Let me first be clear that this post discusses specifically “osteoarthritis”.  My problems with this “diagnosis” do not carry over into the diagnoses of Rheumatoid Arthritis or Juvenile Arthritis.

A man in his late 60’s walked into my office and prophetically stated, “Doc, I finally found out what’s wrong with my shoulder!  I have arthritis!”  While I really like this patient, he’s one of those stubborn guys who will ask me a hundred questions, seem like he’s listening, agree with me and understand on the way out, and then find an opposing view the next day, and all of my hard work is gone.  His problem was beyond obvious.  He had a classic case of shoulder impingement syndrome, mediated by abnormal movement of his arm (overactive trapezius muscle affecting scapulo-humeral rhythm.)  Pain woke him up at night, he was sleeping on the arm, shrugged his shoulder blade up with every effort of movement, and tested painful, but not weak for the rotator cuff muscles.  IT WAS DEFINITELY IMPINGEMENT!  So he runs off to his primary care doc, who takes an x-ray of the affected side, sees some mild insignificant degeneration gives the dreaded “A” word diagnosis.  Clearly, I was wrong.  Oh wait… No I wasn’t.

Arthritis cannot be diagnosed solely on an x-ray.  It’s not just some degenerative changes.  It is a very complex set of interactions between bone, soft-tissue, inflammatory change, neurological habits and movement patterns.  Does degeneration predispose a patient to this?  Sure.  Does it mean the patient is helpless and stuck forever with pain?  Should he buy stock in Tylenol or Advil quickly?  NO!  This is why I hate the diagnosis.  If my patient had listened only to the primary care doctor, he is really left with no options, other than to deal with the pain.

The reality in this (and many other) situation(s) is that if the doctor takes x-rays on the patient’s other shoulder, he would have found similar, if not worse findings.  He would have also found degenerative change in the spine, hips, knees and ankles.  So why was the shoulder the patient’s only complaint?  According to x-ray, he was FULL of “arthritis”.  I do my best to educate patients and the public that pain is not mediated by a series of degenerative changes.  His pain is mediated by function.  There is both biomechanical pain and chemical pain.  Often, when one type is there, it drags the other with it shortly after.  Examples help.

Example 1:  I smack you in the forearm with a hammer.  The pain is chemical in nature, as the tissue begins a process of healing, nerves send signals of pain to the brain, inflammation causes chemical pain.  One week later, since you’ve been protecting that forearm, you haven’t moved your elbow correctly, and now it hurts.  Now it’s biomechanical.  

Example 2:  I immobilize your elbow to be totally straight for 5 days.  You will definitely have pain when you go to move it, and likely you will have pain in your shoulder and wrist as well.  They are moving either too much or not enough, the body knows this is incorrect, provides a feedback to the brain, where it then “instructs” to move your arm (biomechanical)  It will invariably also swell, aggravate soft tissue, etc… (chemical.)  

My patient in question was given some specific strategies to restore the movement in his arm.  Mostly, I told him to pay attention to how he raised his arm, don’t sleep on it, and use ice and Phoenix KinetiCream to minimize the inflammation.  Guess what!  It worked.  In the end, we want to restore biomechanics to the joint as best as possible and minimize chemical pain.  We want to do this as naturally as possible as to not cause any further insult to the body.  That creates normal function, and normal function is how pain is most effectively controlled.  This is why I love being a chiropractor.  I get to help restore FUNCTION daily!  Remember this when you hear the term “arthritis” get tossed around, whether it be about you or a loved one.

Take care of yourself, please.  You only have one body.  Keep it healthy.

-Craig Banks, DC, CCSP®
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