Expert: Scott F. Gillman, DC, DACBSP - 7/10/2009

Question
Hello Dr. Gillman,

Im a 20 year old extremely fit and otherwise healthy male.

I recently began having reasonably painful neck pain (making movement painful) and a tired/strained sensation in my neck and spreading to both my shoulder blade and collarbone.

I went to a chiropractor. She made the diagnosis that C1 and my occipital had become out of alignment and promptly peformed a maneuvre to fix. The pain left almost immediately.

However, the strange sensation spreading down my collarbone and shoulderblade persists. I have been back since, with the chiropractor citing no structural problems.

I would be extremely grateful for any ideas or advice,

Michael

Answer
Micheal,

The region that you feel symptoms can also come from irriation of deep cervical spine stuctures in the middle or lower neck.  This includes protruding discs at the C5 or C6 level where the disc is irritated but is not overtly touching or compressing the nerve.   This is called sclerotomal pain, from the embyriologic terms: dermatome, myotome, sclerotome.   Nerve irritation or impingement causes referred pain into a dermatomal zone.  C5 nerve goes to the shoulder and upper border of the shoulder blade, and C6 goes lower down the shoulder blade and into the forearm and thumb (as examples).    Conversely, the "tired" feeling can be coming from the other end of the loop: the shoulder.  If you have a rotator cuff impingement then you'll get a burning or fatigue feeling with having your arm in any elevated position, e.g. blowdrying hair.   There obviously is some sort of problem, and either it is a structure and the chiro cannot find it, or it is a functional problem and the chiropractor isn't able or trained to assess it.   I would have the DC test your entire shoulder girde for motion and strength.  I would also see if your scalene muscles (in front of your neck and collar bone) are a problem as they can refer symptoms into this zone and also become tight and affect the nerves that go to this zone (the collar bone/shoulder blade).    The chiropractor has to get her hands on you and test all of these structures.  

Hope this helps.

Dr. G