Background
This case study tells the story of a 35-year-old mom who recently had a baby thought she had a stubborn shoulder injury and was diagnosed as having a rotator cuff problem. Although there was no incident that created an injury. She didn’t improve with traditional rotator cuff and shoulder therapy at another facility. Her pain and arm symptoms persisted and really started to interfere with feeding her baby. She tended to get worse or start to have pain during late-night feedings, hours at her desk, or while cooking. Her symptoms included pain extended down to her elbow., occasional numbness in her right hand. What is interesting is that she didn’t complain of neck pain.
Why Neck Problems Can Feel Like Shoulder Problems
Differentiating a shoulder problem from a neck problem can be tricky sometimes. The nerves that exit the cervical spine supply both sensation and strength to the shoulder, arm, and hand. When these nerves are irritated , pain may appear in the shoulder, shoulder blade or arm and hand even if the shoulder joint itself is healthy. Often sustained neck flexion posture or looking down, forward head, repetitive neck movements, disc changes, joint narrowing or combination of the aforementioned can produce these symptoms from compression on a nerve root. Arm pain without numbness and tingling is usually a better scenario than with having associated numbness and tingling. Some variations of patterns include neck pain with arm pain, neck pain with the triad of arm pain, numbness and tingling, no neck pain but an isolated spot on the arm that has tingling or pain, no neck pain but lateral shoulder pain. If your pain spreads, burns, or tingles, or if it’s not improving with shoulder-only treatment, and the arm symptoms seem to change with neck movements then have your neck checked.
The Examination:
This patient wasn’t sure what positions or activities were driving the arm symptoms so we sent her home with a questionnaire to check for patterns. Her symptoms appeared when she was in a sustained side head tilt while breastfeeding and holding the baby. She also felt it at night when laying even though she wasn’t breast feeding. She didn’t have symptoms with general housework tasks or desk work. However she did feel her arm symptoms when she was cooking. Often by the time cooking was over her arm symptoms were fully flared up. Her exam and activities certainly pointed to a neck problem. Here are key points of her exam.
- Movement exam revealed full AROM in the shoulder and neck.
- Shoulder exam for rotator cuff problems or impingement syndrome were negative
- Sustained neck flexion (looking down) tolerance test produced her arm symptoms
- A detailed physical exam of the neck reproduced arm symptoms
- Neural testing indicated neural tension reproducing her symptoms
Treatment
Once we identified the true cause, the treatment plan shifted to address her neck and daily stressors. The biggest lever we pulled was posture coaching for breastfeeding and kitchen work. We adjusted her feeding positions to reduce strain on her neck. For cooking tasks, we had her look up toward the ceiling as in stretching once she started to feel tension in the neck and shoulders. Additionally we broke up kitchen tasks to prevent hours long posture of looking down. She was given specific neck exercises to reduce arm symptoms and her disc herniation. Manual therapy included upper cervical spine mobilization, suboccipital release and neural mobilization exercises. Later she began progressive strengthening once her pain calmed down. We built strength and endurance in her postural muscles and shoulders to be able to handle the sustained positions of caring for her baby.
The Outcome
Within two weeks of targeted care, her shoulder and arm pain decreased dramatically. Breastfeeding no longer presented a challenge due to increased postural strength and modified position of her neck. She was also able to cook without having an arm flare up. She learned exercises to do in case she starting feeling arm symptoms or neck pain from looking down.
Takeaway Message
This case shows how important it is to look at the whole picture, not just one body part. For new moms or anyone juggling multiple physical demands, neck-related pain can masquerade as shoulder pain. If you’ve been told you have a shoulder problem but treatment isn’t helping , then your pain may be coming from your neck.
