Tech Neck, Text Thumb, Mouse Hand - and everything in between - by Ainslie Bryce

How the impact of a systemic change in human lifestlye is impacting on our physical health

In this age of technology and advancing information, a lot of us have seen manual, physical work become almost obsolete and moved into automatic/robotic type of work. Most of us have instead become slaves to technology ourselves, and can’t get away from computers, phones and other forms of technology that gain and share information. It’s not just a phone call away anymore and there's no longer the classic 9-5 work hours.

As much as we try to move our bodies and stretch to make the most of what we have, we still suffer from common ailments such as conditions commonly referred to as computer neck, texting thumb and ‘poor posture.' This is the reality of our life now, as we know it. 

With the stress and demands put on most of us through the pandemic, a lot of people were working from home. This meant the couch became the office, the laptop was our main computer and our phone was still attached to our hands and eyes. And although we still sometimes use the phone hear our hear, it’s also used in many different ways - hence the terms in this article to describe what I’m treating a lot lately …

Tech neck. Text thumb. Mouse hand and everything in between! 

So let me start with the big muscles, Trapezius (upper, middle and lower). Then I can move into the deeper layers of the upper back, shoulder and arm muscles.  Let's get started!

Trapezius

There are 3 parts to this muscle group. The upper, middle and lower. They all have different referral pain patterns. The pain patterns usually arise from trigger points, or tight muscle bands in the muscle fibres. 

The upper trapezius trigger points (TrPs) usually refer to along the back of the neck, across the shoulders and into the back of the head sometimes as far as the temple area. The lower trapezius typically refers to the back of the neck, and bottom of the jaw, as well as the scapular or shoulder blade and under the shoulder blade. The middle trapezius, which is less common, refers pain and discomfort to the vertebrae and under the scapular area as well. 

The trapezius does a lot of actions. The Upper Trapezius draw the clavicle (collarbone) backwards and elevate the scapula as well. It also rotates the clavicle at the joint in the middle at the top of your chest bone - The sternoclavicular joint. The Lower Trapezius stabilises the scapular for the rotation of the clavicle mentioned above, while the Middle Trapezius pulls the shoulder blades together which stabilises traction forces (pushing and pulling of the arms).

There are many reasons that the trapezius forms trigger points - often linked to muscular imbalances from the lower body, but can also link with movements at the shoulders such as throwing and catching, or other shoulder associated movements. Over-activation is commonly resulting from  the stress of sustained elevation of the shoulders. Like when sitting at the computer for long hours with poor posture, leaning forward to see the computer screen or holding things above your head for a length of time. 

A trigger point feels like a ‘knot’ or ‘lump’ in the muscle. When pressed it can increase the pain and you may feel pain around it, above or below it, or in a different muscle all together. Most of the time trigger points can be lessened but won’t totally disappear. They can be managed with different treatments and exercises. Stretching can be an exercise. Weight lifting, even light weights can help increase blood flow to the muscles. Aerobic exercise can help by increasing your oxygen intake, and pumping blood through the muscles. 

Levator Scapulae

If you know your latin, you’ll be able to interpret that this muscles main role is to elevate the shoulder blade. And when it get’s sore, the pain can refer into the neck and along the length of the shoulder blade. It can refer to other areas, but it is not very common. When this muscle is in spasm the most noted restriction is the rotation of the neck, making looking over your shoulder very painful. This occurs when the shoulder has been held in a position of elevation for a period of time, but it doesn’t help when it's exposed to a cold breeze. Sitting under the air conditioner is not very good, nor is sitting near a doorway that can expose you to changes in temperature - this is all due to the subconscious reaction of shrugging your shoulders up to warm your neck. This muscle can also be triggered by the start of a cold as well - while trying to keep warm or coughing, this can cause the muscle to be held in a constant state of contraction.

The treatment for this muscle is massage, gentle stretching and gentle rotation of the neck, working on wasing this muscle back into its original working function. There are some specific exercises you can do for easing and retraining tension, much better taught in an appoiuntment than over a blog. But doing some corrective exercises will help you in the future should this happen again. This muscle is very commonly put into spasm and will most likely happen again if lifestyle factors aren’t monitored to minimise recurrances. If you are given tools to help yourself out of this painful condition, you should try some of the exercises given to you prior to your appointment should you have to wait.

