If you have shoulder pain (and are looking for a pain management clinic in Edmonton) consider the Unpain Clinic. We have a multi-disciplinary team eager to help you reduce your pain and improve your quality of life by providing patient centered shoulder pain treatments. We also love to educate our patients (and website visitors) so we have put together these information pages to help you understand more about the shoulder and shoulder pain.

Anatomy of Shoulder

The shoulder is a very shallow ball and socket joint optimized for mobility, but not great stability. The shoulder or glenohumeral joint is created where the head of the humerus attaches to the glenoid fossa of the shoulder blade. The glenoid fossa is not very deep so a rim of cartilage called the labrum attaches around the fossa to provide a deeper cup for the head of the humerus to sit in. The two bones and labrum are surrounded by a fibrous capsule with a special synovial lining that produces lubricating joint fluid, many ligaments, tendons and number of muscles.

The main muscles associated with the shoulder are the rotator cuff muscles which include the supraspinatus, infraspinatus, teres minor and subscapularis. The rotator cuff muscles are the main[h1]  stabilizers and movers of the shoulder, but there are many other accessory muscles which contribute to shoulder movement and strength. Some of these accessory muscles include the biceps, triceps, deltoid, coracobrachialis, latissimus dorsi, pectoralis major and minor and teres major. Each of these muscles functions to move the shoulder in a different plane of motion.

We can’t talk about the shoulder without also talking about the shoulder blade (scapula) and collarbone (clavicle). The scapula sits on the posterior rib cage and is required to have a certain mobility and strength to support the arm where it attaches to the thorax. The scapula is the attachment point for the rotator cuff muscles and some of the other accessory muscles of the shoulder. The clavicle forms the anterior part of the shoulder girdle and also serves as an attachment point for some of the accessory shoulder muscles. A piece of the scapula called the acromion and the lateral end of the clavicle form a secondary joint called the acromioclavicular (AC) joint which helps to protect the shoulder joint itself from direct trauma from above.

What is Shoulder Pain?

Shoulder pain is any unpleasant or distressing sensation felt in the region of the shoulder. In the case of the shoulder there are two main causes of pain:

• Traumatic injury – a sudden event that can cause instant pain and dysfunction such as a torn muscle, strain or sprain, fracture, impact injury or blunt force trauma. These types of injuries usually require medical attention within minutes or days of onset.
• Non-traumatic disease processes– might seem to come on over time and may seem to the patient not to have an obvious cause or source. This type of pain could be related to:
  • muscular dysfunction or overuse
  • changes to the health of joint elements such as ligaments, tendons cartilage or bone
  • degenerative processes related to metabolic changes, infection, systemic diseases or aging

Common Causes of Shoulder Pain:

• Rotator cuff /tear/tendinopathy
• Dislocation or fracture
• Arthritis – osteoarthritis, rheumatoid arthritis –can affect the shoulder joint itself or the AC joint
• Frozen shoulder (adhesive capsulitis) – slightly more common in patients with diabetes
• Bursitis
• Tendinitis of one of the accessory muscles of the shoulder
• Poor posture and bad biomechanics
• Overuse strains and muscular dysfunction
• Shoulder impingement syndrome
• Nerve injuries in the neck or shoulder –e.g. cervical disc herniation can cause pain to feel like it is in the shoulder

When to see a doctor?

You should see your medical doctor immediately if:

• you have experienced a sudden traumatic injury, especially if it you heard a loud pop or snap at the time of injury 
• your shoulder is red, very warm, very swollen or if you have an obvious deformity
• If you have dramatic changes in your range of motion  – e.g. you can’t move your shoulder, elbow or hand
• you have pain with signs of an infection (fever, chills, redness)
• If you lose feeling in your hand or arm (not like when your arm falls asleep)
• If you suspect your shoulder pain may be referred pain from a diseased organ

Shoulder pain that isn’t really from the shoulder, AKA referred pain.

Shoulder pain can also occur when another area is affected or diseased and the pain refers to the region of the shoulder. Usually this pain is not triggered by shoulder movements and comes on more suddenly with other symptoms -typically in the absence of any shoulder injury.

