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Shoulder Pain - Heart Attack or Rotator Cuff Injury?

Rotator Cuff Rehabilitation
Basic rotator cuff rehabilitation addresses loss of mobility. The two main activities are finger walking and pendulum swings.

In finger walking, stand about 18 inches away from a wall, positioned so your torso is perpendicular to the wall. Reach your arm out to the side and touch the wall with the tips of your fingers. Your elbow should be bent slightly. Slowly walk your fingers up the wall as high as you can go. Walk your fingers slowly all the way down the wall and repeat 10 times. As you continue the exercise over days and weeks, your range of motion will improve.

In pendulum swings, sit at the edge of a hard chair and bend your torso forward, supporting your weight by activating your stomach muscles and resting your non-working arm on inner thigh. Let your working arm dangle to the side and, slowly and gently, begin to swing the arm in a small circle. The movement begins by a gentle swaying of your torso. Slowly increase the diameter of the circle to a maximum of about 18 inches. The whole routine should take about a minute. 
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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We value our patients' experience at Stamford Sports & Spine. If you are currently a patient, please feel free to complete the following Client Experience Questionnaire. The Questionnaire is in Adobe Acrobat format, and requires the free Acrobat Reader to view.

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Dr. Andrew Zomick & Dr. David Avallon

I have been coming to Stamford Sports and Spine for almost 10 years. I am active and have unfortunately been in a few car accidents. The care and treatment offered at Stamford Sports and Spine is world class and without them I would be living with an inordinate amount of pain and discomfort. Going to Stamford Sports and Spine has made my injuries manageable.


Very good team of therapists. Flexible and available schedule. They helped get my teenage athletes back on the field in half the time.


I was experiencing some pain in my right shoulder and numbness down my arm to my hand. The range of motion in my shoulder was limited and I could not participate in volleyball. Dr. Z came to our office offering a free chair massage and a chance to come in for an evaluation. I did this and we worked out a treatment plan that included therapy and adjustments. I noticed in the first few weeks the pain subsided greatly in my shoulder. The numbness in the arm and hand were present but noticeably better. After three weeks, the range of motion in my shoulder was back to normal and the pain was gone. Now after one month of therapy the numbness in the arm is extremely better and I do not notice the symptoms as often as I used to. Coming into the office has helped tremendously. I can now play volleyball pain-free.


After moving from London to the USA, two weeks into living in Stamford and having carried and unpacked a lot of heavy boxes my shoulder froze and I was in a great deal of constant pain. After finding Stamford Sports & Spine on the internet I made an appointment and the corrective programme S.S.S. put together for me meant that I immediately had some pain relief, and over the next few weeks the pain left completely. The programme is also ensuring that I am not only pain free but fully corrected so as this problem should not occur again. Very friendly staff and very detailed assessment programme that has ensured my full recovery.


From my first visit to Stamford Sports & Spine I was extremely impressed and pleased with their service. Everyone including staff and doctors were very knowledgeable with their chiropractic services. I learned a great deal about my symptoms and overall care more than I expected. I have visited a few other chiropractors but none were as thorough as Stamford Sports & Spine. I was experiencing severe pain in my shoulder and arm and after a few visits my pain decreased substantially. I really appreciate all the services from the adjustments, rollers and even exercise room. I would highly recommend this facility to everyone. The entire staff are friendly, professional and just simply great!


Everyone was incredibly professional and helpful.  The staff is friendly and goes beyond what was expected to meet my needs and education me about my condition.


Came in with severe and constant numbness and tingling in my legs and feet. The treatment worked quickly and resolved all of my symptoms. Thanks!


My arms were falling asleep every night and had numbness and tingling during the day. I no longer have any of those symptoms during the day and have very rare episodes of pain at night due to my treatment here at Stamford Sports & Spine


I came in for hip pain and stiff neck that also affected my right arm and hand. Using the relaxing rolling / traction bed and electrical muscle stimulation along with stretching and the adjustments my hip pain is gone. I can walk without sharp pains running up and down my legs. My neck range of motion has improved and my muscles are more flexible and less spastic.


I had severe neck pain which was aggravated by a recent move. I have been coming to be adjusted for a few weeks now and not only has it helped with the neck pain I had been experiencing, but it has also made me feel better overall. I feel like I am able to sit up straighter, and my muscles are looser and less tense. I no longer have the intense pain I had once been experiencing


When I came in my pain was a 10 out of 10. After just one week of care my pain went down to a 4 and has been improving ever since. The staff are very friendly and great educators. I learned a lot about my body and how to take better care of myself.


After a car accident,  I had to seek help for my upper back and neck pain. Slowly but surely I started to feel better, not immediately, but by keeping up with my visits with Dr. Q & Dr. Z. Now I can tell you that I feel leaps and bounds better, and am now looking forward to a pain-free summer.


I have been with Stamford Sports & Spine for more than a year now. I still remember how much pain I was in during my first session. I can now walk in and out without any aches or pains.


When I first started going to Stamford Sports & Spine, my back had been seizing up with alarming regularity. After just a few months of working with Dr. Z and Dr. Q, I feel much more confident in my daily activities and have even been able to return to the gym.


Thank you to Dr. Z, Dr. Q and the whole Stamford Sports & Spine team! For many years, I have been suffering from severe back pain that would sometimes keep me from going to work. The recurring pain would come and go and I couldn't figure out what I was doing to cause it. When I came to the office, Dr. Z took x-rays, did a complete examination and educated me as to what was happening and why. I began treatment and was given exercises to prevent these injuries from happening in the future. Since starting the treatment, I have seen a great improvement in my back. The pain is gone and I have an increased range of motion. Thanks again to the entire staff who are very friendly and always willing to accommodate my hectic schedule when I make appointments.


The strabismus in my eyes caused a vertical deviation in my eye placement.  This resulted in my head naturally tilting to the right and throwing my muscular structure in my neck and shoulders off.  I had accepted the tilt and tightness as a way of life and a natural dis-figuration of my spine.  I almost didn't sign on for initial treatment.  After 3 visits I have already noticed a difference in the position of my head, my posture and regular comfort levels.  There is still a ways to go to rid that area of  a lifetime of dysfunction, but what a relief to know it's treatable and already improving.


I found Dr. Z and Dr. Q earlier in the week after experiencing some back pain and sciatica. After the consultation and x-rays I began therapy. After just 2 treatments I felt much better and had a significant reduction in discomfort in the area of concern. I am looking forward to continuing my treatment in an effort for long term recovery and a return to my heavy exercise routine.


FANTASTIC. When I leave I feel like a whole new woman. I have been going there for my neck pain and headaches for about 1 year now; off and on and ever since I started treatment there my headaches have been reduced to one every few months instead of a few every month. The intensity of of my pain has also been reduced to almost nothing. The doctors seem to have a very friendly relationship with all of the patients and I feel very welcomed by the staff as well. Not to mention I love how they incorporate therapeutic massages into my treatment. I have since sent over many of my colleagues and family, who also share the same feelings. Thank you.


I had a great experience. My low back pain is completely gone. I found the staff extremely knowledgeable, accommodating and friendly. I would highly recommend them.

--Jay F.

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