Question - Shoulder (pain and ROM loss)

by Christine

I am having progressively increased L shoulder pain ( I am right handed 46 year old nurse)and loss of ROM. Forward activities do not seem to irritate or cause further pain, however any thing above a 90 degree angle to the side or backward motion such as reaching for a seatbelt cause extreme pain from the left shoulder into the deltoid and elbow. A back stroke to swim is impossible at this point. I can however do modified pushups.

What is confounding is that with my forearm bent close to my body the pain is not as severe nor the ROM as inhibited when attempting full ROM. However with a fully extended arm the pain and ROM are most severe.

I am seeing PT but seem to be getting nowhere. My physician does not seem to feel the need for an MRI. It is affecting my daily life more an more and feels like it is "freezing" with less range of motion everyday.

I have attempted some of the exercises in your book but the pain is becoming really severe. (I am not on pain meds other than Tylenol).

Any guidance or suggestions at this pont is appreciated to get back to my daily life!

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Aug 06, 2008
I have seen this before...
by: Bart - SII

I have seen this before, and it can be very very frustrating. From my experiences, and from what you describe, it sounds like you are suffering from adverse neural tension within the shoulder and upper extremity. The fact that your motion and pain is less with your elbow bent is what is indicative of this type of problem.

Neural tension will develop when a joint or body part is not used in a normal manner for a period of time. It can also be caused by injury or other insult to the soft tissue. What happens is that the nerve tissue is unable to move and adjust when you move your arm, so it increases the tension on the nerves, reducing blood flow, and causing referred pain - in the shoulder it usually goes down the lateral side of the arm and even into the elbow.

Neural tension is often an overlooked problem, and if not treated, your motion will continue to suffer. I would talk to your PT about trying some neural glides or neural flossing techniques - specifically for the nerves of the brachial plexus. This type of treatment usually takes 3-4 sessions to see lasting improvement, but it can increase your motion by 10-30 degrees in a treatment session.

The other thing you may have them look at is strain counter strain techniques or positional release therapy for your elbow extensors. I have had several shoulder patients with similiar complaints who have tons of knots and tender spots in their forearm - when those spots are released and treated, their shoulder motion improves.

Hope this helps - comment back with other questions.

Aug 30, 2009
rotator cuff
by: Anonymous

I think its a rotator cuff problem, with the supraspinatus involved. The fact that front activity is normal but rotation out or back is painful suggests something in the shoulder is getting squashed.

Nov 20, 2009
Avascular necrosis
by: Anonymous

I have all of the same symptoms. My ROM especially at 90 degrees or higher and anything going up my back are limited and painful. I finally got an MRI and was diagnosised with Avascular Necrosis. It wouldn't hurt to look into it.

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