The shoulder is a complex joint that requires an in-depth exam to differentiate between the various causes. At the same time, I do see one condition that is quite common that seems to be commonly misinterpreted as shoulder pain.
It has gotten to where I can almost diagnose this on the phone. Bear in mind, I will always perform a complete physical exam when a patient comes in for care. But I’ve had numerous phone conversations that sound like this:
Patient: “Doc, do you work on shoulders?”
Me: “Yes I do. What’s going on?”
Patient: “My shoulder hurts and no one can help me with it. I’ve been to physical therapists. I even had an MRI that showed nothing.”
Me: “Does it hurt right in the ball and socket joint of the shoulder or is it more in the shoulder blade area?”
Patient: “Well, it’s more in the shoulder blade. But sometimes when it’s really bad it feels like it goes down my arm.”
Me: “Does it hurt worse you take a deep breath in?”
Patient: “Yeah, it does.”
Me: “How about when you doing things with your head flexed forward? For example, if you are hunched over the computer?
Patient: “Oh yeah, that’s when it first started really hurting me.”
Me: “It sounds like your problem is not in the shoulder. It is in your upper back where the ribs form a connection with your spine. This is definitely something I can work on. I’ll connect you to the front desk and they can set up an appointment for you.”
When the patient comes in, if it is a rib issue as is so commonly the case, I can almost always feel right where the pain is coming from. I palpate down the side of the spine where the ribs join the vertebrae of the spine. I will commonly feel a rib that is protruding a few millimeters from its proper place. There will usually be muscle spasms in that area and perhaps even swelling. Very often when I press down the patient will exclaim, “That’s it. That’s where the pain is coming from.”
The good thing about this condition is that a misaligned rib tends to respond well to treatment. A few chiropractic adjustments to bring the misaligned rib back into its proper place and the patient will often experience significant pain relief. At the same time, it is important to work on all the other issues that contribute to the rib misalignment. Addressing the patient’s forward head posture, other restrictions in the upper back area as well as providing some guidelines for workstation ergonomics will all help keep the problem from returning.