Shoulder Pain From Computer Use? Chiropractic Solution.

A Chiropractic Solution for Mouse Shoulder

BY HOWARD PETTERSSON, DC AND J.R. GREEN, DC

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.

mouse shoulder - Copyright – Stock Photo / Register MarkCommon 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:

  1. Thoracic and costovertebral segmental fixation
  2. Lower cervical segmental fixation
  3. 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.

References

  1. “10 Ways to Fix Your Mouse Shoulder Pain, Now.” PainDoctor.com, Aug. 14, 2017.
  2. 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.
  3. 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.

 

 

https://www.dynamicchiropractic.com/mpacms/dc/article.php?id=58266

Exercise of the Month March

This month’s exercise is quadruped scapular stabilization.  This is a great exercise to improve shoulder stabilization.

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Keri Moran, PT
Bruce Buckman PT, DPT, ART

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2017

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WELCOME Michael O’Reilly PT, DPT, Physical Therapist

The Spine and Health Center of Montvale welcomes Michael O’Reilly, PT, DPT, Physical Therapist to our Team.

 

Exercise of the Month March

This month’s exercise consist of a deep squat with a kegel and a 5 sec hold. This exercise prepares the body for labor. Kegel exercises are great to prepare your pelvic floor for labor and the squat is a great exercise to build up much needed endurance.

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Keri Moran, PT
Bruce Buckman PT, DPT, ART

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645


Exercise of the Week #35 – Plank with Lengthening

This week’s exercise of the week is a plank variation which involves sliding the feet back and then walking them back to the start position. It is a tremendous core strength and stability builder. Check it out!

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Keri Moran, PT
Bruce Buckman PT, DPT, ART

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645


Diagnosing and Preventing 2,000,000 Ankle Sprains Per Year

by Dr. Bruce Buckman PT, DPT, ART

2,000,000. It’s a huge number. It’s also the estimated number of ankle sprains sustained every year in the United States alone. One in six injuries sustained by a high school athlete will be an ankle sprain, more specifically a lateral ankle sprain, making it the most commonly occurring injury in all high school sports. While most ankle sprains heal relatively quickly, 50% of the time they account for a loss of sport participation for more than one week. As always, it is important and necessary to understand ankle anatomy before learning prevention; but first, what are the risk factors for ankle sprains and how are they graded?

  1. Prior Injury
    • As with many injuries, prior injury is a significant risk factor for future ankle sprains, with 15.7% of all ankle sprains being that of a recurring injury in sport that involves jumping and landing.
  2. Braces
    • Think you are protecting yourself by wearing a brace? Think again! A 2013 study highlighted that athletes were wearing braces when 10.6% of ankle sprains occurred. Braces being worn included lace up, ridged frame, and neoprene sleeves.
  3. Contact
    • Play a contact sport? 42.4% of all ankle sprains occur as a result of contact with another player.

Grading Ankle Sprains

Grade I Sprain

  • Slight stretching and microscopic tearing of the ligamentous fibers
  • Mild tenderness and swelling around the ankle

Grade II Sprain

  • Partial ligament tearing
  • Moderate tenderness and swelling around the ankle
  • Abnormal looseness of the ankle joint

Grade III Sprain

  • Complete ligament tear
  • Significant tenderness and swelling around the ankle
  • Ankle instability

ankle sprain physical therapy

Fig. 1 Anatomy of the Ankle

Importance of an X-Ray

The Ottowa Ankle rules are well-established clinical guidelines used to determine the need for radiography (x-ray imagining). These rules are very good at ruling out the occurrence of an ankle fracture, if the following are not present. According to these rules, x-rays are indicated if there is pain in the malleolar zone and any of the following:

  1. Bone tenderness or pain to palpation of the distal 6 cm of lateral malleolus (Fig 1.)
  2. Bone tenderness or pain to palpation of the distal 6 cm of the posterior edge of the medial malleolus (Fig 1.)
  3. Inability to weight bear four steps immediately after the injury or in the ER

Bones and Ligaments

The ankle is composed of three structures: the Tibial malleolus, Fibular malleolus and Talus making up the “Mortise or Talocrural joint”. This is the principle joint of the ankle making up plantarflexion (toe pointing), and dorsiflexion (toes pulling up). With the SubTalar Joint the ankle also allows motions of Inversion (toes in), and Eversion (pinky toe pulling out). These motions are restricted by ligaments. The lateral, or outside, ligaments of the ankle joint include the Anterior TaloFibular Ligament (ATFL), which restricts inversion range of motion. It is also the most commonly injured ligament along with the CalcaneoFibular Ligament (CFL). The medial, or inside, ligament of the ankle joint is the very strong Deltoid Ligament Complex which restricts eversion range of motion. It is less often involved in ankle sprains due to its strength; however, can be affected in a traumatic inversion/ eversion ankle sprain.

