I have a good friend who asked me to address this as her husband is suffering badly with shoulder pain, so this one is for you Lynn. If you were not 1500km away I would love to help. I hope this is helpful in some way.
Bone spurs – what are they?
Your bones are growing and changing shape all the time according to the forces placed on them. Did you know that? They grow uniformly in a ‘bone’ type shape not any which way only because they have a protective capping type of outer surface.
Now as we age or experience injury, the protective capping of the bone may be chipped or worn out. In this scenario the bone continues to do what bones do – grow – however in the wrong direction. The bone grows in the form of little spurs, typically intruding into a joint space.
Bone spurs in the shoulder.
The most common example of bone spurs in the shoulder is called ‘subacromial spurring’. This is where the spurs impede and inflame a specific tendon (the supraspinatus tendon). The reason why this tendon is so commonly affected is because it is the only tendon in the body that has to pass between two bones.
See tendons are the white bands that attach muscle to bone. They are the bit that the muscle pulls on to move your limbs, but they normally sit on the outside of joints. You may reach behind your bent knee as you are reading this and pluck your hamstring tendons like a guitar string.
Supraspinatus is a tendon in the shoulder that passes between two bones. The acromion bone above and the humerus bone. It is the only tendon in the body to pass between two bones (see the second diagram). So you can imagine, if there is some bone spurring in this space with bone on one side and bone on the other, the tendon has nowhere to go. As it tries to glide back and forth in its joint space it is squashed, irritated and inflamed.
This can become a very debilitating pain that will keep one up at night, and get angry with even the slightest movement.
What can be done about it?
Before I talk about what can be done, I must mention the fact that the body is not simple. Just because we can see spurs in the location of the pain (as in the image above) this does not automatically mean that they are the cause of the pain. There is quite a bit of science demonstrating that just because there are spurs present, this does not mean removing them will fix the pain! It takes skilled assessment, and usually a process of elimination, to determine whether the pain is in fact tendon inflammation or referred pain from the muscle or joint and bursa inflammation or even pain from a nerve in the neck. I see all of these causes regularly and regularly resolve the complaint. Even when there are spurs present on X-ray.
3 solutions . . .
If you have ongoing shoulder pain with little relief, it is of course wise to chat to your GP first. He is a good guy to eliminate any nasty (or life threatening) causes for the pain, like tumours for example. Once your GP has established that you are not going to die from this symptom he may not be the most helpful clinician to then treat the pain. His therapy usually goes something like this:
‘Take this Panadol!’
Now to solutions:
- The first potential solution is to get Myotherapy manipulation on the rotator cuff muscles. Supraspinatus is one of these. I have heaps of stories of patients who have confirmed bone spurs in the shoulder, yet manipulation of the muscles in the shoulder has resolved the pain. This is by far the cheapest and shortest route to relief – if it works. You would be silly not to do this first.
- Second solution: Aggressive rest. When spurs have caused tendon inflammation, then to stop using the arm for 10 days to three weeks combined with anti-inflammatory medication (consult your GP) can often settle the inflammation and then with careful introduction of activity, the pain will stay subdued.
- A more specific application of anti-inflammatory medication is known as a cortisone injection. This is when a doctor injects anti-inflammatory fluid (cortisone) right into the shoulder. This is a bit of a last resort. Bear in mind that cortisone rarely fixes the problem. Even if you get relief for a few weeks or months, it has not solved the real issue. In conjunction with a good muscle manipulation, often the relief from the injection provides a window by which Myotherapy treatment can restore normal function. This combination is MUCH more likely to provide lasting results than cortisone alone.
Finally, if these measures have been exhausted and there is no relief, then surgery to remove these subacromial bone spurs is your final option. If you get to this point, the good news is this: Subacromial decompression (as it is called) is one of the most successful shoulder surgeries around.
Why?
Because it is relatively simple. It is a matter of shaving off those intruding spurs and taking the pressure off the tendon. This leaves the body to work its healing magic in the tendon and joint space.
If this was helpful please share it around. Most people are simply not aware of the conservative solutions like Myotherapy treatment that work so often. They end up in surgery when they may not have needed it.
– Tim
