Why Can’t I Lift My Arms Overhead?

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I love when patients walk in and I can easily show them how their body works. This past week, I was able to do that with a patient who couldn’t lift his arms over his head. In seconds, I was able to fix that issue with a simple maneuver. In doing so, I demonstrated how the upper neck is connected to shoulder function. Let me explain.

We’ve Got It All Wrong: The Body Isn’t a Bunch of Individual Parts

In the field of medicine, we’ve really done the human body a disservice by conceptualizing how it functions based on a single part or system. The body, however, is one interconnected machine, not a bunch of individual part and pieces. For instance, if you have shoulder pain or trouble lifting your arms overhead, most physicians are going to focus on the shoulder. If a physician is focused on the whole body, he or she might find that the shoulder problem is due to muscles in the neck that have weakened and become unstable. Irritated nerves in the neck can also present as problems lifting the shoulders overhead. Let’s zoom in a bit closer on the neck muscles and nerves.

Neck Instability: Muscles and Ligaments

Your neck is kept stable by muscles and ligaments. The muscles provide active stability to keep things aligned as you move. The ligaments act as passive stabilizers that prevent too much motion when the bones move one on the other. These pieces of living “duct tape” prevent things from getting misaligned.

Deep in the neck running along either side of the cervical spine are the deep stabilizing muscles. As shown in the video below, these are a series of small finger-like muscles that travel all the way down the spine, and their primary purpose is to keep the bones of the spine (vertebrae) stable. In the neck, this stability helps keep everything nicely aligned when moving or bending the neck.

When these muscles weaken, they can atrophy (shrink), and this creates neck instability and abnormal motion in the neck. This can cause the shoulder muscles, such as the trapezius, to pick up the slack and work overtime to help provide neck stability ( learn more about this by watching my video above ). Understandably, this can create pain, stiffness, or functional issues, such as difficulty lifting the arms overhead.

The ligaments in the neck are your last line of defense from too much movement of the vertebrae. They act like living pieces of duct tape that hold one bone to the other and prevent misalignment. For example, if the muscles fail, there needs to be something that prevents the bones from wrecking the disc or a nerve. This is done by your ligaments. For example, in the patient that I’ll discuss below, his ligaments allow too much motion of the C1 vertebra on the C2.

Irritated Neck Nerves

Irritated nerves in the neck can create shoulder issues in a couple of ways. First, the nerves that supply the shoulder muscles exit the spinal canal through the cervical spine in the neck. If one of these nerves becomes irritated or pinched in the neck, it can present as weakness of the shoulder muscles that help lift the arms, which can disrupt function. Oftentimes, because a physician may only be focused on the shoulder, an MRI finding such as an old rotator cuff tear may actually be an incidental finding but it’s attributed to the shoulder problem. Yet an examination of the neck might have determined there’s an irritated nerve at play.

My Patient: Why Can’t I Lift My Arms Overhead?

In the short video at the top of this post, I present the case of one of my patients to demonstrate how important the neck is in shoulder function in answering “Why can’t I lift my arms overhead?” While this patient actually has a congenital abnormality in his neck that is causing his neck instability, I’ve seen this same phenomenon for many years in patients who have upper neck instability either due to muscle atrophy or upper neck craniocervical junction (CCJ) instability (due to loose or damaged ligaments), so the effect is relative.

The patient in the video was born without a dens (odontoid process), which is a part of the C2 vertebra (the bone at the second level of the cervical spine in the neck). The dens actually stabilizes the C1 vertebra (the atlas) on the C2 vertebra (the axis). These two vertebrae together form the structure that allows the head to rotate (see video for the anatomy). Without the dens, this patient’s C1–2 moves too much, as demonstrated on an upper-neck DMX (live X-ray with motion) in the video, creating a great deal of upper-cervical instability.

You’ll see in the video that when I ask him to raise his arms overhead, he struggles. Why? He’s using his upper trapezius and levator scapula muscles not only to lift his arms but also to stabilize his neck. However, when I stabilize his head on his neck, he’s able to accomplish the task easily. Why? Because now those muscles only have to lift his arms, what they were designed to do, rather than pull double duty as a neck stabilizer and a prime mover.

We can use a rowboat as another example. Say you rowed out to the middle of a lake and tried to perform dead lifts with weight while in the unstable boat. You would expend a great deal more energy because your muscles are both lifting the weight and stabilizing the boat. Once you row onto shore and perform the same dead lifts on solid ground, you can lift more weight more easily as your muscles can just focus on lifting the weight. In fact, an entire industry has grown up around this phenomenon called Standup Paddleboard (SUP) yoga. This is yoga made more difficult by performing it while on an unstable paddleboard.

