Bad shoulder? Massage could cause additional discomfort, disability

Monday, October 29, 2007

SCOTTSDALE, Ariz. – Massage, most often associated with visions of stress relief, spa days and relaxation, could at times be the cause of considerable discomfort and physical disability.

According to researchers at Mayo Clinic, a potential complication can arise from massage, resulting in a local compression nerve injury in the shoulder area. Their report examines the clinical and electromyography (EMG) issues related to spinal accessory nerve injury caused by massage. The spinal accessory nerve is a small nerve traveling in the back side of the upper shoulder area that is vulnerable to injury from local compression. Spinal accessory nerve injury is not common, but is known to occur as a complication of surgical procedures or trauma in the upper shoulder region. Massage, it should be noted, has not been previously recognized as a cause of injury to the spinal accessory nerve.

Illustrative of such an injury is a case in which a healthy 38-year-old Arizona woman received a massage and experienced left shoulder pain. The pain persisted following the massage, and she experienced difficulty lifting her arm. Special tests for evaluating nerve and muscle function, called EMG studies, confirmed injury to the spinal accessory nerve. Magnetic resonance imaging (MRI) revealed evidence of swelling in the upper shoulder area. This swelling was specifically in the trapezius muscle, which is supplied by the spinal accessory nerve.

The patient underwent physical therapy and gradually improved over six weeks. However, two years later, the patient still experiences persistent mild left shoulder pain and weakness.

Senior author of the study, Mark Ross, M.D., Department of Neurology at Mayo Clinic in Arizona advises, "People should tell their massage therapists if they experience pain during massage. Although nerve injury is not a common complication of massage, clients and therapists should be aware of the potential risk."

Dr. Ross also advises that massage therapists avoid applying excessive focal pressure to the neck and shoulder area.

Sara Schrader, M.D., also Department of Neurology, Mayo Clinic, co-author of the report, notes, "Those experiencing pain or shoulder weakness after massage may benefit from a visit to their physician to find out if nerve damage is the cause of their symptoms. Their physician can determine if EMG testing is necessary and what would be the most appropriate treatment."

Complete findings and results of the study were presented at the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) 54th Annual Meeting in Phoenix at the JW Marriott Desert Ridge on Oct. 20.

About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. As a leading academic medical center in the Southwest, Mayo Clinic focuses on providing specialty and surgical care in more than 65 disciplines at its outpatient facility in north Scottsdale and at Mayo Clinic Hospital. The 208-licensed bed hospital is located at 56th Street and Mayo Boulevard (north of Bell Road) in northeast Phoenix, and provides inpatient care to support the medical and surgical specialties of the clinic, which is located at 134th Street and Shea Boulevard in Scottsdale.

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