Muscles 

ankle sprain physical therapy

The muscles of the ankle act to dynamically stabilize and protect the ankle joint to avoid injury to the ligaments mentioned above. Arguably, the most important muscles of the ankle that are involved in lateral ankle sprains are the Peroneus Longus and Peroneus Brevis. These two muscles originate at the fibula with the Peroneus Longus coursing around the posterior aspect of the lateral malleolus, underneath the foot, inserting into the first metatarsal (1st Toe). The Peroneus Brevis travels along the same path inserting into the styloid of the 5th toe. Together, these muscles stabilize the arch of the foot and act to prevent inversion range of motion.

ankle sprain physical therapy

 

 

ankle sprain physical therapy

The Anterior Tibialis muscle is another significant stabilizer of the ankle complex, originating from the lateral aspect of the tibia, and inserts into the top of the first metatarsal. Finally, the Gastrocnemius and soleus muscle originate at the backside of the tibia and fibula. Together, they insert into the Achilles tendon, which acts to plantarflex and inverts the ankle joint.

High Ankle Sprains

ankle sprain physical therapy

Fig. 2 Anatomy of the lower leg

High ankle sprains are different and typically more severe than a lateral “low” ankle sprain. High ankle sprains occur when the ankle is dorsiflexed, locking up the ankle joint, and forcefully planted on causing a twisting motion of the ankle. Due to the anatomy of the ankle, the syndesmosis (red arrow) is spread and occasionally torn. These ankle sprains involve the Tibiofibular joint’s syndesmosis (Fig. 2) and usually require increased healing time.

I know you are all wondering…

Does taping help? To sum up the research, the jury is still out on this question. Most research has found minimal evidence suggesting that ankle taping actually reduces susceptibility. Furthermore, research has actually found ankle taping to reduce proprioceptive feedback (the ability to understand where your ankle is in space) in an athlete who finds himself or herself in an unstable or abnormal position. Some research has supported the use of ankle taking by athletes who have experienced one or more ankle injuries, but it is important to understand that this should never be used as the first-line treatment for ankle injuries. Unfortunately, there is currently no recommended best practice guideline for this question.

Check out Part II in our video library for an explanation of 5 exercises to reduce the risk of ankle sprains. In conclusion, ankle bracing and or taping should not be used in place of aggressive physical therapy including strengthening, stabilization, muscle endurance training, and balance/proprioceptive training.


 

­­­­­­­­­­­­­­References

Swenson D, Collins C, Fields S, Comstock R.  Epidemiology of US High School Sports-Related Ligamentous Ankle Injuries, 2005/06-2010-11. Clin J Sport Med 2013;23(3):190-196.

McKay GD. Ankle injuries in basketball: injury rate and risk factors. Br. J. Sports Med.2001;35:103-108.

Exercise of the Week #33 – Foam Rolling Quads and Calves

Check out this week’s Exercise of the Week – Foam Rolling for the Quadriceps and Gastrocnemius (Calf) muscles. Foam rolling should be a staple in every athlete’s and weekend warrior’s workout routine. Watch the video below to see how to foam roll properly!

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Keri Moran, PT
Bruce Buckman PT, DPT, ART

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645


 

 

Exercise of the Week #32 – Thoracic Rotations with Power Band

Check out this week’s Exercise of the Week – Thoracic Rotations with Power Band in a tall kneeling position. This exercise works well for baseball players and golfers because it improves thoracic spine mobility and core stability.

Our Physical Therapists

Keri Moran, PT
Bruce Buckman, PT, DPT

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645



Exercise of the Week #31 – Push-Ups with Alternating Knee Taps

Check out this week’s Exercise of the Week – Push-Ups with Alternating Knee Taps, which is great for core strength and stability, as well as increased obliques activation.

Our Physical Therapists

Keri Moran, PT
Bruce Buckman, PT, DPT

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645



Exercise of the Week #30 – Eccentric External Rotation Ball Drops

Check out this week’s Exercise of the Week – Eccentric External Rotation Ball Drops, a great exercise for shoulder strength and stability especially for throwing athletes.

Our Physical Therapists

Keri Moran, PT
Bruce Buckman, PT, DPT

Our Physical Therapy Services

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DISCLAIMER: NOTHING AVAILABLE THROUGH OR ON THIS WEBSITE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OUR WEBSITE DOES NOT OFFER MEDICAL DIAGNOSES OR PATIENT-SPECIFIC TREATMENT ADVICE. IT IS IMPORTANT THAT YOU CONSULT WITH YOUR HEALTHCARE PROFESSIONAL ABOUT ANY CONDITION YOU MAY HAVE. YOU SHOULD ALWAYS CONSULT WITH YOUR DOCTOR BEFORE BEGINNING ANY EXERCISES OR EXERCISE ROUTINE. DO NOT DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ IN OR ON THIS SITE.

© The Spine and Health Center of Montvale 2016

2 South Kinderkamack Road, Suite 200, Montvale, NJ 07645