A Man in His 50s Unable to Raise His Right Arm
Do You Experience Any of These Symptoms?
- Shoulder pain when lifting your arm
- Pain at the front of the shoulder after weight training
- Difficulty performing a bench press because of shoulder pain
- You’ve been told you have frozen shoulder, but your symptoms continue to worsen
- Pain when reaching overhead or behind your back
- Looking for treatment beyond pain medication and rest
These symptoms may be caused by biceps tendinitis, rotator cuff dysfunction, or shoulder impingement syndrome, rather than frozen shoulder alone.
This case report describes a patient who was initially diagnosed with frozen shoulder but whose examination findings were more consistent with long head of the biceps tendinitis associated with shoulder joint dysfunction.
A man in his 50s visited Spine Chiropractic complaining of severe pain in his right shoulder and an inability to raise his arm.
His shoulder pain began approximately three weeks before his first visit.
Initially, the discomfort was relatively mild, but about one week before attending our clinic, he suddenly found that he could no longer lift his right arm because of severe shoulder pain.
Soon after the symptoms first appeared, he visited a local orthopedic clinic.
Following a brief examination, he was told,
“It’s just frozen shoulder.”
He was prescribed anti-inflammatory medication and topical pain patches but received no additional treatment.
Because he felt his condition was continuing to worsen without a clear treatment plan, he searched online for a clinic specializing in shoulder pain near Kannai.
While browsing Google Maps, he found Spine Chiropractic and spent time reading the detailed information on our website regarding shoulder pain and frozen shoulder.
Feeling confident that we would perform a thorough assessment rather than simply treating the symptoms, he decided to schedule an appointment.
Although he had never received chiropractic care before and was initially uncertain about what to expect, he felt reassured after reviewing our website and decided to proceed with treatment.
Assessment of Shoulder Pain
Patient History
Several years earlier, the patient had started weight training as part of his regular fitness routine and had consistently trained one to two times per week.
Approximately three weeks before visiting our clinic, he experienced mild pain in the front of his right shoulder while performing the bench press.
Initially, he was still able to move his shoulder normally, and the pain occurred only during specific movements, particularly when extending the shoulder backward under load during bench pressing.
However, approximately one week before his first visit, he woke up with significantly increased pain throughout the shoulder and suddenly found himself unable to lift his arm normally.
Concerned by the rapid progression of his symptoms, he visited an orthopedic clinic.
Although he was diagnosed with frozen shoulder and prescribed medication, he felt that no active treatment was offered and began searching for another solution.
Postural Assessment
Observation of the patient’s seated posture revealed that the right shoulder rested noticeably farther forward than the left.
This forward shoulder posture suggested altered shoulder biomechanics and increased mechanical loading on the anterior shoulder structures.
Static Palpation
Palpation revealed significant tenderness and increased muscle tone around the anterior aspect of the shoulder.
The following structures demonstrated positive findings:
- Anterior fibers of the deltoid muscle
- Long head of the biceps tendon
- Subclavius muscle
- Pectoralis minor muscle
These findings indicated substantial overload of the anterior shoulder complex.
Motion Palpation
Active shoulder range of motion demonstrated characteristic differences depending on arm position.
Shoulder elevation with external rotation (thumb pointing upward):
Elevation was limited to approximately 80 degrees because of pain.
Shoulder elevation with internal rotation (thumb pointing downward):
Pain was considerably less, allowing elevation to approximately 120 degrees.
Shoulder elevation in the neutral position:
Pain limited elevation to approximately 90 degrees.
Marked pain was also reproduced during internal rotation with the shoulder abducted to 90 degrees, suggesting mechanical irritation involving the anterior shoulder structures, particularly the long head of the biceps tendon.
Orthopedic Examination
A comprehensive orthopedic examination of the shoulder produced the following results:
- Painful Arc Test: Positive
- Dawbarn’s Test: Positive
- Codman’s Drop Arm Test: Negative
- Yergason’s Test: Positive
- Speed’s Test: Positive
Taken together, these findings were more consistent with long head of the biceps tendinitis than with a typical presentation of adhesive capsulitis (frozen shoulder).
Muscle Strength Examination
Manual muscle testing demonstrated:
- Deltoid: Unable to maintain the testing position because of pain
- Biceps brachii: 4/5
Additional muscle strength testing was deferred because pain prevented reliable assessment.
Chiropractic Treatment for Biceps Tendinitis
Based on the clinical findings, the patient’s symptoms were considered most consistent with long head of the biceps tendinitis, rather than a typical presentation of frozen shoulder.
Although approximately three weeks had passed since the onset of symptoms, the examination suggested that inflammation of the tendon was still present.
For this reason, the initial treatment focused primarily on reducing inflammation before attempting to restore full shoulder mobility.
Therapeutic ultrasound was first applied to the long head of the biceps tendon to promote tissue healing, reduce inflammation, and alleviate pain.
Cryotherapy (ice therapy) was then used to further control the inflammatory response and minimize secondary irritation around the injured tendon.
Because the patient had been protecting the shoulder for several weeks, significant muscle guarding had also developed throughout the shoulder girdle.
Soft tissue therapy was therefore performed to reduce excessive tension in the:
- Anterior deltoid
- Pectoralis minor
- Subclavius
- Biceps brachii
- Surrounding shoulder stabilizers
Care was taken to avoid placing excessive stress on the inflamed tendon during treatment.
