Shoulder Pain and Symptoms Guide

Shoulder pain can occur in various conditions, including overuse of the rotator cuff and tendons, bursal irritation, joint stiffness, trauma, and neck nerve issues. It is necessary to distinguish whether pain occurs at a specific angle when lifting the arm, whether it is severe when lying down at night, or whether actual strength has diminished.

We do not simply diagnose adhesive capsulitis (frozen shoulder) based solely on age, nor do we attribute the cause merely to asymmetrical shoulder shape.

• Pain when lifting the arm forward or to the side
• Difficulty in reaching behind the back
• Night pain that worsens when lying on the affected side
• Weakness when lifting objects or putting on clothes
• Pain that began after falling or supporting oneself with the arm
• Numbness extending from the neck to the arm and hand

If you cannot lift your arm on your own but it can be raised relatively easily when moved by someone else, or if movement is restricted in both cases, these are important clues.

If your shoulder shape changes after falling, you cannot raise your arm at all, and there is severe swelling and bruising, you must check for fracture or dislocation. Worsening neck pain together with sudden arm paralysis and reduced hand sensation also requires neurological evaluation.

If chest pain, shortness of breath, and cold sweats occur together with shoulder pain, seek immediate evaluation in the emergency room.

We examine the circumstances under which pain began and repetitive movements or sleeping positions. The patient's active range of motion for lifting the arm is compared with the passive range of motion when the medical team gently moves it, and shoulder rotation, scapular movement, and rotator cuff muscle strength are assessed.

We can also check whether arm pain and numbness change with neck movement, as well as any nerve symptoms in the elbow and wrist.

Chuna manual therapy may be considered when there is no suspicion of fracture or dislocation and management of movement connected between the shoulder joint, scapula, neck, and back is needed.

We do not forcibly move to the limit of range while enduring pain, but rather adjust the technique and intensity within the currently achievable range. After treatment, we check for changes in arm elevation, dressing, and sleep.

Acupuncture·pharmacopuncture can be selected based on pain and muscle tension around the shoulder. Once the pain subsides, range-of-motion exercises and rotator cuff/scapular surrounding muscle exercises are progressively advanced.

Much shoulder pain can be treated with Chuna manual therapy, acupuncture, pharmacopuncture, and phased exercise. In the acute stage when pain is severe, pain relievers or injections are sometimes used alongside them; however, caution is warranted as reports indicate that repeating steroid injections around shoulder tendons can weaken the tendons. Once acute pain has passed, treatment focuses on regaining arm strength and movement.

The movements of lifting forward, lifting to the side, raising hands behind the back, and sending hands behind the head are compared. We also examine whether the range of motion differs when moving independently versus when moved gently by the medical team.

In cases where the shoulder is stiff in all directions and painful at night, or painful only in a specific range, or where movement is possible but strength is weak, different assessments may be required.

After a fall in which you land on your hand or shoulder, severe pain with an arm you can barely lift, or a change in shoulder shape with rapid swelling, requires checking first for fracture or dislocation. If you suddenly lift a heavy object and feel a 'pop' sensation accompanied by weakness, you can check for tendon injury.

In this situation, do not force your arm up through pain or attempt self-correction.

If shoulder pain radiates to the arm and hand or changes when moving the neck, we also examine the cervical nerves. Conversely, if pain is reproduced only when moving the shoulder joint and hand sensation and reflexes are normal, a problem with the shoulder itself may be more relevant.

We assess the strength, sensation, and reflexes of the arm, along with neck and shoulder movement, to determine the treatment area.

We check not only the pain score but also whether it has become easier to put on clothes, wash hair, fasten a seatbelt, take items off a shelf, or lie down on the painful side. If movement improves slightly but strength continues to decline or night pain worsens, re-evaluation is required.

Chuna manual therapy is a method that can be considered for managing the movement of the shoulder, scapula, neck, and back; it is not a treatment that returns tendon ruptures or fractures with the hands.

Record whether the arm can be raised forward or to the side to a certain extent, whether pain wakes you up at night, whether strength suddenly decreased after trauma, and whether there is numbness in the neck or hands. Please also teach us actual movements that are difficult to perform, such as putting on clothes and washing hair.

If the focus is on joint and muscle function issues without trauma or significant muscle weakness, Chuna manual therapy, acupuncture, pharmacopuncture, and exercise can be combined according to the condition. If swelling and acute injury are suspected, imaging tests or other examinations may be recommended. Even if pain is reduced with analgesics or injection therapy, we separately confirm whether the ability to lift the arm, night pain, and daily movements have recovered.

If you completely avoid using your arm due to pain, joint mobility and muscle strength may decrease further. Conversely, repeatedly lifting the limb while referencing the painful angle may continue to stimulate the tendon and surrounding tissues. Maintain light daily activities at the currently possible height, while experiencing pain and night reactions, gradually increasing the range.

Pain may increase temporarily after exercise or treatment, but if you find it difficult to sleep through the night, symptoms worsen noticeably until the next day, or arm strength decreases, you should adjust the intensity. Even when pain decreases after shoulder injection, it is advisable not to immediately resume heavy exercise but rather to re-evaluate range of motion and muscle strength.

If pain has decreased slightly, do not resume high-reach tasks or heavy strength exercises all at once. Adjust activity levels based on the height at which the arm is raised, the number of repetitions, and night pain the following day. If you notice that the strength in the opposite arm continues to decrease compared to the other, or if your arm suddenly feels like it's dropping when lifting an object, we will re-evaluate the condition of your tendons and nerves.

Before your visit, please check how high you can raise your arms forward and to the side, whether you wake up when lying on the painful side, and if your strength has decreased since immediately after the injury. After treatment, we compare not only the pain score but also whether daily activities such as washing hair, putting on clothes, and using high shelves have actually become easier.

The shoulder appears stiff, so pain is endured without forcibly moving it to the full range of motion. Compare the range of motion when moving independently versus when moved gently by another person, and compare actual muscle strength to determine exercise and treatment intensity; then check for night pain and swelling reactions the following day.