The upshot? In answer to “Why can’t I lift my arms overhead?” it’s easy to see that the reason my patient can’t do this is because his upper neck is unstable. When I stabilize his head on his neck from the outside, he has no issues. This is a great demonstration of how critical neck strength is in shoulder function. This is just one of the many systems in your body that are all interconnected. That includes how your feet control your knee position and how your back is critical for leg function. Hence, the next time you meet a doctor who only wants to talk about why your shoulder hurts or is weak, and doesn’t consider your neck in that equation, find a new doctor.

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12 thoughts on “Why Can’t I Lift My Arms Overhead?

  1. Irene korpan

    Hello. I am on able to lift my arm above shoulder and less I hope it first with my other arm. It started as a sore neck I thought I slept wrong and then do the neck soreness my whole shoulders and upper back worse becoming sore. A few days later it became hard to lift a fork to my mouth and eventually became almost impossible to shampoo my hair and less I would lift my arm with my other arm and stabilize it on the wall and then I could use my hand to help shampoo my hair. I’ve been going to therapy and having neck traction. is this the right thing to be doing?

    1. Regenexx Team

      Irene,
      Generally speaking, when physical therapy doesn’t help it’s time to get the type of exam that can accurately diagnose what the problem is. It would likely be a good idea to get an MRI of your neck and your shoulder and once the Candidacy review is complete we can set up that type of exam. Please see: https://regenexx.com/blog/a-colorado-regenexx-patient-review-pain-free/ and https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/ https://regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ 855 622 7838

  2. Annie

    My neck and arms feel fine, but when I lift my arms above shoulder height, such as taking off a T-shirt, the back of my right thigh hurts! The thigh was diagnosed as sciatica, but I don’t see any mentin of the sciatic nerve or the hamstring where the pain is being affected by arm position. Any ideas?

    1. Regenexx Team

      Hi Annie,
      Because body is an interconnected unit rather than separate parts an extensive exam to see what’s going on would be needed. Some examples: https://regenexx.com/blog/can-your-neck-cause-hip-pain/ and https://regenexx.com/blog/hip-replacement-pain/ and https://regenexx.com/blog/hip-labral-tear-recovery-without-surgery/ The locations where that type of exam can be done are on the website here: http://www.regenexx.com, or you can give us a call to assist in setting one up at 855 622 7838.

  3. karl hammond

    my trapezius muscle on the left side hurt

    1. Regenexx Team

      Hi Karl,
      Please see: https://regenexx.com/blog/weak-neck-muscles-can-cause-shoulder-trap-pain-lifting/ We’d need to examine you to see what’s going on in your case. To set up an exam please call 855 622 7838.

  4. Barb

    I have had neck and shoulder pain since I was a teenager. Recently, I had a neck surgery to remove a lymph node, and a week later, I was experiencing extreme shoulder pain and “jolts” of shocking pain on the same side as the neck surgery, which I think is a pinched nerve. I have been going to physical therapy now for a few weeks working on strengthening my shoulder muscles, but I still can’t lift my right arm above my shoulder (I am very flexible so this is quite shocking) without holding it up with my left arm and/or twisting my body. I also have not felt progress with regards to the intensity of the pain. Neither the surgeon nor the PT are able to explain to me what happened during the surgery that led to this intense sudden pain and immobility of my arm. Is there a different type of doctor I should be seeing to help figure this out?

    1. Regenexx Team

      Hi Barb,
      Yes, because unfortunately, the extensive exams needed to make an accurate diagnosis are a rarity today. While it may be a pinched, or damaged nerve, but we’d need that extensive exam you to see what’s going on. If you’d like to do that, please give us a call, number here: https://regenexx.com/conditions-treated/

  5. Caroline

    Hi I can’t raise my left arm up in the air or wash my hair, or tie my hair back, the other arm is fine, had MRI done of shoulder and arm both ok, doctors don’t know why I can’t put my arm up in the air, it just won’t go. Can anyone tell me what is wrong.

    1. Regenexx Team

      Hi Caroline,
      As it explains in the blog, this is often due to upper neck instability. We’d need more information to see what’s going on in your case and if you’d like to do that we can Evaluate your case via Telemedicine. You can set that up by scrolling down to the bottom of this link: https://centenoschultz.com/

  6. Faith Igbineweka

    Hello, I can’t lift my left arm above my head and the pain is so severe. Before now, I sometimes have this pain in the back of my neck, I can’t turn it but if I apply hot gel and some pain relief drugs I will be fine. Though I was told is the way I positioned my neck. But fees weeks ago I had unsual experience, I woke up in the morning and i could not lift my left arm and my neck was stiff. I used hot gel to massage the neck and I was a bit relief. I can turn my neck to both side moderate pain. But my arm to my shoulder pain is unbearable. What can I do?

    1. Chris Centeno, MD Post author

      Sounds like this may a C5 nerve issue. You may want to find a Regenexx physician.

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