Although shoulder range of motion was clearly restricted, it was not yet possible to determine whether the limitation resulted primarily from inflammatory adhesions or protective muscle guarding.
For this reason, aggressive joint mobilization was intentionally avoided during the first visit.
Instead, treatment emphasized:
- Reducing inflammation
- Improving soft tissue mobility
- Restoring normal muscle function
- Reducing mechanical stress on the anterior shoulder
The patient was informed that shoulder mobility would be reassessed as the inflammation subsided and that more active rehabilitation would be introduced gradually when appropriate.
[Treatment Progress]
Second Visit (One Week Later)
The patient reported that shoulder pain was still present and that active range of motion had not changed significantly.
However, he also felt that the intensity of the pain had begun to decrease.
Reassessment demonstrated a slight improvement in passive shoulder motion, suggesting that inflammation and muscle guarding were gradually subsiding.
Treatment remained focused on controlling inflammation while gentle mobilization of the clavicle and shoulder girdle was introduced to begin restoring normal joint mechanics.
Third Visit (One Week Later)
At his third appointment, the patient reported noticeable improvement in both pain and shoulder mobility.
Because the clinical findings suggested reduced stress on the tendon and improved soft tissue flexibility, treatment progressed to a more active phase.
The primary goals became:
- Increasing shoulder range of motion
- Restoring normal scapular movement
- Improving shoulder joint mechanics
Particular attention was given to correcting the patient’s anterior shoulder posture (rounded shoulder), which was considered one of the primary biomechanical contributors to his injury.
Before leaving the clinic, the patient was advised:
“Today’s treatment involved more active joint mobilization. It is possible that the tendon or surrounding ligaments may feel temporarily sore from the increased movement. If that happens, please apply ice to help reduce the inflammation.”
Fourth Visit (One Week Later)
The patient reported mild soreness when moving the shoulder on the evening after treatment.
Following the recommended home care, he applied ice to the shoulder.
The soreness lasted for approximately two days before resolving.
By the third day, he noticed that his shoulder felt considerably lighter and moved more freely than before treatment.
Because his recovery was progressing well, treatment continued to emphasize restoring shoulder mobility, scapular mechanics, and normal movement patterns.
As his condition had become more stable, treatment intervals were extended to once every two weeks.
Fifth Visit (Two Weeks Later)
At his fifth appointment, the patient reported that he experienced no significant post-treatment soreness following the previous visit.
Despite the longer interval between treatments, his symptoms had not returned to their previous level.
This indicated that the improvements in shoulder mechanics were being maintained.
Treatment continued to focus on restoring full shoulder mobility while correcting the rounded shoulder posture that had contributed to excessive loading of the biceps tendon.
At this stage, treatment every two weeks was considered appropriate, and progress continues to be monitored.
Current Status
The patient continues to receive chiropractic care and reports that his shoulder pain has improved by approximately 70% compared with his initial presentation.
Although he has not yet returned to heavy resistance exercises such as the bench press, he has been encouraged to begin lightweight seated chest press exercises as part of his gradual return-to-training program.
These exercises are intended to restore movement confidence while allowing the shoulder to adapt progressively without overloading the healing tendon.
Clinical Perspective
This case is representative of a common weightlifting-related shoulder injury, particularly among individuals who regularly perform the bench press.
During the lowering phase of the bench press, both the pectoralis major and the long head of the biceps tendon are placed under considerable tension.
As the barbell is pressed upward, substantial force is transmitted through the tendon.
If shoulder mechanics are compromised or lifting technique is suboptimal, excessive stress may accumulate within the tendon, resulting in inflammation and pain.
One of the most significant contributing factors in this patient’s case was his anterior shoulder posture (rounded shoulders).
This altered shoulder alignment placed the long head of the biceps tendon under additional tension even before exercise began.
Combined with repetitive loading during the bench press, this abnormal shoulder biomechanics likely initiated the inflammatory process.
Although chiropractors in Japan are not legally permitted to provide medical diagnoses, the patient’s history, physical examination, and orthopedic findings were much more consistent with long head of the biceps tendinitis than with a classic presentation of adhesive capsulitis (frozen shoulder).
Long-term recovery requires more than simply reducing pain.
Restoring normal shoulder alignment, improving scapular mechanics, maintaining flexibility of the surrounding soft tissues, and optimizing exercise technique are all essential for preventing recurrence.
The patient has responded well to treatment and has expressed interest in transitioning to a preventive maintenance program once rehabilitation has been completed.
Looking for an English-Speaking Chiropractor in Yokohama?
At Spine Chiropractic, we provide evidence-informed chiropractic care for a wide range of musculoskeletal conditions, including:
- Biceps tendinitis
- Frozen shoulder (adhesive capsulitis)
- Shoulder impingement syndrome
- Rotator cuff disorders
- Weightlifting and gym-related shoulder injuries
- Bench press injuries
- Postural shoulder pain associated with desk work
Our clinic is conveniently located in central Yokohama, just 1 minute from Bashamichi Station, 7 minutes from JR Kannai Station, 8 minutes from Nihon-Odori Station, and 12 minutes from JR Sakuragicho Station.
We provide chiropractic care in both English and Japanese for local residents as well as international patients.
If you are experiencing persistent shoulder pain, have been told you have frozen shoulder, or have developed shoulder pain after weight training, we would be happy to help you restore movement, reduce pain, and safely return to your normal activities.