My coverage area is only up to my elbow so I don't know about not getting as much coverage in your shoulder and neck area. But I do know that I often feel the stimulation in my other hand as well. Because the cervical space that the leads are in is so small and tight, there are a lot of positional changes when you move (the stim getting stronger or weaker) and also this is why it can be felt in the other side of the body as well. As far as that goes, it's better with the perm, but definitely still there. I would talk to your doctor about getting more coverage for the upper area, though.