Where Is the Problem?

Last updated: November 2022

In recent years I’ve had more problems with reduced neck and shoulder mobility and increased pain. I went for some sessions of physical therapy and found that helpful, but not a cure-all. Over several visits, I learned some exercises, adjusted my positioning for working at my computer, and got some supportive splints custom-made for me.

Limited strength and range of motion

It had been a long time since I had some attention paid to my hands, arms, and upper body in general, so it was well overdue and the therapy was helpful. However, it also opened up for me some awareness of my struggles in this area of the body and how much function I had lost slowly over time.

Is my neck to blame?

Since the therapy sessions, I continue to notice reduced motion and strength, plus days where I have severe neck/shoulder pain and discomfort. I realized that my situation, like a lot of us with rheumatoid arthritis, isn’t a one-and-done scenario. It also isn’t clear where the problem actually originates.

When I originally went to physical therapy, it was because I was having debilitating pain at the base of my neck on the left side. I could hardly move and was in near-constant pain. It also would radiate up and give me terrible headaches.

The therapist gave me some neck and shoulder blade exercises that immediately helped give me some relief from the pain and discomfort. I have kept them up, but I still periodically have bad days with this area of my body. Repositioning for my computer work has also been helpful, but clearly, there are other forces at play because I still feel problems.

Does my shoulder play in role in my symptoms?

I’ve also been aggravated by the loss of motion in my left shoulder. Although it doesn’t give me a lot of pain, I can’t move it well and my entire arm is weak because of this lack of movement. When I saw my orthopedic surgeon for a checkup on my artificial hips and knees, I asked if it was worth seeing someone about it. He referred me to a colleague who is an expert in shoulders and has experience with juvenile rheumatoid arthritis (now juvenile idiopathic or JIA) cases.

The X-ray of my shoulder revealed what I already felt: it’s a dang mess in there. It makes sense that I can’t move it, but another question came up in the discussion—is my pain related to a lack of movement in my neck? Am I overcompensating for that joint by contorting my neck and using those muscles in ways that aren’t sustainable? It’s likely, but impossible to know.

It may be a combination

Probably the most likely scenario for my ongoing literal pain in the neck is a combination of multiple factors. Sure, I have neck damage and a limited range there, but I also have perhaps even worse damage to my left shoulder, which then puts additional strain on my neck and all the muscles and soft tissues in the area. While the physical therapy provided some relief, additional steps may be needed.

With rheumatoid arthritis and the compounding damage to the body (first certain joints, then more joints, then soft tissues, then damage from not using the joints correctly due to the damage, and so forth), it can really snowball over time and the problems get tangled up with one another. This also makes treatment tricky—what problem do you focus on? Or is it more like a checklist that you handle one at a time?

After all these years, unfortunately, I don’t have the answers yet. My approach has been to focus on one thing at a time and on doing what I can (and can manage with my time, energy, and resources). Sometimes my body is just a tangled mess and I just have to take it slowly and methodically to provide myself the best care and support that I can.

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