Severe Neck / Shoulder pain - delayed?

[Tonybob]

Hi Guys, I'd like a few more opinions on what is causing my aggravation:

The first time the pain occurred (a week ago now) it was severe, immobilising and my first thought was pinched nerve somehow. My entire left arm/shoulder and trapezius were all exhibiting severe pain and no matter what position I got into, it was very uncomfortable, sitting up with my arm mainly hanging down was about the least painful position. Very slight numbness / tingling in the arm/fingers told me it was affecting my nerve. I couldn't understand how it had come about except to say that I can only conclude it was one of two things:

1 - The pain occurred as I was about to go to sleep on the Friday (1st March) night about 11:30pm, the previous morning 6:30 am I had been to the gym (typical) and didn't exercise again in between this and the pain, but my thoughts are that I had overworked / overloaded my shoulders doing gym work which seemed to have delayed consequences - in between this period of time there was no discomfort or anything, the pain was sudden and unexpected. I had done some shoulder shrugs in the gym (not something I always do but not new to myself) and I think this was the overkill part. I'd done various other weight-bearing exercises prior to this that utilise the shoulders too. I'm typically 70kg and regard myself as very active / fit, plenty of carido work with 2 weights sessions a week too. Nothing else I can think of happened until the pain kicked in.

2 - I can't recall if I had 'cracked' my neck just before this occurred (about an hour if that) or if I cracked my neck because of the pain. By this, I mean, at one point +/- an hour of having the pain, I twisted my head purposefully to the left side and it really went with a loud crack - although I have had this occur before without consequence.

Anyway, I managed a total of 2.5 hours sleep that night! And at 9:30am the following day I was at the local physio! It had calmed down enough to be able to drive the 5 mins it takes to get there. The physio's initial assessment was an exceptionally stiff neck muscle, but this bewildered me a little, but she manipulated the area and that was pretty much it, but there was no further relief. The pain was lower all that day but underlying and dull / achy. Again, I struggled to sleep that night but it was better.

The following day, the pain had manifested itself not so much in the trapezius now, but it felt like my deltoid had been detached from my shoulder, that's where the pain was, mainly towards the rear at the joint of the delt/scapula area. It only gave me pain in a few positions, and mainly, sharp intense pain in various positions, like if I were to bend forward to tie my shoelace, instant agony right at the last stretch.

It was (and still is) noticeable that my trapezius is somewhat raised when relaxed, looking in a mirror :

P1050362.JPG

During the nights, I wake after a few hours sleep as the pain starts again, maybe form being in a sedentary position for a long period, but only my back or right side. I'm currently typing as the pain kept me awake this morning! I saw the Physio again on Monday morning, the pain as in 'pinched nerve' hasn't re-occurred but the dull, achy arm / neck pain is still lingering and not subsiding quickly at all. She again manipulated the shoulder / neck, pretty painfully, said the neck muscle has eased up a lot, and also checked for pain while mobilising my arm in various positions (I had then mentioned my theory that it was weight-training related), I was bothered that my rotator cuff could have been damaged, but the positioning and movement of my arm didn't show any pain in any other position. The discussion led to the physio saying that my left scapula is now 'winging', I struggle to raise my arm above shoulder height as it feels very weak, and in doing so, the scapula really pops out. My right, good side is slightly pronounced in this apparently but certainly not to the extent it is happening over the other side.(I am right arm dominant too). So, the basic conclusion was then, kinesio tape over the shoulder to help take some of the stress, and trying to rehab the shoulder into a normal position by outward & upward arm movements while trying to retain the scapula where it should be. This feels almost impossible as I have absolutely no control as the the scapula's movement, but I can feel it's position 'winging' quite easily.

Oh, here is what happens when I try to raise my arms too! Note the flat deltoid & hidden lat, the pic is reversed to compare with the normal right side.

shoulder+1.jpg

It's now Friday morning and recovery is extremely slow, the dull, achy pain woke me again at 4am, possibly as the shoulder had cooled down while sleeping / being immobile for 6 hours during the night & horizontal.

I'll be seeing the Physio again on Monday but was hoping to discuss something other than my neck/arm/shoulder..as I was hoping it would have eased up massively by then.

Regarding strengthening my serratus anterior in future, I'd be pretty convinced that the 'winged scapula' is not something I should expect to have with the types of weight-bearing exercises I do? I was, up until friday, aiming towards a 100 kg one rep max bench press, but my plans are on hold! That morning I'd done 85kg for 5 reps for the second time that week. I also do a lot of swimming (freestyle) I suppose the training questions should come after! But, for now, I would highly appreciate any input as to this current problem that doesn't appear to be subsiding as quick as I'd like.

