This week I will discuss a Patient presenting with Neck and Shoulder that has been ongoing for a number of months. The cause of their neck and shoulder pain is the C5/6 left facet joint of the cervical spine (neck). The facet joints are small joints or hinges that link each vertebrae or bony block of the spine together. The C5 and C6 vertebra send nerve innervations to the area around the shoulder blade and lower neck region. Restriction between C5 and C6 brings about local nerve impingment.
Patients Signs & Symptoms
Achy pain behind the left Shoulder with referral pain towards the neck
Clicking and grinding sensation in her neck when looking over her shoulder
Driving, holding the phone, working on her Laptop and overhead arm movement aggravate Neck & Shoulder Pain
Ongoing clicking noise in her Left shoulder on overhead arm movement
Patient has Forward Head Posture and mild curvature of her middle spine (thoracic spine)
When the Patient looks upwards to the ceiling coupled with looking over their painful shoulder the neck and shoulder pain are immediately present.
A left Facet Joint impingement/ restriction at the C/6 vertebra of neck (cervical spine). This confirms movement restriction between the C5 and C6 vertebra when compared the movement of the vertebra joints above and below this level. Bringing our arm above shoulder level leads to neck extension hence aggravating the painful symptoms.
Patient advised to avoid elevating arm above shoulder level where possible. Treatment will target the restricted C5/6 facet joint with graded manual mobilisation to encourage greater range of movement in this joint. The mobilisations that serve to gap or open the C5/6 facet joint also stretch the facets joint capsule and collagen fibers of the joints ligaments thus improving their flexibility. Further manual treatment is performed on the muscles that surround the neck joint as these will have become tight and affect neck movement. The patient will undergo an exercise plan that will target the following areas A) increase more extension the middle thoracic spine due the presence of a mild curvature, b) strengthen mid shoulder blade muscles and neck alignment exercises to improve neck and shoulder strength & posture, c) strengthen rotator cuff tendons of the shoulder to reduce poor stability at the front of shoulder joint.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles. Contact Number: 0504 26672 Email: firstname.lastname@example.org
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Injury Solutions Clinic
Physiotherapy & Injury Rehabilitation Clinic in Tipperary