Shoulder and arm pain reaching: A Neuromuscular Therapy point of view

by Christina Abbott on June 23, 2009

As a Neuromuscular Therapist practicing in the Boston area for nineteen years, how do I think about the causes of pain in the shoulder and arm when patients lift their arms or reach for something?

With everyone on computers now, it is a common problem to have a work station that is too high and necessitates lifting of the arms to type or move the mouse. Anyone who works at a job that requires repetitive lifting or reaching is subject to these injuries. It is also a common complaint among athletes who lift their arms to throw or hit a ball. The problem is mainly chronic tension and lack of blood flow (ischemia) in one specific muscle of the rotator cuff group that lifts the arm (supraspinatus), but usually the entire group gets involved as well as accessory muscles in the top of the shoulder.

If the muscle is left untreated or improperly treated, two things can happen. First, the condition can become a tendonitis or bursitis from the constant rubbing of the tendon against the bone above it or across the bursa meant to pad and protect it from friction. Second, it may require surgery to 1) repair a frayed tendon, 2) remove bone spurs that form during chronic inflammation or 3) remove part of the bone (acromion process) at the outside tip of the shoulder (acromioplasty) to create more space for the arm to move in the shoulder joint.

When the space becomes too small for the tendon to move back and forth when the arm is raised and lowered, it is called an impingement. It’s painful!

supraspingrp

As I’ve said before, when you’re a hammer, everything looks like a nail. I’m a Neuromuscular Therapist, so I’m always looking at Trigger Points as causes of pain. This little supraspinatus muscle nestles in a hollow in the shoulder bone underneath the upper and middle trapezius muscles at the very top of your shoulder. It’s tendon goes out under the acromion process and attaches to the top of the upper arm bone (humerus). When it contracts or shortens, it pulls on the humerus like a puppet string to raise the arm up from your side to shoulder height. When it becomes chronically ischemic, it can develop a Trigger Point, or nodule of hyperactivity that refers pain outward from that point. Guess where the supraspinatus refers? To the top of the upper arm (deltoid)! So there you have another good reason for pain in the arm.

In general, I look for four reasons for pain: 1) local muscle dysfunction or injury, 2) Trigger Points, 3) joint dysfunction, and 4) nerve involvement either as compression at the spine, or as entrapment in contracted soft tissue or by the taut band of a Trigger Point. So of those four reasons, I’ve covered joint pain and Trigger Point pain. Local muscles like this supraspinatus or the trapezius above it or the deltoid at the top of the arm could be painful from an injury like a rotator cuff tear or just from chronic tension with accumulated waste products. Considering nerve involvement here, it could be from compression of a spinal nerve in the neck, but there are no major nerves here locally to be entrapped by the muscles.

The next post is about treatment.

{ 4 comments… read them below or add one }

Parima October 27, 2009 at 7:09 pm

Hi Christina,
Your write up “Shoulder and arm pain reaching: A Neuromuscular Therapy point of view” titled was so helpful. I have been trying to research the internet for an exact explanation of why using a mouse causes me shoulder pain. Your blog just hit the nail on the head.
I am keen to get my condition treated. Unfortunately , I am located in plano, dallas , texas and wanted to ask you if you are aware of a center / therapist who might be working in this area. I am keen to get some help for my condition.
regards
Parima

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Christina Abbott November 2, 2009 at 11:27 am

Hello Parima, Thanks for your comments! There are two training centers for Neuromuscular Therapy and both have lists of practitioners. http://www.nmtcenter.com and http://www.stjohnseminars.com. You could also try the Upledger Institute http://www.upledgerinstitute.com. If you have no luck there, check with a local rehabilitation center and ask for an anatomically knowledgeable muscle therapist with some training in Trigger Point therapy, NMT methods, Deep Tissue therapy or Rolfing. Good luck!

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Scott May 21, 2010 at 1:25 pm

Hi Christina,
I have the problem that when I reach out with my left arm to get the mail, reach into the frig for food, or just reach behind to thread my belt through the loops, I have very bad pain inside my bio arm. I have had surgery and have had bone removed/cleaned and it has been about 3 months now. Now, the pain that I started with before the surgery has returned to the same pain level. However, now my right are is starting to act like my left arm and this does worry me. I use pain meds to decrease the pain but I always have pain. Can you help me out.
Regards,
Scott

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Christina Abbott May 24, 2010 at 1:17 pm

Hi Scott,
Your symptoms sound like a supraspinatus tendonitis or tendon impingement. The muscle is part of the rotator cuff. It’s job is to lift the arm up to shoulder height, but it pulls a lot when your arm is behind your back. The cure is to loosen up the whole shoulder joint so the bone of the upper arm has room to move in the shoulder joint. When the muscles get tight, it pulls the joint too tightly and friction results from the bones rubbing together. Sounds like you had an acromioplasty and bone spurs. They will come back if the underlying problem isn’t fixed which is tight muscles causing friction that causes inflammation. Look at my shoulder stretch routine that includes the doorway stretch and stretches for the muscles in the chest and under your arm. This is the routine I use myself that I need to control tension from the Neuromuscular Therapy treatments i do in my work. I have to stretch to prevent having the same problem as you!

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