Shoulder Pain - Heart Attack or Rotator Cuff Injury?

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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Testimonials

  • "Regular visits with Dr. Roeder have significantly reduced the frequency of migraines I have suffered and the amount of neck and shoulder pain I have lived with for years. Because of Dr. Roeder I am able to focus on my busy life again"
    S.L., San Diego
  • "This was my first encounter with a chiropractor and found the experience to be delightful, gratifying and well worth it! Instead of being given a bunch of pills and told to come back next week, the manipulation for my back and side injuries including carpal tunnel syndrome, responded very well to the treatments. Thank you, Dr. Roeder for a job well done"
    W.B., San Diego
  • "I came in originally for neck pain, but getting adjusted helped lower my blood pressure & my insulin levels too.Dr. Roeder is so thorough in her care-I never knew how much better I could feel.I no longer have to take blood pressure medicine now."
    A.W., San Diego
  • "Since meeting Dr. Roeder at a health seminar, she has changed my life, drastically-improving my health 100%. I had a wide range of symptoms, including chronic fatigue, constant and severe headaches, body aches, nausea, difficulty concentrating and I felt extremely tired and weak. She diagnosed me with having Fibromyalgia and Candida. She put me on an anti-inflammatory diet and started me on chiropractic treatment and instructed me on strength exercises. I have lost 40 lbs and feel fantastic! Whenever I eat something that sets off a symptom, I can identify the food source now. I know how to eat well and stay away from foods that cause inflammation. Had it not been for Dr. Roeder's expert care, I believe I would still be suffering from all those symptoms-- instead I feel fantastic!"
    M.O., Spring Valley
  • "My son was diagnosed at a very young age with Hyperkyphosis. The doctor told us that surgery would be his only option but we needed to wait until he got older.My husband and I were heartbroken to think about such a major surgery for our little boy.We wanted to help him anyway we could without doing surgery. We are so thrilled to say that after seeing Dr. Roeder my son's back has made a major improvement.That there is a stronger chance that he may not need surgery after all.My son is three now and he is a very active little boy and you can't even tell that he had ever had a bad back.He is able to do what all little boys do:run, jump and climb!Taking my son to Dr. Roeder was the best decision that me and my husband have made as parents.I am so happy that Dr. Roeder is part of our lives.In fact all of my extended family members are patients of her too!Thank you so much Dr. Roeder for all of your help.You have been such a positive part of our lives.You are part of our family."
    G.C., San Diego
  • "My daughter has been diagnosed with Von Willabrand's and Precocious Puberty at age 7. She had her first period at age 8, and it was for three days. The doctors said that her hormone levels were off and there wasn't any truly safe treatment. After talking to Dr. Roeder, she started chiropractic care to help her body cope better with this disorder and hopefully change her hormones. Now my daughter and I have been told by doctors at Children's Hospital that it looks like she won't be starting her period until two years from now-this will be the normal time when she should start! They told us to keep up the good work of whatever we have been doing because it seems to be working."
    J.H., San Diego
  • "I got treated for a neck and back injury that appeared to be chronic following a major car accident. I had been to chiropractors before but without much success.After seeing Dr. Roeder now though, my mobility and general feeling of well-being has greatly improved."
    C.H., San Diego
  • "Dr. Roeder was recommended by a friend and I am completely satisfied. I was having low back pain also some neck pain. My back feels better than it has in years. I feel Dr. Roeder is complete in recommending exercising and treatment!"
    M.L., San Diego
  • "I just wanted to say thank you for making me 'new' again. Also, for helping us through our tough times. You always have been nice to us and helpful when we were in your office-it was just like a second home! Every time I walked through the door I felt calm and relaxed. You always asked us how we were doing and how we have been. I thought that was very thoughtful and caring of you-especially considering that awful car accident we had been in. None of my doctors before had been as courteous as you. You have really made a bad experience into a great experience in a blink of an eye. I always loved that EVERYONE was always smiling! I wish that when I grow up I can be like you, always making people happy and feel better! Well, I think that you just made another patient happy because of your wonderful 'magic.' Oh and I know I already said this but I think I am speaking for everyone when I say: Thank you Dr. Roeder!"
    J.F., San Diego (pediatric patient)