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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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  • "If I could give 10 stars I would! I found this place through reviews a year ago on a whim. I have not been disappointed. Amazing staff and Dr Peters is seriously on another level professionalism, mannerism and charm.
    Dr Peters works with my 16 yr old daughter often and she is at total ease with him. He has helped her through many injuries as an athlete and with myself and my old creaky bones.
    If you need a chiropractor I highly recommend!!"
    -Kelly C.
  • "Did a ton of research before finding Dr. Peters. I'm very picky when it comes to Chiropractics. The Doc is legit and the staff Kourtney & Jeff are the best."
    -Joe M.
  • "He takes time to assess and evaluate every patient and is not about crack 'um and go. He has healing hands and truly cares for his patients. Additional info you may find helpful: I never have to wait. He sticks to his schedule so I am in and out in 30 minutes. He usually spends about 20 minutes with me. Jeff at the front desk always greets me with a smile and by name. The business is bright, fresh and clean."
    - Bridget Harris
  • "The doctors explain things so well and make sure each visit is filled with QUALITY time. Their explanations allow me to better understand the maintenance I need for my own body to function the very best in my daily routine."
    - K.C. Mercer
  • "I have been coming here for over a year now and am happy to say the doctors there are great! I have seen numerous improvements with continued chiro and acupuncture in the way my body feels."
    - Cyndee
  • "The doctors explain things so well and make sure each visit is filled with QUALITY time. Their explanations allow me to better understand the maintenance I need for my own body to function the very best in my daily routine."
    - K.C. Mercer