I Thought It Was My Rotator Cuff. It Was My Neck.
- Dr. Lucas Marchand
- Jul 23
- 5 min read
By Dr. Lucas Marchand, DC — MyChiro Mobile Chiropractic, Sioux Falls, SD
She came in convinced it was her rotator cuff.
She'd also been quietly worried about her wrist — wondering if something was fractured, though she couldn't point to anything that had happened. No fall, no acute injury, no specific moment she could trace the pain back to. Just a chronic, building ache on the right side — neck, shoulder, and something going down toward the wrist — that had been present long enough that she'd started naming the structures she thought might be responsible.
The assessment told a different story.
Within the first few minutes of orthopedic testing, the clinical picture shifted from "shoulder problem" to "cervical problem referring into the shoulder" — a distinction that matters enormously for treatment, because the shoulder was never the source.
Why the Shoulder Gets Blamed
The cervical spine refers pain in predictable patterns. The nerve roots that exit the cervical spine — C4, C5, C6, C7 — each have dermatomal distributions that extend into the shoulder, arm, forearm, and hand. When a cervical facet joint becomes irritated or a foraminal opening narrows enough to compress or irritate a nerve root, the brain doesn't always localize the pain to the neck. It localizes it to wherever the nerve goes.
The result is a patient who feels pain in the shoulder — sometimes acutely, sometimes as a chronic dull ache — while the cervical spine, which is producing the signal, feels entirely normal to them. No neck pain. Just shoulder pain. And naturally, they assume the shoulder is the problem.
This is one of the most consistent misattributions in musculoskeletal practice. Not because patients are wrong to name what they feel — they're accurately describing the location of the pain. The error is assuming that location equals source.
What the Assessment Found
On palpation, the cervical spine and upper thoracic spine were completely non-tender. No pain with direct pressure to the paraspinal musculature, no appreciable muscle spasm. If the neck was the problem, it wasn't announcing itself through the obvious channels.
The orthopedic tests were more specific.
The maximal foraminal compression test — where the head is gently compressed and rotated toward the affected side, narrowing the foraminal opening and loading the facet joints — was positive on the right. The test reproduced her right-sided neck and shoulder pain. That reproduction is the clinical signal that the cervical facet joints or the adjacent neural structures are involved in producing the symptom pattern she'd been experiencing.
The cervical distraction test confirmed it from the other direction. When axial distraction was applied — gently unloading the cervical spine by separating the vertebral segments — her symptoms reduced. Pain that decreases when you remove compression from the cervical spine is pain that's coming from the cervical spine.
The Empty Can test — the primary orthopedic screen for supraspinatus and rotator cuff integrity — was negative. No pain with resisted shoulder abduction in the scapular plane. No weakness suggesting a rotator cuff tear. The structure she'd been worried about for months was functioning normally.
Cervical range of motion confirmed right rotation restriction — the movement that loads the right cervical facets and narrows the right foraminal openings. Every other plane of motion was normal. The restriction was specific and directional, consistent with right-sided facet involvement at the mid-cervical levels.
The Wrist Question
The wrist concern is worth addressing specifically, because it's clinically instructive.
A patient with chronic right-sided symptoms from C6 nerve root irritation — which runs from the mid-cervical spine through the shoulder, down the lateral forearm, and into the thumb and index finger — will sometimes describe the distal symptoms as wrist pain. The nerve doesn't announce its anatomy to the patient. It just produces sensation where it goes.
Without trauma, without a specific mechanism, without acute onset, the likelihood of a wrist fracture producing chronic unilateral upper extremity symptoms is extremely low. The more parsimonious explanation — one structure explaining the full distribution of symptoms — is the cervical spine referring through its nerve root distribution.
This doesn't mean wrist pathology can't coexist with cervical pathology. In a patient with chronic cervical issues, the altered mechanics and compensatory movement patterns they've developed can produce secondary complaints elsewhere. But the starting point for any evaluation is: what is the single structure most likely to explain the full clinical picture? Here, that structure was the right mid-cervical facet complex.
What Treatment Looked Like
The cervical adjustment — a high-velocity, low-amplitude thrust to the restricted right cervical segments — produced an audible cavitation and immediate post-adjustment relief. This is the consistent finding with facet-mediated cervical pain: restore motion to the restricted joint, reduce the compressive load on the adjacent neural structures, and the referred symptom pattern reduces with it.
The treatment sequence at MyChiro for cervical presentations follows the same three-stage approach used for any spinal complaint — tissue preparation, range of motion restoration, adjustment. For a presentation with no significant muscle spasm, the preparation stage was brief. The restriction was joint-level, not tissue-level, and the adjustment addressed it directly.
Home care for this presentation involves alternating ice and heat — ten minutes of each — to manage the residual inflammation in the facet joint capsule. The cervical chin tuck exercise to restore cervical retraction and reduce the forward head load that compresses the posterior cervical elements. And follow-up in the near term to assess whether the restriction returns or resolves.
The Broader Clinical Point
This presentation — shoulder pain from a cervical source, misidentified as rotator cuff pathology — isn't unusual. It's probably the most commonly misattributed upper extremity complaint in clinical practice. The rotator cuff is a convenient explanation because shoulder pain is real and the rotator cuff is in the shoulder. But the shoulder is rarely where the problem starts.
In nearly a decade of mobile chiropractic practice in Sioux Falls, the clinical pattern is consistent: patients who have been managing shoulder pain for months, who have tried rotator cuff exercises from YouTube and found they don't help, who have sometimes been told to rest the shoulder or given a steroid injection that provided temporary relief — many of them have a cervical facet problem that nobody assessed because the pain presentation pointed away from the neck.
The empty can test is negative. The cervical compression test is positive. The distraction test provides relief. The adjustment helps. The "shoulder problem" resolves because it was never really a shoulder problem.
Getting Assessed in Sioux Falls
If you've been managing right or left shoulder pain that doesn't have a clear traumatic origin, that hasn't responded to shoulder-specific treatment, or that co-occurs with neck stiffness or any arm symptoms — the cervical spine is worth assessing before the shoulder is treated in isolation.
MyChiro serves Sioux Falls, Brandon, Tea, Harrisburg, Renner, Canton, and the surrounding area. Same-day appointments are usually available.
Book your visit here. Or call or text (605) 201-4862.
