Case Summary: Neck/shoulder pain with arm referral

Posted Jan 20, 2017 by Pinnacle Spine & Sports

These case summaries are examples of real people treated here at the clinic (names changed for privacy). They are not an exhaustive study of the whole condition, merely an opportunity for you to see the sort of things that we have been able to help with in the past, and how we may be able to help you if you’re suffering a similar condition.

“It’s like I’ve got a big knot under my shoulder blade that I can’t reach.”

shutterstock_37035556Rebecca (name changed for privacy), a 37-year-old office worker, presented to our clinic with a 3 day history of constant left sided neck and shoulder pain referring down into the left arm and middle back region. She was unsure as to what had caused this issue and reported no traumatic or obvious activity leading up to the presentation of the symptoms.

The pain was described as a dull ache like pain, which is hard to localise giving presentations of weakness and throbbing. Severity of pain was 7/10 and she reported that the symptoms were increasing. This was the first time Rebecca had suffered from this problem. Symptoms were worse straight after waking up and after work and before she went to sleep. She described it like a knot under the shoulder blade that she couldn’t reach.

She reported that anti-inflammatories seemed to relieve the pain mildly, whilst prolonged postures and work aggravated the symptoms.


Safety tests were all negative (ie. showed no signs of risk). All neural tension tests were negative (no reproduction of symptoms) ruling out any disc or neural pathology. All upper arm strength tests were normal and deep tendon reflexes were unremarkable.  Orthopaedic examination revealed no further information. Palpation of the neck, shoulder and rotator cuff muscles reproduced the exact pain and symptoms referring into the left arm and middle of the back. Several points of tightness and tenderness were recorded and these points seemed to replicate the exact pain she was feeling.

Common pain referral pattern from the levator scapula/upper trapezius region
Common pain referral pattern from the rhomboid muscle, as well as the levator scapula/upper trapezius region

Rebecca was diagnosed with left sided myofascial trigger points in the rhomboids, upper trapezius, levator scapulae and rotator cuff muscles with referral into the left arm. Associated tightness of the thoracic paraspinal and periscapular muscles was noted with forearm extensor tightness and tenderness.


A treatment plan involving 2-3 visits per week for 2 weeks was advised depending on responsiveness. Re-assessment after an initial treatment period would determine future treatments.

Initial treatment consisted of releasing the neck & shoulder, middle and upper back muscles with massage and trigger point techniques at points of exquisite tenderness. Deep upper neck & cranial muscles were then released focusing mainly on the left side. A very light and brief release of left sided rotator cuff muscles were performed – this was very tender so a gentle technique was employed.


Gentle neck and thoracic chiropractic adjustments were performed on both sides with an immediate improvement in ROM. The patient reported an instant improvement in tightness and stiffness. The

Upon presenting for her 2nd treatment, Rebecca reported a huge improvement in symptoms. She stated that the pain is no longer referring into her arm and is localised only to the neck and upper shoulder regions. She was a bit sensitive and tender however noted how significant the improvements were after just one treatment.

The treatment was continued and modified slightly to focus on the neck and shoulder areas, with the main goal being to achieve movement and reduce areas of tight muscles and trigger points. The chiropractic adjustments were providing great relief and she reported a improvement in movement and pain levels.

3 weeks into the treatment she reported that all symptoms were completely resolved. Rebecca was able to work without any discomfort and enjoyed the Christmas period with family without any issues. She was extremely pleased and noted the importance of maintaining these changes with follow up appointments.

Does this sound like something you’ve experienced in the past? We may be able to help. Call us on 9743 2311 or click here to book online today.

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