Scalene muscles

These 3 muscles can be responsible for pain more commonly found down in to the shoulder region. These muscles - anterior, medial and posterior - can be a cause of Thoracic Outlet Syndrome which often shows up with neural tension down the shoulder and arm, such as where you may feel tingling and numbness in one or both arms and hands.

Referred pain from all three muscles can radiate down the front, back or side of the same side arm. At the back, the pain referral pattern is usually to the shoulder blade/spinal area and the middle of the shoulder blade. The front referral pattern is to the chest muscles; and the side referral pain pattern can be to the front & back of the arm. It may jump over the elbow and reappear in the forearm, extending to the thumb and index fingers. Hence the term text thumb, or mouse hand, even though the issue may actually stem from the neck! There will be a more detailed article about these muscles in the future. 

There are also some major muscles that can cause pain in the front of your arm and shoulder - Infraspinatus, Deltoid, Supraspinatus, Pectoralis major and minor.

Infraspinatus

The Infraspinatus muscle refers pain into the shoulder joint. This pain can be deep in the front of the shoulder region and the joint itself, extending down the front and side of the arm and into the forearm. Some of your symptoms may include pain when sleeping on either side , the inability to reach behind your back or to comb your hair or brush your teeth, The injury usually occurs when you have been trying to reach backward and up, a lot of my patients say it happened when they were reaching behind to the back seat in the car or a file in their office on the shelf behind them.  Myotherapy helps with tension release and trigger point release as well as prescribing corrective exercises and rehabilitation stretches. 

Deltoid muscles

The Deltoid muscles form the shape of a ‘cap’ over your shoulder joint, coveringit from three angles. The referred pain pattern isn’t like other muscles where it sends pain to other muscles. instead staying local to the region of the affected part of the muscle. There are 3 parts to Deltoid: anterior (front), middle and posterior (back). Each part of the muscle lifts the arm in the direction of that part of the muscle e.g. the anterior deltoid lifts the arm forward and away from the body. The middle deltoid lifts the arm away to the side of the body and the posterior deltoid lifts the arm back and away from the body.

Trigger points develop in these muscles from impact trauma in sports or other activities, from over exertion or possibly from an injection site. There may also be what we call satellite trigger points from other muscles. We need to rule out other traumas like rotator cuff tears and bursitis as well as trigger points in other muscles in the same area.

Supraspinatus

The Supraspinatus muscle is often a major contributor to rotator cuff pain. The referred pain pattern from this muscle is felt as a deep ache in the middle of the deltoid muscle and can extend half way down the arm. This muscle sits on top of the shoulder blade, beneath the trapezius. Trigger points are activated when carrying heavy objects down by our side and when the person is working or lifting above shoulder height.

The best way to reduce the pain is to stop the activity that was causing it, so you may need to use a trolly when moving heavy objects and use a step ladder if needing to get things overhead. Stretching while under a warm/hot shower will help ease tension and pain in this muscle too. Eventually the pain cycle will ease, at whcih point you can commence strengthening work to better withstand the load you require of it to live your active life.

Pectoralis Major and Minor

These are multi layered muscles that sit on the front of your chest & cover part of your shoulder. The PecMinor sits beneath the PecMajor, and togther takes on a playing card fan type of arrangement. The referred pain pattern for PecMajor can be local and you may feel it just under the collar bone (subclavian), and deep into your chest. For women you may feel breast pain and it may extend down your arm into your 4th and 5th fingers. Sometimes the pain in this muscle can be similar to cardiac arrhythmia on the right side, and may be mistaken for the pain of ischemic heart disease on the left side. Trigger points in the PecMajor may be from overload of the pectoralis or associated with myocardial infarction.

Pectoralis Minor has a referred pain pattern that may seem like angina. It is usually referring to the front of the shoulder and may refer down the arm into the forearm and fingers. To ease the tension in this muscle, is it important to monitor your posture. Generally, sitting up straight and pulling shoulders back so as not to stoop so much will help. Sleeping on your back may help easing this tension too.  A broad pectoralis stretch is also recommended. Warmth is already recommend - either have the running water from the shower on the front of your shoulder and chest, or put a heat pack on the area to help relax the muscles. 

Reference:

This piece of work has been written with reference to Travell & Simons’, Myofascial Pain and Dysfunction The Trigger Point Manual. Volume 1. Upper Half of Body second edition