Mid back thoracic and shoulder pain.

[oddscwodd]

I have been suffering with a stabbing pain from what feels like under my Scapula and pain through out my shoulder arm and Biceps. Initially diagnosed as a torn rhomboid muscle the pain has been on going since March 2010.

I compete in wrestling and Mixed martial arts and had just started training after rehabbing a Bad AC joint injury.

One morning after training felt my back was stiff so reached up for the top of the door in order to stretch my back out when a shooting pain came from the are of my rhomboids. Original physio diagnosed it as a rhomboid tear and we rehabbed it. The pain eased but did not go away and my shoulder became irritable. I thought this linked to my AC joint problem. Stopped training in June of 2010 as I could not cope with the pain. Went to see a reccomended Physio whose instant reaction was a herniated disc cervical C5-C6. Initial meeting with Neurologist said that the symptoms point to this and it was the most likely problem. MRI scans showed no Bulge or impingement in the cervical area of the spine. There was however a small bulge in the thoracic region of the spine but this, he kind of said, would not lead to the symptoms exhibited in this case.

I have now been told that the neurologist thinks that this is a peripheral nerve injury which will improve over time with physiotherapy. My Physio suggested it may be repeated nerve trauma of the C5 nerve root causing residual neuralgia and I am set to see him as soon as poss.

My reflexes in both arms are limited. I have loss in sensation of touch to the skin of my right shoulder and am 5% weaker on the right handside of my upper body than left.

Any suggestions? Did my initial rehab for my neck and got the old pain again around my lower scapula area. Any thoughts on next steps would be extremely appreciated.

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[Vanc_WA_PT]

My money is on peripheral nerve injury from foraminal stenosis/impingment of nerve root; you'll want to steer away from activity that compresses your cervical spine or extends your neck i.e. upright rows, lat pulldowns behind the neck, lateral flys, military press etc and conversely do things that relax your neck, upper traps, scalenes SCMs and that gently stretch your neck like massage, suboccipital release, light cervical traction; any activity that increases neurologic symptoms, though, should be avoided.

[oddscwodd]

Thank you for your advice. Wouldn't the MRI have shown any Stenosis though?

[Vanc_WA_PT]

The MRI may say something like 'facet arthropathy' or 'degenerative changes'; narrowing of the bony space where the nerve root exits the spine is all stenosis is; if you had no significant disomfort while in the MRI then likely the openings were not pinching the nerve root so looking at the film (which is only a snapshot of your spine at that moment) there would seem to be nothing to make note of; if they took a scan at the moment you shrugged a 200lb bar then the foraminal space may be much closer to your nerve root and at risk of irritating it and would be worth mentioning in the report. Just my opinion.

[oddscwodd]

Thankyou. I will definitely mention it to the Doctor on thursday.

[oddscwodd]

Hi just went to my GP. He is excellent. He made sense of the neurosurgeons babble. Saying they are Neuro SURGEONS and that if they can not see anything to cut out they have nothing to do. Kind of makes sense. He also said that the report says that the MRI shows no evidence of degenerative changes or anything like that. A very healthy spine. I was worried that the mechanical cause of the injury may still be occurring. the Gp said that the MRI shows no evidence of any impingement on nerve roots or spinal cord. So in that sense good news from a sensible man.

I asked him your question about it being a picture of the now, not the then. He said that there would of been in the vast majority of cases some evidence of that on the MRI as I am still facing the pain. He has referred me to neurology which he says is the next step and has started treating the problem as a nerve pain problem with amytriptyline.

Hopefully this two pronged attack will help. See my physio on Monday for his advice to see what he thinks. Any further thoughts would be greatly appreciated.

[Vanc_WA_PT]

great news that you like your GP; sounds like you're in good hands; you might ask the PT if they feel neural stretching techniques would be appropriate - good luck

[Musculoman]

Try some neural "flossing" first if your physio deems it appropriate. Neural stretching can aggravate the nerve in some cases, and while it can be effective, should start out very light and progress as tolerable. Some light thoracic stretches may also help over a period of time. While improving your neural pathway, you will want to take as much tension off your nerve roots/peripheral nerves as possible to decrease irritation, this means good posture, shoulder position and mechanics, reducing aggravating factors etc. A lot of Vanc_WA_PT's information is great in terms of exercises to be wary of.

[AndySchmidt]

I'd agree with both the clinicians below, neural mobilisation could be the way to go, try to see someone that knows all the up to date David Butler et al stuff. Good luck

[oddscwodd]

The saga continues. Saw my Physio on Monday and he meticulously worked over my spine. He found that the T10-T12 were hypomobile and locked solid. He gave me some exercises to try to mobilise this section of the spine. He suggested I get the thoracic section checked out as the Neuro surgeons report was on the cervical region. He says that it is unlikely to be a factor but that I should have it looked at just incase.

Getting a private consultation soon. Looking into the neural flossing and started to work through it. Thanks to everyone for there help.

[alophysio]

Hi oddscwodd,

I agree with the people above...all good advice.

What i was thinking when i was reading your story was that your motor patterning might be affecting the soft tissues and putting excessive strain on your nerves via the neck and the thoracic spine.

What that means is that you may have an issue with coordinating the muscles you are using and they are crunching your spine and soft tissues.

Because you are young and healthy, your MRI is clear - but remember that it is only a snapshot in time...

Try to balance out the stiff and hypermobile joints and make sure that your muscles are not overactive or underactive during your activities or movements...your physio should know what all that means

Cheers!