But surprisingly, this is not the case for a majority of patients I have seen over the years.  Most cases of pain I see are idiopathic; meaning, “with no apparent cause (at least in the eyes of the patient).”

A typical history of such a patient goes something like this:

Me:  “Ok Sue, I understand you are experiencing pain in your upper back, right side.  When did it start, and how, to your knowledge?”

Patient:  “At least the past five or so years.  I don’t know what started it; it just seemed to have appeared gradually.  It is good some days, then bad, and lately it has been getting worse, so I decided to  get it checked.”

At this point, I continue with the history by asking questions related to the patient’s occupational, social/recreational, and past medical history.  Usually there is something in the history that can be linked to the complaint, like a past car accident, a particular sports activity during college, or something about the physical requirements of her occupation.  But in some cases, there still is nothing in the history that can explain the pain.

But where there is a problem, there is an answer.  It’s just that sometimes the answer requires some smart detective work.

If you suffer from pain that can’t seem to be traced to a specific cause, realize that musculoskeletal pain, aside from systemic related disorders such as rheumatoid arthritis, lupus, bone disease, and others, develops from some kind of mechanical breakdown  in the musculoskeletal system.  It can be something obvious like a hard fall that injures and misaligns a joint; something seemingly innocuous like sleeping on your right side for most of your adult life;  or something very subtle, like a subluxated heel bone that does its damage via a drip effect.

So, your best bet is to find a practitioner who is very experienced in human biomechanics.     Chiropractors or physical therapists such as Craig Liebenson, DC who emphasize body kinematics and targeted exercise rehabilitation  will typically have a keen eye for abnormal or dysfunctional movement.  The course of treatment will involve identifying and acknowledging the problem; aggressive rehabilitative exercise regimen, and lifestyle modifications.  Manual therapies may be employed, such as spinal manipulation; and orthotics may be required, at least during the initial phase of treatment.

This applies to conditions including unilateral hip or knee pain, TMJ pain, neck pain with right or left rotation, rib or sternum pain, and many others.  Oftentimes the condition is secondary to a primary cause, so the doctor should not jump to conclusions and direct all treatment to the site of pain.  A thorough investigation and inspection is required.

The post Pain With No Apparent Cause first appeared on Ask Dr. P - The Pain Doc.

The thoracic outlet is an “opening” at the base of the neck, on both sides, where the nerves and artery that service the arm on that side exit through as they descend into the arm.  It is formed by the anterior and medial scalene muscles, the first rib, and the clavicle (collar bone).

If the thoracic outlet narrows in any way, due to one or more of these structures, neurovascular compression is possible (compression of the nerves and artery).  This can result in shoulder pain, neck pain, weakness in the affected arm and hand, numbness and tingling in the arm down to the hands, especially the last three fingers; and in some cases swelling of the arm.  Carrying something like a heavy bag on the affected shoulder makes the symptoms worse.

In thoracic outlet syndrome there is usually a history of prior injury/trauma to the shoulder girdle, such as a car accident or sports injury.  People with long necks and long arms are said to be more predisposed to this condition as the weight of the arm and length of the neck tend to put more stress in the thoracic outlet area.

Left alone without resolution, it is possible to develop permanent nerve damage resulting in chronic pain, weakness in the arm and hand, and reduced sensation in the inner arm area.

What to Do if You Suspect You Have Thoracic Outlet Syndrome

If you suspect you have thoracic outlet syndrome, see your doctor or an experienced chiropractor.  There are some simple orthopedic tests that can be done to see if you likely have TOS.  An MRI study can help visualize the thoracic outlet and identify if there is swelling; and needle electromyograph (EMG) can determine if the arm muscles are getting the proper amount of nerve flow.

If the diagnosis is confirmed, physical therapy exercises are usually prescribed to help open the thoracic outlet space.   In some cases, imaging studies show a fibrous band  responsible for compressing the neurovascular structure; in these cases surgery may be an option.  This involves the scalene muscles — three, short muscles that connect the lower neck vertebrae to the ribcage.

In the meantime, try doing this exercise.  It is designed to create more space between the collar bone and the ribcage.  If this is where your compression is occurring, it may help.

 

The post Exercise for Thoracic Outlet Syndrome first appeared on Ask Dr. P - The Pain Doc.