It’s probably more common than you think. Whiplash injuries, especially serious ones, are notorious for causing pain and disability beyond the neck. Whiplash is considered a full body disorder and symptoms can range from pain to dizziness, headache and fatigue. Depending on the type of collision and restraints, other body parts may be injured as well. One study (Abbassian A, Giddins GE. Subacromial Impingement in patients with whiplash injury to the cervical spine. J Orthopedic Surgery 2008;3:25.) looked at shoulder complaints in individuals who had suffered a whiplash type of trauma. Out of 220 patients with whiplash, 26% had shoulder symptoms and 5% had what is known as an impingement syndrome.
Referred pain from the neck and nerve injury to the muscles that stabilize the shoulder can give rise to an impingement syndrome. Also, direct trauma from the pressure supplied by a seatbelt during a frontal impact can cause fracturing of cartilage and sprain of the surrounding ligaments. The pointy top of the shoulder is the acromium and some impingements (binding and compression) can affect the tendons of the rotator cuff or other soft tissues just under this bone. Sometimes a bursa (fluid filled sac) can swell during the night causing pain.
Because most patients with whiplash who have shoulder pain are thought to have referred pain from the neck, an impingement syndrome may be overlooked. This can delay treatment, resulting in prolonged disability, pain, and chronicity.
An MRI may be needed to fully diagnose the problem and confirm the lesion. Sometimes the labrum, cartilage surrounding the bone, can break away causing significant pain. There may be inflammation surrounding the different tendons as they are caught between the shoulder bone and the soft tissues. Most shoulder injuries can be conservatively treated and rarely require surgery.
Chiropractors are trained to differentiate between neck and shoulder problems and provide specific treatments to each area. Sometimes, an adjustment may be needed to align the shoulder joint or neck. In other cases the shoulder can be helped by specific exercises for the rotator cuff muscles. The important part of this issue is first getting the problem properly diagnosed. If you don’t know what is causing the pain, it is nearly impossible to have a specific, effective solution.