Several organs can refer pain to the shoulder area including:

• the heart – can refer to the left or right shoulder –in women it can be either side, in men it is usually the left. Pain may be accompanied by nausea, chest tightness and/or dizziness or a feeling of anxiety
• the pancreas – usually refers to the left shoulder and can be acute or recurrent. May occur after eating certain foods and may come with nausea or vomiting and changes to bowel[h1]  function
• the lungs – usually refer to the same side as the affected lung and may come with shortness of breath, chest tightness, wheezing or coughing
• the spleen – usually refers to the left shoulder and can occur with fever, nausea, vomiting, light headedness.
• the stomach or colon – usually refer to the left shoulder and can occur with nausea, vomiting, bowel function changes or blood visible in vomit or stool.
• the liver – usually refers to the right shoulder and may occur with changes in skin color, nausea or vomiting
• the gallbladder – usually refers to the right shoulder and is more common after eating fatty foods. It may also occur with nausea or vomiting.

If you suspect your shoulder pain is due to referral of pain, seek out emergency medical help immediately, especially if your symptoms come on suddenly and are very severe.

Treatment:

Many treatment options are available for shoulder pain relief and included below is a list of a few common options:

• Physiotherapy – physiotherapists (or chiropractors) will assess you and create a plan of management for your pain which could include one or more of the following:
  • Education and advice
  • Rehab exercises or stretches
  • Cryotherapy (cold) or thermotherapy (hot)
  • KT taping or bracing
  • Ultrasound, Laser therapy, TENS therapy
  • Manual therapy (soft tissue therapy, joint manipulation or mobilization)
  • Shockwave therapy
  • Dry needling or IMS
• Medication – medication can sometimes be useful to help you manage shoulder pain and can include over the counter options from your local pharmacy or might be prescribed by a medical doctor.
• Surgery – surgery for the shoulder may be necessary in cases of severe injury or non-response to conservative care. Your healthcare professional will advise you if you might need surgery and make appropriate referrals to your medical doctor, orthopedic specialist or surgeon.  

Exercises for shoulder pain

The best exercises for shoulder pain are usually targeted to the specific muscle(s) and tissues affected[h1] , however, there are a few safe and effective shoulder exercises that can be good for a variety of shoulder complaints. 

• Pendulum
  • Stand next to a counter or chair, using your strong arm to brace yourself
  • Lean slightly forwards and let the affected arm dangle towards the floor
  • Sway your hips to get your arm moving in small circles for 1-2 minutes.

Scapular retraction

• Sit or stand with good posture
• Use the muscles between your shoulder blades to pull them together
• Don’t let your shoulders rise toward your ears when you do this, keep them down.
• Relax the hold and repeat 10-20 times.

Pec stretch

• Stand slightly to one side your palm on the stretching hand flat on the wall, below shoulder height
• Rotate body gently away from the wall to feel a stretch
• Hold for 30-60 seconds and repeat on the other side

Shoulder shrug circles

• Sit or stand with good posture and roll your shoulders in wide, lazy circles, keeping your arms relaxed by your side.
• Perform for 1-2 minutes

Across chest stretch

• Bring one arm across your chest.
• Place it in the crease of your other elbow or use your other hand to support your arm.
• Hold for up to 1 minute and switch sides. Repeat 1-2 times.

Neck release stretch

• Lower your chin toward your chest until you feel a comfortable stretch along the back of your neck.
• Gently tilt your head to the left to stretch your right shoulder and hold for 30-60 seconds then switch sides to stretch the left shoulder. Repeat 1-3 times/side.

FAQs

What is the main cause of shoulder pain?

The most common cause of shoulder pain that we see at the Unpain Clinic is long term wear and tear linked to aging, poor posture, overuse or old injuries. Wear and tear can affect muscles and tendons, cartilage, bone, ligaments and joints and can present as a number of clinical conditions depending on which of these elements are most affected.

How do I relieve shoulder pain in Edmonton?

That depends on the cause of your pain -there are many possible options for shoulder pain relief and many healthcare providers able to provide effective treatments to help you get out of pain. If you aren’t sure what to do, working with a qualified healthcare professional is a good place to start. Medical doctors, chiropractors and physiotherapists are all qualified to provide assessment, make treatment recommendations and refer you to other providers if alternate care is required.

Should I see a doctor or chiropractor for shoulder pain?

Both can be a good place to start, but if you have a sudden severe traumatic shoulder injury or suspect that your shoulder pain may be referred pain from a diseased organ, see your medical doctor first. They can order the appropriate tests and imaging to rule out non-musculoskeletal pain and in the case of severe injury like fractures or dislocations, will be able to refer you ASAP for proper orthopedic or surgical management.

If your shoulder pain is due to a problem with muscles, tendons, ligaments or joint mobility then a chiropractor or physiotherapist can absolutely assess you and if appropriate will formulate a plan of management to help you feel better.

