Pinched nerve

Pinched nerves or “radiculopathies” are a common complication of disc herniations or spinal stenosis in the cervical and lumbar spines.  A disc herniation in the cervical spine can cause arm pain, while a disc herniation in the lumbar spine can cause leg pain or sciatica.  Nerves can also be pinched or compressed peripherally in the musculature of the neck, low back or buttocks and cause similar symptoms that disc herniations or stenosis cause.  If you have arm or leg pain you need a thorough examination to determine where and from what the nerve is being pinched.

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Shoulder Pain and Injuries

Shoulder Pain and Injuries

Learn more: watch the video or read the transcript below.

The Structure of the Shoulder

The shoulder is a complicated joint. It moves in many directions, and it can be very stubborn when it starts to become painful. The first thing a person wonders when they experience shoulder pain is “What’s going on with my shoulder?” Since the term rotator cuff is so common, many patients come in to my office and ask if they might have a rotator cuff tear.

First let’s talk about the structure of the shoulder which is one of the most movable joints in the body, but not the most stable. The way the shoulder is structured, you will see that it is basically a ball-and-socket joint. The ball-and-socket joint sits beneath a bony ceiling that is made up by the clavicle and the acromion, which is a bony projection at the outer edge of the shoulder blade. When you reach and touch your shoulder, you will feel that bony ceiling. Between the bony ceiling and the top of the ball-and-socket joint is a very complex and dynamic environment. Contained in this area is a group of tendons, blood vessels, and other structures, which include fatty tissue and bursa.

The bones of the shoulder are held in place by tendons, muscles and ligaments.  The five tendons of the rotator cuff, which hold the bones of the shoulder in place, begin as muscles that come up and insert into the ball part of the ball-and-socket joint. Those muscles and tendons provide us with all of the fine motor movements of the shoulder.

Tightness of the Shoulder

Many of my patients with shoulder pain come to see me because they are experiencing a limited range of motion, pain that occurs with everyday activities, and pain while sleeping. This can be caused by a person creating an impingement, or pinching, in their shoulder just by tensing the shoulder during activities. The repeated tensing of the shoulder can begin to shorten and tighten the musculature that houses the shoulder, and it can create a condition called Impingement Syndrome. This is when the tendons can be trapped under the acromion, and the ball-and-socket joint is pulled and starts to rub and grind away at the tendons.

Tendon Problems of the Shoulder: Descriptions and Symptoms

  • Tendonitis
    • This is simply inflammation of the tendon. This not only occurs in baseball pitchers who constantly use their shoulder, but can be a result of injury or simply from aging.
  • Tendinopathy
    • This when we start getting tearing of the tendons themselves. The tears come in four grades:
      • Grade one is an inflammation or some very, very fine tearing of some of the fibers in the tendon.
      • Grade two has a little bit more damage to the tendon, and it’s starting to get some depth to the tear itself. The person is probably already starting to have some problems sustaining weight with that shoulder motion.
      • Grade three is when the tendon has a fairly deep tear to it, and the person is probably going to have some real difficulty taking the shoulder through ranges of motion.
      • Grade four is where the tendon is torn completely in two.

Diagnosis and Treatment

The first step in dealing with shoulder pain, as with any large joint, is getting a correct diagnosis. A determination needs to be made as to whether it is a muscular issue; a tendonitis, an inflammation of one or more of the five tendons of the shoulder; a tendinopathy with tearing or a combination of issues.

That’s where the diagnostic process comes in. In our office we perform testing to make a determination about which category a patient’s pain or injury is in.

When a patient is in the early stages of these conditions, our treatments includes rest, ice, massage therapy, physiotherapy in the office, and perhaps manipulation of the neck or the shoulder. We will usually carry out about a two-week course of care as long as we see improvement and we are convinced that we are helping. If there is no improvement, we will provide you with a timely referral. We have referred patients for physical therapy, massage-therapy, and if needed, for an MRI and then on to the orthopedic surgeon for a consultation.

If you would like further information on shoulder pain or problems, please go to our website,  To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587

November 19, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Color images are courtesy of the US Library of Medicine and the US National Institutes of Health

Back and Neck Pain, Causes and Solutions

What is Causing that Back or Neck Pain

Learn more: Watch the video or read the article below

There really are two types of pain that we will experience when we feel back or neck pain. The first is mechanical pain, and the second is non-mechanical pain. You can see a breakdown of the causes of each in the following lists:

Potential Causes of Non-Mechanical Back or Neck Pain:

  • Infection

  • Tumor

  • Cancer

  • Other Diseases

Potential Causes of Mechanical Back or Neck Pain:

  • Joints

Dr. Phelan describes jointsA joint is the point of contact between elements of an animal skeleton whether movable or rigidly fixed together with the surrounding and supporting parts (as membranes, tendons, or ligaments).

  • Ligaments

Dr. Phelan describes ligamentsLigaments are a tough band of tissue that serves to connect the articular extremities of bones or to support or retain an organ in place

  • Nerves

Dr. Phelan describes nerves

Nerves are any of the filamentous bands of nervous tissue that connect parts of the nervous system with the other organs.

  • Discs

Dr. Phelan describes discs in thespine

A disc is any of the tough elastic discs that are interposed adjoining vertebrae and that consist of an outer fibrous ring enclosing an inner pulpy nucleus.

  • Muscle

Dr. Phelan describes muscles
A muscle is a body tissue consisting of long cells that contract when stimulated and produce motion.

  • Tendon

Dr. Phelan describes tendonsA tendon is a tough cord or band of dense white fibrous connective tissue that unites a muscle with some other part (as a bone) and transmits the force which the muscle exerts.

  • Bursa

Dr. Phelan describes what a bursa is

The bursa is a small, thin, watery sac between a tendon and a bone.

When going to see a provider of any kind, whether it’s a medical doctor or a chiropractor, the first thing that we have to do is determine what type of pain you are experiencing. Once we’ve safely eliminated the non-mechanical pain category as a source of your pain, we can start to focus on the origin of the pain itself. We will check the potential sources for your pain, which may be caused by one or more of these sources. All of these sources are capable of producing pain, either by themselves or in concert with any of the others.

Your top priority should be to receive an accurate diagnosis. Dr. Phelan is an outstanding diagnostician, and he will provide you with the most conservative plan possible to help you to heal as quickly as possible. When treatment plans require services outside of spinal manipulation, physiotherapy, exercise, ergonomic lifestyle changes, or massage, then Dr. Phelan will provide you with a referral to another highly qualified physician.

If you’re interested in speaking with us about back or neck pain, please go to our website,  If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587

November 14, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Images are courtesy of the US Library of Medicine and the US National Institutes of Health