Shoulder Pain Case Study

A 43 year old police officer presented in the clinic with a one week history of right shoulder pain.

It is important to undertake a thorough assessment involving questions and physical tests to determine the best way to treat a problem.

The patient explained that his pain started when he woke up one morning.  He had also noticed, “a strange feeling” in his middle two fingers that came and went with no pattern.   He did not recall straining his shoulder and had not undertaking any strenuous lifting. He had no other health complaints and was a keen runner.  His pain was worse at night.

His pain was brought on when he raised his arms above his head and eased as soon as he stopped the painful movement.

Daily pattern –  No pattern, the problem was dependent on activity

Past medical history –  Nothing significant

Medication – Not taking any at present

Social History – Lives at home with his wife and two children

Observation

On examination he presented with generally good posture and muscle tone.  He had no pain at rest.

Movement

On movement he had pain on raising his arm in front of him and to the side when the arm reached shoulder level.

Muscles

All local shoulder muscles tested strong.  There was some tightness in the pectoralis minor muscle at the front of his chest and his scalene muscles (muscles on the side of the neck) on the right were tight.

Nerve movement

There was some restriction of nerve movement in the arm.

Joints

The shoulder joint did not appear restricted however the lower neck joints were stiff and the first rib on the right was elevated.

Impression

My initial thoughts were that this gentleman’s problem came from stiffness in the neck and restricted movement of his first rib, (probably due to the tight muscles in the neck!). This in turn was restricting how the nerves moved as they run from the neck down the right arm.  This was causing the “strange feeling” in the fingers.

Treatment

I discussed the presentation with the patient to ensure he had a good understanding of the problem and the likely outcome of treatment.

I mobilised the neck joints and the rib.  This brought about increased movement before pain started.  Pain was now experienced when the arm was above his head as opposed to at shoulder level.

Home instructions

I also advised this patient to stretch his neck muscles regularly (5 times every two waking hours) at home with holds of 20 seconds.

Outcome

He was seen three times over two weeks and his shoulder pain ceased. He had good movement and good length of the muscles in the neck and chest.  The nerves were moving better and the “strange sensation” in the fingers had gone.

Three weeks later he phoned complaining of the same symptoms.  This time he explained that he had been lying on his left side for long periods, on the couch watching TV with his head tilted to the right.  The treatment was repeated over two sessions and the symptoms cleared.  Following this episode of treatment he was advised to not lay for long periods with his head to the side as this was seen to be shortening the muscles on the right side of the neck and therefore pulling on the ribs and neck joints and triggering the symptoms.

Thoughts

It is important to identify and address the underlying problems as well as treating the symptoms that present in the clinic to bring about long term solutions to problems.   It is also important to note that the area that you feel pain in is not always the area that is causing the pain!