Expert: Dr. Timothy K. Durnin - 8/1/2007

Question
QUESTION: Hi.  About 3 months back I had a feeling in my neck/shoulder area which is best described as a rubberband snapping, then burning sensation.  I experienced this same strange feeling 2 more times over the course of a few months.  In May,after lifting large bags of topsoil, I felt this electric shock that went across both shoulderblades, then a burning sensation between my shoulder blades.  Two days later, I began experencing tingling in both hands and both feet, along with severe neck pain.  I was unable to move my neck either side to side, nor up or down for about 4 weeks.  A regular x-ray of the neck showed nothing.  Two weeks later, I was sent for a Brain MRI which was normal, then just last week,a cervical MRI which was also normal.  My neck movements are a little better, however I keep getting a sharp tearing feeling in the top of my left shoulder (close to my neck) along with tingling in my mid-back and hands.  My dr. said it is very rare to have herniated disks in the upper back, but I feel there is a problem in that area because I have  burning/pain in the center of my upper back.  The chiropractor I was seeing told me he will not treat me any longer until an x-ray is taken of my spine.  When he pushes beneath my shoulder blades the pain is horrible, and he tells me this is where the muscle is attached to the ribs.  Any idea on what this could be?  I am at a loss, and am not sure whether to see an Orthopoedic dr or what???  Thanks for your help!

ANSWER: Hi Lori,

If you had an X-ray why hasn't your Chiropractor seen it?

"A regular x-ray of the neck showed nothing"

"The chiropractor I was seeing told me he will not treat me any longer until an x-ray is taken of my spine"


This with the MRI's should indicate a connective tissue problem that won't show up on any imaging study.

Since your imaging is normal, the likely suspect is a subluxated rib where they attach to the spine or a muscle spasm from lactic acid buildup. On outside chance exists that there is a metabolic disorder but simple blood work can rule this out. How long were you treated by the D.C.? Without knowing what was done in treatment it is hard to say what else should be done. An orthopedic is a good idea if non-invasive measures have been exhausted, I suspect he/she will put you on muscle relaxants or steroids to help the discomfort. I would want to get to the bottom of it and make sure a thorough orthopedic and neurological exam with blood work is performed. This should include blood chemistry, CRP, ANA and arthritic panel. I also need to know who ordered the x-rays and MRI's, they should advise you with regard to referral, this shouldn't be left up to the patient to figure out. Once the loose ends are tied up I can direct you to the best of my knowledge.

Dr. Timothy Durnin
drs.chiroweb.com



---------- FOLLOW-UP ----------

QUESTION: Thanks for the quick response.  This is kinda complicated.  The Chiropracter did see the regular neck x-ray 1st taken in May which was normal.  I continued seeing him for 12 visits, with no improvement.  I went to a neurologist who did an evaulation and  nerve conduction test (because of tingling in all limbs) which were all normal.  He sent me for Brain MRI (rule out MS) all normal. Continuted going to chiro. and when he would work around my shoulderblade area and mid-back the pain was extensive and he told me that is where the muscle meets the ribs on both side.  After treatment I would have severe burning in upper mid back.  After a few more visits with him, he told me he wanted an x-ray taken of my entire spine, before he would see me anymore, but because I had follow-up appt. with Neurologist that same week, he wanted to hold off on the regular spine x-ray.  The Neurologist ordered  Neck MRI - which was normal.  Neurologist now is sending me back to my primary care dr. because he said neurologically I am normal.  This is extremely frustrating.  (by the way back in May I did have blood work taken (which was all normal!).

The thing that I dont understand is what the electric shock then burning feeling I had across my shoulderblades and  rubberband like snapping I experienced in the shoulder neck area?  After this is when I started with all of the tingling and pain.  Currently I experience a severe "catching" feeling in my left shoulder area that takes my breath away, then goes away after a short time.  

Answer
Hi Lori,

Many times connective tissue problems do not show up on x-ray, MRI or any other imaging technique. This doesn't mean all is normal, likely it means it is tendon and/or muscle in nature. I think the G.P. will try a Medrol Dose Pack to minimize the pain and calm the area down. Since I only have history and no hands on to go by, it is very difficult to accurately speculate on cause. I would try an Ortho to be sure it is only muscle and tendon, but from the tests, it probably is. I must say this is very uncommon and difficult to nail down, I wish you luck on your recovery. More than likely the Medrol (steroid) will take care of it. Please keep me informed if a new diagnosis becomes available.

Take Care!

Dr. Tim