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Shoulder issues on the rise this month!

By: Meredith Scott

April 16, 2015

Pain felt in the shoulder area can sometimes be coming from your neck. This is due to the nerves and muscles that arise from your neck pass through your shoulder on their way down the arm. The nerves from your neck also travel down your arm through the Brachial Plexus, thus neck pain may extend down your arm (Schwart, 2005). Typical issues surrounding pain of the shoulder due to cervical spine pain include cervical spondylosis, which is arthritis of the spine. Spinal stenosis, which is the narrowing of the spine, and disc prolapse which involves the spongy disc being pushed backward and presses on the nerves to the arm (Schwartz, 2005).

Muscles necessary for proper function of the cervical spine include the trapezius, deep cervical flexors, rhomboids, sternocleidomastoid, scalenes, cervical erector spinae, and suboccipitals. When these muscles do not work accordingly, cervical alignment relies on increased activity by the upper trapezius, levator scapulae, sternocleidomastoid leading to dysfunctions in posture of the spine and head. Impairment at the cervical spine can lead to injuries including shoulder pain, trapezius-levator scapula dysfunction, AC impingement, scapulothoracic dysfunction, and thoracic outlet dysfunction (Clark, 2014).

In a study conducted by Joshi, it was found that glenohumeral external rotation muscle fatigue protocol used in this study caused decreased lower trapezius and increased infraspinatus activation with increased scapular upward rotation range of motion during the activities provided (2011). The subjects were tested using their dominant shoulder through a diagonal movement task before and after a fatiguing exercise involving low-resistance, high- repetition, prone glenohumeral external rotation from 0° to 75° with the shoulder in 90° of abduction (Joshi, 2011). This highlights the interdependence of scapular and glenohumeral force couples. Fatigue-induced dysfunction in the lower trapezius may incline the infraspinatus to become injured through chronically increased activation (Joshi, 2011).

Another study provided by Lynch, investigated the correction of posture, increase of strength, and decrease of shoulder pain and dysfunction in swimmers (2012). The subjects participated in an eight week posture exercise training program. The exercises were successful at decreasing the forward head and rounded shoulder postures of the elite swimmers (Lynch, 2012). It was evident that at the start of the study 78% of the subjects experienced some form of shoulder pain. Yet, after the preventative measures of this study were used, there was improved posture among the swimmers and a decreased impact of should pain (Lynch, 2012). This shows the trend between correction of forward head posture, rounded shoulder posture, and shoulder pain.

Interaction between the cervical spine and the upper extremities is imperative for optimal joint function during athletic activities. The interaction between the vertebral column and shoulder girdle dictate upper extremity movement (Wilk, 2009). Vascular and neurological structures originate from the cervical region and pass the shoulder girdle on their way to supply the upper extremity. In cervical radiculopathy, neck pain often precedes and then accompanies pain radiating down a through the extremities. Radiculopathy occurring at the level of C4 and below may cause numbness, and paresthesia of the neck and upper extremity (Wilk, 2009). These symptoms can be exacerbated by extension and lateral rotation of the side of pain. The patient’s symptoms may be relieved by bringing the shoulder abducted over the head or creating manual traction that relieves the nerve compression by holding the head in the hand. Movement of the neck in all ranges of motion can produce pain. The relation between the cervical vertebrae, shoulder, and upper extremity can be the source of pain and disability (Wilk, 2009).

1. Clark, M. A., Lucett, S. C., & Sutton, B. G. (Eds.). (2014). NASM Essentials of Corrective Exercise Training. Burlington, MA: Jones & Bartlett Learning. ​

2. Joshi, 2011

3. Lynch, 2012

4. Wilk, 2009

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