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 Week #11 – Scap Stability Clocks

Check out this week’s Exercise of the Week – Scap Stability Clocks. This exercise is great for shoulder and scapular strength and stability. The first way is in a quadruped position and the second and more advanced version is in a plank position.

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Chiropractic Treatment for the Shoulder

Check out what just one chiropractic treatment for the shoulder did for this patient. Dr. Kelly Blundy, D.C. is a chiropractic physician who can help you get your range of motion back. Be it from a rotator cuff injury, frozen shoulder, arthritis, impingement, or some other injury, limited shoulder range of motion can affect a lot of our everyday activities. The doctors and therapists at The Spine and Health Center of Montvale can help. Give us a call at 201.746.6577 to find out more.

Shoulder Impingement Syndrome : Supraspinatus Tendonitis

I began doing yoga in 2003. It helped with so many of my physical issues I was hooked instantly! Years of dance class made me a natural at the bendy twisty poses.

Two years ago I was in a restorative relaxing gentle class. We were told to go into Cow Face Pose.

cow face

This pose doesn’t make me think, “Moo” so much as “Ow!”

 

I rolled my right shoulder as I had for the thousands of classes I had take prior. It felt tight but I “breathed into it”. The following pose was King Pigeon Pose.

 

king pigeon

“I’m not showing off, it’s a great hip opener!”

As I spun my right arm around to finish the pose I heard and felt a commanding “POP!” The warm trickling pain that followed was alarming, but not enough to make me stop the class. Two days later I couldn’t get my arm to move away from my body. Putting on a bra was impossible, as was lifting anything heavier than a pencil.The damage to my arm was a torn rotator cuff muscle. I had torn the Supraspinatus tendon at its attachment. It wasn’t severe but it was enough to need rehabilitation and treatment. This injury is very common. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem. The Rotator Cuff muscles are: Supraspinatus (the most commonly injured muscle), Infraspinatus, Subscapularis, and Teres Minor.

anatrot

 

They hold the “ball” of the upper arm bone into the shoulder socket.  One reason is that is can be caused by many different actions. The most common in older adults is falling onto an out stretched hand. This jams the upper arm bone (humerus) into the socket resulting in a shear of the muscles attachments to this bone. The two common reasons teens and young adults suffer from this is weight training with incorrect technique and repetitive overhead arm activities like throwing a ball or swimming. Adults see this as well due to job related stressors like mechanics or carpenters.

With the increase in computer use we all have poor upper body posture allowing the shoulders to roll forward and in. This stress weakens and destabilized the joint.

How it can be treated depends on severe the tear is. An MRI will be the best diagnostic test to see exactly were the tear is and how much is involved. Conservative treatment involves using passive modalities to reduce inflammation and pain as well as exercise to strengthen the muscles of the joint.

Cold Laser Therapy: Low-level lasers are used to reduce inflammation, which is often a significant cause of shoulder pain.

Myofascial Release, or MFR, is a chiropractic treatment that reduces pressure from joints and muscles in the shoulder, allowing for significant pain relief and improvement of mobility. Active Release Technique provides the best range of motion to the muscles.

Joint Mobilization and Manipulation helps the spine maintain alignment and improve movement of the shoulder joint.

Kinesiotaping : This method of taping helps with edema and improves strength and function of the joint.

If the tear is significant surgical intervention is also an option.

I recovered fully with conservative care for 2months. I do have some “clicks” at the joint now and then. Plus I have learned that “breathing into” pain may not be a good idea!