feel bad for not seeing a chiropractor earlier. She went over in detail my x-rays and explained my issues. Dr. Christie takes her time going over what she is doing before she adjusts me."
    Ralph S. Seattle, WA
  • "Dr. Tiffany Christie is my first chiropractor, and I am quite content about making her my last. She takes the time to understand my needs and develops a personalized treatment plan to reach my goals! She makes every visit a treat - she is personable, professional, and passionate about what she does! Her infectious smile, awesome staff, and pain relieving adjustments have me leaving feeling better than when I first come in.

    It truly shows when you have health care professionals that enjoy what they do; I feel that their energy radiates onto their patients. Moreover, I get that from Dr. Christie and her staff who provide me with the quality compassionate care that I expect. 5 star treatment and I highly recommend visiting Dr. Christie for all your chiropractic needs!"
    - Paul G Seattle, WA
  • "I've been to many other chiropractors and not one of them took the time with me that Tiffany did. I was impressed with all of the treatments she offered besides adjustments. She did some soft tissue work on me and used a tool to help break up the scar tissue in my shoulders. I felt a ton of relief when I left. Dr. Tiffany is super sweet, which is a nice change from my last chiropractor who was all business. I LOVED the pre-treatment rolling bed she had me lie on. Get the muscles loosened up and just plain feels good! She also has some retail items that are helpful for aiding in sleeping ergonomically and physical therapy items. It was super nice to work with a chiropractor who wasnt in a rush to get me in and out. That made a big impression on me. Definitely give her a call!"
    Cary T. Seattle, WA
  • "Dr. Christie is amazing! Best upper cervical adjustments I have ever had. She also is quite skilled with Graston techniques. She is always ready to suggest a new kind of stretch, to help me between appointments. Not only is she a very knowledgeable, she is also a pleasure to interact with. Chiropractic care has never been this good!"
    Stephanie E

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