Also, is rest a better option, or heat & manipulation advantageous, as I was aching just as much / even more after the seeing the Physio on Monday, the recovery feels delayed somewhat

I'll keep this thread updated too, as I know how frustrating it can be to give input and then not hear a word after that! Thanks in advance.

Tony...

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[Tonybob]

Any Help? It's been a week and a half now and although the immediate pain doesn't now exist, there is still a constant dull ache, the physio really bedded into my neck yesterday and obviously I feel worse for it now, she's confident it is only nerve compression and no muscle problems. I still can't lift my arm above shoulder height, just no strength at all. Sleeping is a struggle, especially with a little baby waking us too!

[physiobob]

Hi Tonybob, sounds like a classic referral pattern from the neck area, perhaps around C4 which provide sensation out to the lateral shoulder area. You should not expect this to resolve in a few days and it might take a few weeks of mobilisation to settle things down. No weights on the area in the mean time. The flattening of the lateral deltoid area and asymmetry in the lats may be secondary to what's going on rather than actual muscle damage. A winging issue that is unilateral (on one side) might be some compromise of the long thoracic nerve. See Winged Scapula for more info on that. It is feasible that this is involved in your presentation and your physio can test for that.

It may well be that some of your signs (things we can visualise) may have been present before this issue and you are only noticing them now due to the closer observation. The primary thing would be to centralize your pain back to the neck region and then resolve that. Then you can see what's left and address any training biomechanics and general spinal mobility

It's a free service and people are often very busy so cut them some slack if there is not a response within a day or two. I for one am off skiing today :-)

[Tonybob]

I appreciate the response and apologise, I thought I had posted initially a lot earlier - this type of pain makes it feel like the problem happened months ago!

there's no chance of doing any weight-bearing / resistance exercise, the fact I can't move my arm above shoulder height tells me that! Just feels so weak. The winged scapula does seem to be occurring from the lack of other muscle doing their job - the physio seems to think it isn't perfect in the good shoulder anyway.

I don't mind missing weights sessions at all, its the swimming I want to get back to but not likely for some weeks going off how the healing response is, then its having that confidence that it won't suddenly occur again. This just did seem to come on abruptly without any warning signs and that's what really bugs me.

All I suppose I can do is to keep mobilised as often as possible to relieve the pain. I'm just keen on speeding up the healing process!

thanks

Tony.

[finchr]

There are 2-3 options here. Personally my 1 st bet would be cervical related. There is an easy way to test it. Support your injured or weak arm on a table. Now bend your chin to your chest, bend your head backwards or up, turn it to the right as far as you feel comfortable doing, then to the left. Do the same with side bending 1 time. Now try to pull your head back like you were trying to put your head on the headrest of your car while driving Do any of the motions produce tingling or increase your pain?

If not, try repetitive movements with your arm on the table still (to decrease pressure on your nerve roots and place your shoulder muscles on slack). Yes, I am a certified McKenzie practitioner. If it is neck related(symptoms reproduced or peripheralized while the shoulder is on slack) it can be treated with movement if it is a mechanical injury and problem. Personally, from the sounds of it, I do not think the muscle guarding is primary, so do not think doing soft tissue neck work addresses the primary problem. From your response you get no relief as a result of anyway

It could still be rotator cuff related, but the neck has to be ruled out 1 st. If it is neck related I would look up mckenziemdt.org, put in you country and city and they will tell you where a certified provider is.

Have your therapist try mechanical traction on you. Again, if you improve quickly, it is most likely neck

The neck would be a whole lot easier to deal with than a RTC tear. If you had a big tear, I doubt you would have been able to do the muscle pose, but I have seen stranger things. Don't micro focus on possible asymmetries that may have been there before even.

- - - Updated - - -

You all get physical therapy for free over there? Damn, salaries must be on the low side.

[Tonybob]

There are 2-3 options here. Personally my 1 st bet would be cervical related. There is an easy way to test it. Support your injured or weak arm on a table. Now bend your chin to your chest, bend your head backwards or up, turn it to the right as far as you feel comfortable doing, then to the left. Do the same with side bending 1 time. Now try to pull your head back like you were trying to put your head on the headrest of your car while driving Do any of the motions produce tingling or increase your pain?

If not, try repetitive movements with your arm on the table still (to decrease pressure on your nerve roots and place your shoulder muscles on slack). Yes, I am a certified McKenzie practitioner. If it is neck related(symptoms reproduced or peripheralized while the shoulder is on slack) it can be treated with movement if it is a mechanical injury and problem. Personally, from the sounds of it, I do not think the muscle guarding is primary, so do not think doing soft tissue neck work addresses the primary problem. From your response you get no relief as a result of anyway

It could still be rotator cuff related, but the neck has to be ruled out 1 st. If it is neck related I would look up mckenziemdt.org, put in you country and city and they will tell you where a certified provider is.

