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Dynamic Chiropractic – October 1, 2018, Vol. 36, Issue 10
Clinical literature abounds with articles about repetitive injury and conditions related to the use of electronic devices, especially stationary or desktop computers and work stations. One of these conditions that frequently brings patients to the chiropractic clinical practice has been called “mouse shoulder.” Here’s how to identify and resolve this all-too-common condition.
British osteopath Jane O’Connor gives us a succinct description of the etiology of mouse shoulder, pointing out: “The shoulder and shoulder blade attach to the body by various muscles that insert into the spine, ribcage, neck and base of the skull.
Holding a mouse … causes these muscles to contract to support the weight of the arm.”1 Dr. O’Connor also notes that repetitive strain can cause shoulder pain and weakness to the mouse user; and that similar injury may accompany other repetitive work-related tasks, such as operating machinery.
Ranasinghe, et al., observe that “complaints of arm, neck and/or shoulders (CANS) affect millions of office workers.”2 They further differentiate the complaints by noting they are “not caused by acute trauma or by any systemic disease.” The costs of CANS are astronomical. As the “leading cause of occupational illness in the United States,” Bongers, et al., estimate that work-related neck and upper-limb problems cost industry “$45 to $54 billion annually.”3
Signs and Symptoms
The patient with mouse shoulder tends to have a readily recognizable pattern of presenting complaints. They report fairly diffuse shoulder pain with focal interscapular point tenderness, and generalized myalgia over the upper trapezius. There may also be tenderness to digital pressure at the head of the glenohumeral joint and on the lateral humerus at the deltoid tubercle. Many patients recognize the underlying cause of their complaint to be associated with use of computers and other devices.
Common examination findings reveal taut and tender fibers in the shoulder and related muscles including the supraspinatus, deltoid, levator scapulae and upper trapezius. Deep palpation in the interscapular region on the side of shoulder involvement almost invariably shows tightness of deep paraspinal muscles such as the rhomboids.
Point tenderness is frequently encountered along the medial border of the scapula, as well as along the costovertebral junction of the upper thoracic spine. Rib humping and prominent interscapular soft-tissue bunching can be readily detected in most cases. A positive shoulder depressor finding often manifests on the side of shoulder involvement from chronic tightness in the upper trapezius.
The patient with mouse shoulder may also complain of intermittent numbness or tingling in the hands and distal extremities. However, biceps deep-tendon reflexes and vibrational sensitivity are usually within normal limits. The patient may demonstrate some pain-limited range of motion while abducting and externally rotating the involved shoulder.
A negative Codman (drop-arm) test helps to eliminate the likelihood of tears and other injuries to the rotator cuff muscles – notably the supraspinatus. Be alert to patient reports of pain in the rotator cuff and deltoid region during the Codman test, because that may be indicative of chronic overuse of the shoulder muscles.
One explanation for the mouse shoulder phenomenon may be contracture of interscapular muscles, especially the rhomboids and portions of the trapezius. Because these muscles are under constant and long-term load to stabilize the shoulder as the mousing arm is working, they may become fatigued and less pliable. Consequently, when the arm is raised or moved into abduction and rotation, the shoulder muscles encounter unanticipated resistance and demonstrate stiffness and pain with motion.
Correcting Mouse Shoulder
Chiropractic intervention for an uncomplicated presentation of mouse shoulder typically involves attention to three areas of involvement:
Thoracic and costovertebral segmental fixation
Lower cervical segmental fixation
Glenohumeral joint dysfunction involving anterior and inferior malposition of the humeral head
Adjusting procedures may use manual technique or instrument-assisted correction, or a combination of both.
Thoracic: Locate thoracic segments to be adjusted by palpating for taut and tender paraspinal fibers and prominent transverse processes on the side of involvement. These vertebral misalignments are almost always on the side of the shoulder complaint at the levels of T2-T4. To adjust an upper thoracic vertebra, take a scissors stance on the side of involvement. For a manual correction, use a single-hand contact with the fleshy pisiform of the inferior hand. Stabilize by placing the palm of the superior hand over the dorsum of the contact hand. Apply a posterior to anterior and slightly superior and medial thrust to the high transverse. For an instrument-assisted correction, contact the prominent transverse and apply a thrust with an anterior, medial and slightly superior line of drive.
Costovertebral: When a costovertebral articulation misalignment is present with a complaint of mouse shoulder – and it frequently will be – contact the rib manually or with the instrument, about a centimeter lateral to the transverse process. Apply an anterior and slightly lateral thrust to the rib. A manual thrust may also include a torque component (clockwise on the right, counterclockwise on the left) to facilitate release of the rib fixation. Release of the rib at the costotransverse articulation often produces immediate abatement of some of the symptoms associated with the mouse shoulder complaint.
Lower Cervical: Segmental fixation of a lower cervical vertebra – usually C7 or C5 – is frequently encountered with mouse shoulder. Use a conventional manual or instrument-assisted adjusting procedure to correct cervical segmental fixation.
