Question
Hi Dr. Gillman,

I periodically get an overall adjustments from my chiropractor. The last time I went I got an immediate and severe burning in my upper right arm area, but not the shoulder. The position I was in for this part of the adjustment was laying on my back, arms folded over my chest with a slight twist of my body, one bended knee over the bottom leg. The burning was the worst I ever felt and it lasted about 30 seconds whereas a more normal burn and time would be just a few seconds. I felt fine that afternoon and evening. When I woke up the next morning I was in severe pain and could not find a position to relieve it. I thought maybe my arm was out of joint and went back to the chiropractor. I was told it was likely bursitis and sent on my way. Due to the severity of the pain, I went to my primary doctor. I was prescribed a muscle relaxer which helped with the pain. The severe pain went away but since the adjustment, I have had bad pain in the upper arm and shoulder area. To make a long story short, I was sent to a specialist who determined I needed shoulder surgery. They cut an inch off my clavicle and cleaned the bursa. That was in December 2008. After almost three months of physical therapy, I have the same pain and problem lifting my arm as I did from the beginning. What could have happened during the adjustment to cause the horrible burning, then severe pain that I still have?

Answer
Kim,

'Too bad you had such a terrible experience.   First, based on what you've told me, there must have been a hypertrophied or arthritic acromio-clavicular joint (AC Joint)in your shoulder to begin with, or else they would not have performed the surgery to cut away the distal end of the clavicle.  Knowing this, it is possible that when you were in the side-posture position for your adjustment, the doctors contact hand on your arm or shoulder (this varies from one practitioner to another) tugged or jammed the shoulder joint.  With an underlying arthritic shoulder, this has the potential to smoosh the tendons and bursa that sit under the AC joint.   If it was the shoulder that was against the table, the same thing can happen.  In this case, you are lying on the shoulder, compressing it, with your arm across your chest, and if the doctor inadvertently tugs on it, it will get strained.   With immediate tissue damage, there is immediate pain. If it's minor, or if the bursa gets tugged, there can be burning pain that lingers.  If you had burning pain symptoms during previous sessions, you should have mentioned it and had it checked out.   In summary, I think you had an underlying arthritic AC-joint shoulder problem that was causing impingement, and the postural strain from the joint manipulation provoked it.   As to how to fix this?  That's tough to do over the internet.   However, I would suggest finding a chiropractor that is multi-modal in approach, offering skilled soft tissue therapy, exercise training, and modalities such as low level laser.  Check previous Q/A's as I've made similar recommendations.  

'Good luck

Dr. G