What can cause shoulder pain without injury?

A few things can cause shoulder pain in the absence of an injury but the most common one is overuse. Overuse occurs when we perform the same activity (or many repetitions of an activity) for an extended period of time or when we exert our bodies beyond their capacity for work. Overuse strain can come from repetitive shoulder movements at work, in sports, or while performing hobbies, shorter periods of lifting maximum loads or even just prolonged periods of sitting or standing with poor posture.

When should I worry about shoulder pain?

If your pain comes on suddenly or very severely, with or without injury, or it is accompanied by an obvious deformity, the inability to move your arm or hand, signs of an infection or lack of sensation in your hands or arms, seek out medical attention immediately. 

What does a pinched nerve in your shoulder feel like?

Nerves around the shoulder can become pinched if they are trapped or compressed by tight muscles or fascia or being impinged upon by a bone, however, it is much more common for a nerve in the neck to become pinched and refer pain to the shoulder region, this is called cervical radiculopathy. If you have a ruptured disc in your neck or you have bone spurs from arthritis narrowing the canal the nerve uses to exit the spine, you can experience pain that refers or radiates into the shoulder, sometimes even with minimal to no neck pain. This pain may also be accompanied by tingling, numbness or weakness in the arm or hand and is usually described as sharp, electric or burning in nature. You may find relief by elevating your bent arm above your head (known as shoulder abduction sign) which is a common sign of this condition.

If you are experiencing this type of pain, see your medical doctor, chiropractor or physiotherapist so that they can help formulate a plan of management for you. Cervical radiculopathy treatment often requires a number of appointments along with home management strategies and depending on the cause, might require surgical intervention.

How can Shockwave Therapy Help with Shoulder Pain?

Shockwave therapy uses high power sound waves to stimulate deep, cellular healing in a shorter period of time than traditional pain relief options.  It is one of the most well-researched technologies in regenerative medicine today, with an extensive amount of study performed on conditions of the shoulder. There is evidence that shockwave therapy can be helpful in treating rotator cuff injuries, shoulder tendinopathy, calcific tendonitis and adhesive capsulitis (frozen shoulder[h1] ).

What methods does Unpain Clinic use to treat Shoulder Pain?

The Unpain clinic is a multi-disciplinary facility that includes physiotherapy, chiropractic, massage therapy and shockwave therapy in its roster of possible treatments for pain. We especially love shockwave therapy because it seems to produce fairly rapid results with minimal side effects or down-time. If you would like to find out if shockwave, or our other services could be[h2]  beneficial for you, feel free to book a no obligation telehealth consultation. 

Do I need an x-ray for my shoulder?

You might or you might not depending on what your healthcare provider learns during your assessment. X-rays are good for visualizing the bone and overall alignment of the shoulder, but sometimes other types of imaging like ultrasound or MRI can be a better choice if structures like muscles, tendons or the labrum of your shoulder need to be visualized. Your healthcare provider will let you know if imaging is required and will choose the best type for you. 

Is a Physiotherapist covered by Alberta Health Care?

Yes and no.  Confusing, right?  Alberta Health Care holds contracts with specific clinics – so you could have a perfectly good physiotherapist in a private practice who is not covered under Alberta Health Care since they do not negotiate contracts with them.  It usually comes down to cost.  If a clinic is offering a more specialized service that is more expensive to offer, it is not typically covered by Alberta Health.  There are, however, many reputable clinics out there that provide excellent traditional care for clients under Alberta Health Care contracts. Unpain Clinic does NOT bill to Alberta Health Care at this time.

How much does physiotherapy cost in Edmonton, Alberta?

Physiotherapy in Edmonton can range anywhere from $50-$400+ per visit.  The price depends on the therapist, the clinic, and the technology or treatment being offered.

Do you need a referral to see a physiotherapist  in Edmonton, Alberta?

No. Physiotherapists are considered primary healthcare providers, along with medical doctors, chiropractors, naturopathic doctors and acupuncturists. These professionals do not require a referral from a medical doctor for you to see them.

Be aware that your extended health benefits plan may require a doctor’s prescription in order for you to claim your visit. The best way for you to know if you need a referral is to call your benefits provider or check out their website.

Here at Unpain Clinic we always accept and appreciate referrals from medical doctors and other healthcare providers and are happy to collaborate and communicate with them to ensure you get the best care possible.

Still have questions?

Book a free no obligation consult with one of our team members to learn more about how we treat shoulders and see if we might be a good fit for you.