Glenohumeral: Manual and instrument-assisted correction of the glenohumeral joint component of mouse shoulder usually involves a posterior and slightly superior thrust to the head of the humerus. One strategy for manual adjusting is to take a scissors stance at about the level of the patient’s elbow. Use the inferior hand to take a broad stabilizing contact over the scapula. Reach under the shoulder and contact the exposed head of the humerus with a stabilized middle finger of the superior hand. Apply an anterior and superior thrust to the scapula with the inferior hand, while simultaneously using the superior hand to apply a posterior and superior thrust to the humerus.
This method tends to work most effectively using a table with a drop mechanism. To correct the glenohumeral joint with an instrument, reach over and retract the shoulder with the inferior hand. Apply a posterior and superior thrust to the exposed head of the humerus.
“10 Ways to Fix Your Mouse Shoulder Pain, Now.” PainDoctor.com, Aug. 14, 2017.
Ranasinghe P, et al. Work-related complaints of arm, neck and shoulder among computer workers in an Asian country: prevalence and validation of a risk-factor questionnaire. BMC Musculoskel Disord,2011;12:68.
Bongers PM, et al. Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part 1) and effective interventions from a bio behavioural perspective (part 2). J Occup Rehabil, 2006;16:279-302.
Dr. Howard Pettersson, a 1976 graduate of Logan College of Chiropractic, is an associate professor of technique at Palmer College of Chiropractic. He was the senior editor of Activator Methods Chiropractic Technique – College Edition, published in 1989, and published Pelvic Drop Table Adjusting Technique in 1999. His most recent publication, written with Dr. Green, is How to Find a Subluxation, published in 2003.
Dr. J.R. Green is a 1988 Graduate of Palmer College of Chiropractic. He retired from the Palmer faculty after many years of teaching basic sciences and chiropractic technique. He is currently in private practice in Galva, Ill., and is also an adjunct professor of chemistry with the Eastern Iowa Community College District. Dr. Green was one of the writers of Activator Methods Chiropractic Technique (1997) and also worked as a technical writing consultant on Activator Methods Chiropractic Technique – College Edition and Pelvic Drop Table Adjusting Technique.
More and more studies are coming out about the power of breathing correctly. Due to our everyday stresses, we have a tendency to breath from our chest. This causes a decrease in oxygen to the right places and untimely increases stress to our body. This type of chronic stress will affect your overall health and decrease your immune system.
What to do?
Practice! Practice! Practice!
You can do this either sitting or standing. You will place one hand on your chest and the other hand on your belly. When you take that nice deep breath in, I want you to focus on pushing the hand that is on your belly out first. As you exhale, make sure you release all the air that you took in. People, who take deeps breaths in but don’t let all the air out, will increase carbon dioxide in the body. Counting while you do this will be helpful. If it takes you 3 seconds to breath in, make sure you exhale for 3 seconds as well. The goal is to get to 10 seconds each way! As you are practicing this exercise you want to make sure that the only hand that is moving is the one on your belly. Try to not move the hand that is on your chest at all.
Consciously practicing your belly breath will increase oxygen through out the body, decrease stress, and increase your health!
For all of you that still have some money in your flexible spending accounts, it is a good idea to make your appointments now. Most Flexible Spending Accounts (FSA’s) and Healthcare Savings Accounts (HSA’a) have a use it or lose it policy. This means that any funds you have left in the account at the end of the year are lost if they are unused!
You can use your FSA’s or HSA’s at The Spine and Health Center of Montvale for anything from; copays, coinsurances and deductibles (for anyone who has not used their insurance this late in the year) to products such as Vitamins, Pillows, Backrests, Support Belts, Biofreeze, Stretch Straps, etc.
The Spine and Health Center of Montvale would like to make it easy for anyone to get the gift of health at our office, be it Chiropractic, Physical Therapy, Acupuncture or Massage. Please don’t hesitate to make an appointment and let us know about any funds left on you Flexible Spending Accounts that you would like to utilize in our office before you lose it! If you have any questions about your accounts we will be available to talk.
This is another great post from my friends at Bonfire Health about inflammation:
We tend to think of inflammation in terms of injuries such as a sprained ankle or a bug bite – those are what are described as ‘acute inflammation’. There’s a much more insidious and dangerous type of inflammation – chronic low grade or ‘silent’ inflammation caused by our lifestyle choices.
S.A.D. DIET AND INFLAMMATION
By now nearly everyone’s heard of omega-3 and omega-6 fatty acids, but most people don’t know the first thing about what they mean. If a person eats the Standard American Diet (S.A.D.), consisting of packaged processed food that is dominated by wheat flour, vegetable oils and sugars (think cereals, bread, pasta, pizza and all prepared snack foods), they are loading their bodies with omega-6 fats which promote inflammation which causes disease (cancer, heart disease, diabetes, obesity, autoimmune). If on the other hand, a person eats lots of organic vegetables, healthy fats, and quality organic proteins (grass fed beef, organic chicken, pastured pork, etc.), they provide a healthy supply of omega-3 fats which inhibit inflammation and promote health.
