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shoulder pain

Shoulder Problems

Some Anatomy

The shoulder is a flexible joint that can perform many different movements. These include:

  • Flexion: raising the arm to the front.
  • Extension: raising the arm to the back.
  • Adbuction: raising the arm to the side.
  • Adduction: lowering the arm at the side.
  • Internal Rotation: describes the shoulder motion when you reach (down) to scratch your lower back.
  • External Rotation: describes the shoulder motion when you reach (up) to scratch the back of your neck.

Some Symptoms and Syndromes

Sustained postures where the arm is held away from the body can contribute to shoulder discomfort, which can greatly affect a person's ability to use standard computer input and output devices. These sustained postures often occur with prolonged mouse usage. Surfing the Internet, playing computer games or any other sustained mouse activity can cause shoulder discomfort.

Case Story 3
O worked in the financial services industry and spent his days monitoring stock and commodity prices. O developed shoulder pain that started as a minor inconvenience but eventually grew into a constant ache that was aggravated every time he used the mouse.

Technology Accommodation
The standard mouse was replaced with a touchpad mouse, which he held in his lap and manipulated with the fingers of his right hand. Because the touchpad is a stationary mouse, it did not require shoulder movement to operate. Footswitches were also added so that mouse clicking could be done with the feet. O replaced his standard keyboard with a small footprint keyboard, so that the bulk of his keyboarding could be done one-handed (left hand only). The monitors were mounted on arms and positioned at the same height in a kind of semicircle, so that they were all the same distance away from O.

Shoulder problems usually include:

  • Pain and discomfort in the shoulder.
  • Limited range of motion (the shoulder is limited in its movement, usually by pain).
  • Pain radiating from the shoulder down the arm or up into the neck.
  • Neck pain may also result from shoulder pain and discomfort.

The shoulder joint is susceptible to a number of soft tissue injuries and problems due to its high degree of mobility. Tendonitis, rotator cuff tears, bursitis, dislocations, frozen shoulder and arthritis, to name a few.

Thoracic Outlet Syndrome

The Thoracic Outlet Syndrome is difficult to diagnose because there is no test that has a high degree of accuracy. Usually, the diagnosis is made after all other causes of the symptoms have been ruled out - a frustrating and slow process sometimes

  • Symptoms: pain, weakness, numbness and tingling, swelling, fatigue or coldness in the arm and hand. These symptoms can mimic many other conditions, such as a herniated disk in the neck, carpal tunnel syndrome, and bursitis of the shoulder.
  • Cause: compression of the nerves and arteries of the arm in the Thoracic Outlet (a passageway formed on the bottom by the first rib and on the top by the clavicle).

Shoulder Impingement Syndrome

A quick test for Shoulder Impingement Syndrome is a sharp pain when you try to reach into your back pocket.

  • Symptoms: generalized shoulder aches in the condition's early stages, and pain when raising the arm out to the side or in front of the body. People often complain that the pain makes it difficult for them to sleep, especially when they roll onto the affected shoulder.
  • Cause: rubbing or pinching of tendons between the bones that make up the shoulder joint (specifically, the scapula and humerus).

Shoulder "Winging"

The position of the arms while keyboarding can also contribute to shoulder discomfort. In many cases the elbows are held out away from the body in a posture that is known as "winging".


Winging: holding the elbows away from the body while keyboarding.

Solutions to Consider

Shoulder problems can be quite debilitating. Shoulder injuries are slow to heal and easily aggravated.

Before proceding to change your keyboard and mouse, consider your posture. Making improvements in posture can help you deal with problems in other areas, such as your shoulder.

  • Are you reaching for your mouse with a fully outstretched arm?
  • Is the mouse at the same height as your keyboard, or are they placed on different surfaces?
  • Does your chair have well-padded and adjustable armrests?
  • How are you sitting; what is the height of your desk?
  • Do you have to perch on the edge of your chair, or are you slouching?
  • Are you twisting your neck to read a document?
  • Are you twising your neck to hold the telephone while you type?

These and other issues should be considered when addressing shoulder problems.

  • Arm Supports

  • Mouse:
    • Contoured or vertical mice do not require you to hold your wrist in full pronation. Both reduce the amount of pronation (although to different degrees).
      Hippus Handshoe Mouse Ergonomic Precision Mouse
      Hippus Handshoe Mouse Ergonomic Precision Mouse

    • Roller-style mice, trackballs or touchpads are stationary mice (you donít have to hold or move these mice while operating). This eliminates shoulder movement while operating the mouse.
      RollerMouse Slimblade Mouse Smart Cat Touchpad Mouse
      RollerMouse Slimblade Mouse Touchpad Mouse

  • Keyboard
    • Adjustable keyboards that can be separated into two discrete segments allow you to move the two halves of the keyboard to get the optimum pain-free position.

    • Fixed-split keyboards, while not as flexible as adjustable keyboards, also provide better positioning for the shoulders than a standard keyboard.

    • The contoured keyboard has two separate keywells, reducing the amount of shoulder rotation.
      Advantage Contoured Advantage Contoured + Cirque Smart Cat Pro
      Advantage Contoured Advantage Contoured + Cirque Smart Cat Pro

    • Combination keyboards, which incorporates both a keyboard and a mouse, reduce the amount of shoulder movement needed to reach the mouse.
      Solidtek SK7070
      Solidtek SK7070

    • A discrete numeric keypad is useful for those who do a lot of number entry. Because they are not attached to the keyboard, these keypads can be positioned in the most comfortable location (such as with the shoulders supported).
      Kinesis Keypad
      Kinesis Keypad

    • Shoulder pain can also result from reaching for the mouse. One accommodation (for right-handed mouse users) is to use a keyboard with the numeric keypad on the left. For those who do not require a numeric keypad, another solution is to use a compact keyboard. Because these keyboards do not have a numeric keypad, the mouse can be positioned closer to the midline.
      Evoluent Mouse Friendly Compact Keyboard Bakker Elkhuizen S-Board 840 + Kensington Orbit Mouse
      Evoluent Mouse Friendly Compact Keyboard Bakker Elkhuizen S-Board 840 + Kensington Orbit Mouse