Management of painful conditions of the upper extremity requires careful evaluation, including a detailed history and objective observation and testing. Although it is necessary to test for both range of motion and strength before establishing a diagnosis, pain management, through support and protection of the injured or painful part, must be the first priority. Understanding that the onset of pain may be delayed in conditions involving nerves to the muscle that are motor only (see p. 252) is an important consideration relating to the duration of the problem.
The reasons for, and the source of, pain in the upper back remain a matter of conjecture. Unlike areas where muscles are supplied by nerves that are both sensory and motor, the rhomboids and serratus anterior are supplied by nerves that are motor only. Consequently, the usual sensory symptoms associated with stretched or tight muscles are not present in these conditions (see p. 252). The spinal accessory nerve to the trapezius contains some sensory as well as motor fibers. Sensory innervation also occurs via the spinal nerve branches (see p. 26)
Pain may occur both in and around joints, or in closely related areas, as a result of changes in alignment of the scapula and shoulder girdle. Alternatively, pain may be most pronounced in the area of muscle attachments to bone.
The loss of normal movement in one area may result in excessive movement in another. Whatever the cause of related pain, the treatment of choice is restoration of muscle balance to facilitate normal movement, both through stretching tight muscles and strengthening weak muscles and through use of supports when indicated.
The treatment suggestions in this section focus on important basics in protection, support, alignment and restoration of both length and strength, with emphasis on a corrective home program to be performed regularly by the patient. This approach is often all that is needed to achieve a positive outcome. (It is beyond the scope of this text to include other treatment options, such as electrical stimulation, isokinetics and weight/ fitness training.)
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