Here are some tips I provide to patient’s to take home with them after their Chiropractic, Physical Therapy, Acupuncture or Massage Treatments:
1. Be brutally honest about your posture. You may think it’s pretty good, but if you are having neck-and-shoulder pain, headaches, issues with arms and hands, or if a bump is forming at the base of your neck, something needs to change. Breathing problems could even be related to curled-in chests. Don’t blame it on your bed or your genetics; you didn’t inherit a bad posture gene, you inherited the habit. The pain is there to show us where our body needs attention and maintenance. Listen to it and use it. It’s impossible to be completely honest about how your posture looks just by seeing yourself in a mirror. Each of us subconsciously adjusts our posture when we look in the mirror. To be truly honest about our posture, we need to accidentally see a side view of ourselves in a window or reflective surface of some kind as we’re walking by. That is where you’ll see the real truth.
2. Stop thinking about your shoulders. Change your focus. Instead of concentrating on your shoulders, work on keeping your chest up and open. Your body will look better, function better and be more comfortable in the long run. You may even be able to breathe and digest food better.
Make sure to pop your chest up, not out. Visualize a string attached to the top of your sternum, pulling it up, and another string on the top of your head. Use your abs to help. When doing this, be careful not to create a curve in your low back.
3. Activate your abs. Use your core to help keep your chest up and open while allowing your arms and shoulders to simply relax back to where they’re supposed to be. This exercise is ideal to practice while sitting at a computer, and it helps keep you from curling in. It’s also effective while moving and working out. If you are doing any type of upper-body lifting in your workout, make sure your abs are tight and your chest is up as high as possible. If you don’t, you will work incorrect muscles and make your neck and shoulders worse.
4. Stretch your pecs and arms. Stretch your arms in every direction: up, down, out, across the body, above your head. Do what feels good.
5. Arm circles. This is a simple exercise to help with neck-and-shoulder tension. Arm circles stretch and work the muscles at the same time. Make sure you activate your abs and get your chest up as high as you can, first. Use your thumbs. If you point them like your hitchhiking while you do your circles, it helps keep your arms straight for a better stretch.
6. Shake it out. Unless the pain you’re having is related to an actual injury, the worst thing you can do is protect or baby it. Unless the muscle is torn or has received some sort of impact, the only thing to blame is our subconscious holding habits and repetitive actions. I realize when we first feel pain in the shoulders, arms and hands, our first instinct is to protect it and stabilize it. It hurts because it’s stuck, and it’s no longer receiving the flow that it needs. Start shaking gently, then build up to shaking them as hard as you can, for as long as you can. Then stretch. Don’t wait until you have time to do yoga or an extended stretching session. If it’s stuck or sore, shake it out, move it, stretch it right then and there.
7. Turn your hands up while you run, or slightly forward while you walk. It pops your chest up and open. When you do any sort of extended walk, jog or run, pay attention to your form and moving correctly, rather than how far you go. While you’re moving is the best time to work on posture, form and body mechanics. If we change our patterns while we move, our muscles retrain themselves much faster.
8. Define posture. The definition of great posture is, getting out of our own way, leaning back, relaxing and letting our skeleton do its job. It’s about only using the muscles that are necessary for each movement we perform.
9. Pay attention to low-back pain. Believe it or not, low-back pain is usually caused by tension in the hips, glutes and upper legs. First, stop locking your legs together. Stretch your legs in every direction you can. This includes quads, hamstrings, iliotibial bands—everything that attaches in the hips. Muscles stretch better if you warm them up with shaking first.
10. How do you walk? Another contributor to low-back pain relates to how our feet hit the ground when we walk. Most of us turn our feet too far out when we walk; some people turn too far in, but it’s less common. Either way, most of us also walk or run while putting all of our weight on the outer (lateral) edge of our feet. When we do this every day, the musculature on the outside of our legs becomes overdeveloped and creates a huge pull on our sacrum, causing low-back curvature and pain.
Work on lengthening and strengthening your inner (medial) leg muscles. Every time your feet hit the ground, the entire palm of your foot should touch. Think about keeping your feet straight and putting your weight more in the middle, or core. If you do this, you will see a difference in the musculature of your legs, as well as experience less low-back pain.
11. Keep your hip joint straight and get your belly weight off of your hips. It’s important when you do this to not lock your knees. Visualize pulling the front of your body straight up from the arches of your feet to your sternum. In traditional Chinese medicine, it is taught that yin (feminine) energy runs up the front of the body, while yang (masculine) energy runs down the back of your body. Visualize your body moving up in the front of the body with each inhale, and down the back of the body with each exhale.
We want to welcome everyone to our new website and our new blog. We are very excited to use this space to update you on many interesting topics about getting and staying healthy. We will be sending you up to date information from the news headlines to top research articles to find you the best health and wellness information that we think everyone should know. We want you to know the information that can really change your life… Supplements that you should take to avoid heart disease? How to add years to your life with food and diet? The five stretches that can prevent low back pain.
In other words, practical essential information that we all need to know to live a healthier and longer life.
Stay tuned and check back with us often. Even better, follow us on Twitter and Facebook and get the information sent right to your computer. In either case, we know you will be glad you did.
The Doctors & Staff at The Spine and Health Center of Montvale