Shoulder, Neck and Upper Back Problems with Possible Numbness, Tingling or Pain in Hands
Because of postural and work habits, decreased strength, injury or illness the soft tissue in front of the shoulders, chest and back of the neck become shorter and tight. These tissues may also adhere to one anther decreasing mobility. The soft tissue in the back of the shoulders, upper back and front of the neck become over stretched, lengthened and weak. The differences between the shortened, stronger tissues and weaker, lengthened ones make the neck, shoulder and upper back in-stable and prone to injury. There can be trauma not only to the soft tissue but to the joint and nerves also. 
The Posture of the shoulder joint will typically be rotated inward to much, falling more anterior (in front) and become tighter than usual. Most people will have a combination of postural abnormalities such as a forward head, rounded upper back (Kyphosus), splayed shoulder blades, neck concavity and excessive inward curve of the lower back (Lordosis). Forward head and shoulders can also lead to other problems such as headaches, loss of sensation (Parathesia), and pain and tingling in the hands and or finger. The tingling sensation may come from decreased circulation from the tight, adhered and or misaligned soft tissue or impingement of a nerve (Radiculopathy) at the neck or shoulder (thoracic outlet syndrome). The best way to treat these problems is through a thorough evaluation and diagnosis from a physician. Intervention could consist of surgery, physical therapy and medications.
Exercise plays a big part in the recovery of these problems. There are a wide variety of exercises and stretches that could decrease or eliminate the signs and symptoms from neck, shoulder and upper back problems.
The amount of resistance, number of repetition, sets, and progression of the exercises depends on your ability, signs and symptoms, and specific diagnoses of your problem. It is imperative that the exercises and stretches be done the proper way.
Some typical exercises that may be given to a person with one or more of the problems we have discussed could be:
Corner or doorway stretch: If you don’t have a corner use a narrow doorway.
Stand facing a corner of a room. Put one leg in front of the other, keeping your low back flat by tightening your belly, and keeping your head and neck back. Raise your elbows to shoulder height while placing your forearms, elbows, and hands against each wall. Do a lunge leaning inward to stretch your chest muscles. Hold the stretch for 5 to 10 seconds depending on your discomfort. In time, when you don’t feel very much discomfort you can increase the stretch 2 seconds. You may be able to eventually hold this stretch for 30 seconds or more.
Do these stretches three times a day. Don’t cause too much discomfort or the stretch won’t be effective. You may feel the soft tissue “give up” or lengthen a few times during the first couple stretches.
If your symptoms increase after you are finished stretching discontinue the stretch. Also avoid this stretch if it gives sharp pinching pain and tingling in hands and fingers or low back pain (LBP). Clock wise shoulder circles:
Sit or stand with a good posture. Shoulders, neck and head back, and your low back flat (tighten belly).
Step 1) Raise shoulder up toward back of ears, then
Step 2) Pinch shoulder back while maintaining step 1, then
Step 3) bring shoulders down by depressing elbows towards pelvis while maintaining step 2
Repeat steps 1 -3.
Do this exercise slowly 10 times, repeat repetition 3 times. Do this exercise 2 times a day, three days a week and slowly increasing to 5 times a week.
As the exercise gets easy you can increase the repetitions by 2 (not more than two in an exercise session). When you eventually reach 20 repetitions hold a 1 or 2 pound dumbbell in your hands and reduce repetitions back to 10. Repeat cycle of progression as stated above, adding 1 pound each time exercise becomes easy. If you use too much weight you will not be able to maintain proper technique and posture.
If your symptoms increase after you are done with the exercise discontinue it. Avoid sharp pinching pain and tingling in hands and fingers.
Neck range of motion and stretching:
Sit in a chair with your feet flat on the floor and thighs flat. Maintain a good posture by having your shoulders, neck and head back, and your low back flat (tighten belly).Slowly move your head as far as you can in the indicated position.
If you are not too painful, apply slight over pressure with your hand.
If you are not too painful, grab the bottom of the chair lightly with your opposite hand, to increase the amount of stretch. Don’t tighten the area being stretched.
Hold the stretch for 10 seconds the first time you do them. You can eventually increase the stretch by 2 seconds if you don’t have too much discomfort. Eventually you may be able to increase the time stretching to 30 seconds each. Repeat this stretch 4 times. Do these stretches three times a day. You may feel the soft tissue “give up” or lengthen a few times during the first couple stretches. Start doing this exercise 3 times a week and slowly increase to 5 times a week.
If your symptoms increase after you are finished stretching discontinue the stretch. Avoid sharp pinching pain and tingling in hands and fingers.
Neck Exercises:
1) Turning / Rotation
2) Side Bend / Lateral Flexion
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Some other exercises that may be real beneficial could be: Codman Pendulum, strengthening exercises for specific muscles of the shoulder, upper back and neck including ones to increase stabilization. Anterior neck strengthening (CCF) using stabilizer. Other exercises that may be beneficial could be Isometric or Eccentric concentric muscle co-contraction. There are various other stretches for the upper shoulder, chest and neck that may also be beneficial such as the wand/stick, towel or ball stretches to name a few.
