Neck and Shoulder Syndrome- Physical Therapy Differential Diagnosis

11/03/14 8:13 AM

By Craig Zettergren, PT, MS, Dip. MDT

Craig Zettergren

Craig Zettergren, PT, MS, Dip. MDT

Far too often, when we are evaluating a client in our office that has “shoulder” pain or “scapular” pain (shoulder blade), we have to rule out the neck (cervical spine) first as a source for referred pain into that area.  The reason is so we provide treatment to the proper source of the pain.  Once you are working on the problem area, the symptoms will go away.  When you are providing treatment to the symptoms and not the problem, the symptoms rarely change and the clients do not get better.  A perfect example of this would be a client who has pain, tingling and numbness into their arm.

As a clinician you can work on the symptomatic areas all you want without getting a change in their overall condition.  If you apply treatment to the neck since there is a pinched nerve, the symptoms gradually get better then abolish.  In our practice we specialize in figuring out the problem source and customize a plan based on that.

Neck- Pain patterns in the neck include neck, scapular, shoulder, arm, forearm hand and fingers.  Any of these sites can have the neck as a source of their pain and these needs to be ruled out.  Other symptoms include paresthesia (pins and needles, numbness, tingling) and weakness.  We typically see a loss of range of motion in the neck and or shoulder and pain with neck and or shoulder movements.

Shoulder Pain patterns in a shoulder patient include shoulder, deltoid, upper arm and or forearm.  There is a loss of Range of Motion in the shoulder and pain with shoulder movement.

At times, clients have a mixed origin with components of both cervical and shoulder.   It is best to direct management first to the neck but at the same time monitor what is happening at the shoulder.  Likewise, if it is suspected that the shoulder problem is cervical in origin, monitor the shoulder as management is directed to the neck.  To monitor the shoulder we take baseline measurements of ROM, pain responses with ROM and strength.  We monitor those closely to determine what has improved in line with the neck response.  So if we are performing neck activities and it has the response of reducing the neck and shoulder pain and improving the shoulder ROM and strength, we can conclude that the neck is the symptomatic structure and treatment does not need to be performed at the shoulder. If you suffer from neck and or shoulder syndrome physical therapy using mechanical diagnoses and therapy, is a helpful tool.  We at the Physical therapy Center of Bristol have offices in Bristol (860-585-5800) and Southington (203-272-8490) and we will be happy to assist you in this process.  Our website is and we accept all major medical insurances, workers comp, Medicare and MVA.

Craig Zettergren is a Diplomat in the McKenzie Institute International Society and is the owner of the company.  

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