Have your therapist try mechanical traction on you. Again, if you improve quickly, it is most likely neck

The neck would be a whole lot easier to deal with than a RTC tear. If you had a big tear, I doubt you would have been able to do the muscle pose, but I have seen stranger things. Don't micro focus on possible asymmetries that may have been there before even.

- - - Updated - - -

You all get physical therapy for free over there? Damn, salaries must be on the low side.

Thanks for the response,

The pain isn't as bad as it was - I was very mobile yesterday and made an effort to really keep the neck / head moving. It subsided for most of the day and came back after laying in bed asleep for about 2 hours, then the dull aches began again and continues to do so this morning. Twisting my head to the left (problem side) is the niggle - just feels stiff, not really painful. Traction was suggested as the next step if it hadn't subsided.

And, no - Physio isn't free unless you wait for about 6 months! By then you're more likely to have fixed the problem yourself or it has subsided! The pain here is too much to wait that long, so I've paid for the treatment so far. I do have private medical insurance but this takes some time to get in place too, you firstly need a doctors referral then see if your private company agree to the treatment. It can be complex sometimes!

Thanks for the input.

[Tonybob]

Well, its just over 4 weeks on and the winged scapula is still persistent. I do believe it is the serratus anterior that has been affected by nerve problems, it often aches a little and after a bit of reading up it seems to tie in with everything, so yeah, the long thoracic nerve seems to be an issue. It feels stiff / tight to as I twist my head to the left side, no pain whatsoever now, just limited ROM with the left arm still. Plenty of crunching and cracking available in my neck as I twist it around! The spine is tender to the left of either the T4 or T5 vertebrae (not sure exactly) too. Getting frustrating that I can't speed up recovery or understand how it happened in the first place. Again, any input is highly appreciated. Need to know what steps to take next!

[Tonybob]

Hi Guys, for anyone interested, I still have this issue! It's been around 10 months now and I have very little strength in my arm when lifting / pushing vertically. I've not done any weightlifting exercises since this occurred. My neck is still easy to crack via twisting in any direction too. There is no pain and I've seen another physio who tried manipulating all the serratus area as well as my pec too, with nothing helping. The winging is still there but according to him, it's hardly winging in a drastic capacity. The one thing that has become more noticable is that behind my clavical, what feels like the trapezius on the left (problem side), is what appears to be a lump / mound - max 1 inch ish, just feels like muscle but it doesn't appear to be apparent on the other side. I believe this could well be the issue which is or has damage the nerve point on that side. It's not painful or tender, jsut feels like extra muscle in all aspects, but permanently tensed yet it doesn't seem to fatigue.

Any further opinions or expertise welcome! I've not seen a doc as I was waiting for it to 'get better on its own' as I had already written it off as something that would fix itself. Think I'll be going to the docs soon enough though, this has been far too long and I'll have to call in my private medical insurance as no doubt serious investigation will need to occur..

Thanks in advance for any support!

[thetung]

Hi there,

I think it may be time to go and see the doc as physio doesn't seem to be having much effect. I would advise that you mention to him the fact that you have pain that wakes you up at night, and also the lump that you described behind the clavicle on the affected side should be looked at. There is a medical condition called a Pancoast tumor which can give a pancoast syndrome. it is commonly misdiagnosed as a musculoskeletal problem when in fact it is a lesion that starts growing on the top part of the lungs and can end up spreading to the nearby nerves of the brachial plexus causing weakness, atrophy (muscle loss) & pain. It would be a good idea to research this yourself and see if you think the symptoms fit and if so push it with your doctor. We are in the age of information so don't worry about coming across as self diagnosing if it makes sense.

all the best

[Tonybob]

Thanks for the input, but after reading up on that, I doubt it is that. The pain doesn't exist any more, it was only a few days worth initially, now it's just the loss of strength - whatever happened seems to have impinged on a nerve more than anything and thereby affecting the serratus anterior. I don't appear to have lost any strength in the fact I can still comfortably do chin ups, but the complete opposite movement I simply raise my arm up and hold it overhead without the trapezius appearing to do all the work, and then I'm leaning to one side to keep it there. It's literally that type of movement that I can't do, anything else seems fine. I still swim although it too a few weeks to even attempt trying front crawl. Now I can swim ok but can feel some fatigue in the shoulder - I'm also beginning t think that swimming with a damaged shoulder may have compounded the issue and the lump I can feel could well be built up muscle at the anterior of the trapezius but directly behind the clavicle, it seems to far up for it to be anything connected with the pancoast syndrome. I think I've somehow caused trauma to the nerve area and in it's natural healing process, formed a protective area that has now not rectified itself. Doc's is the only choice now and unless they specialise in this it's going to have to be a scan / x-ray.