Physical Rehabilitation Medicine/Shoulder Impingement

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Question
Could a shoulder impingement cause significant referred pain in the back/shoulder blade?

I had an injury that caused my shoulder to lock up and a spasm in my back. Months after physical therapy, I was still feeling pain and did an MRI. The MRI didn't cover low enough where I feel the pain, but focused on the top of my shoulder. The MRI revealed impingement in the top/front of the shoulder. However, nearly all my pain is between my shoulder blade and spine, or even below my shoulder blade. When it is severe, it is a sharp, shooting pain, very tight, and even hurts more with deep breathes.

The doctor recommended an arthroscopic shoulder surgery to remove some bone. I am fine doing that, but a little concerned they haven't looked where the actual pain is. The explanation I got was that it is referred pain. Is this likely/common or should I ask for a second opinion and an MRI that targets the correct place?

Thank you-

Answer
Things like this happen often.  It may not be a true "referred pain" but rather things have started to function differently because of the impingement.  I would highly recommend strengthening your lower and middle trapezius muscles as well as the rhomboids.  Google them and how to strengthen.  

You may need to still have surgery for the impingement (acromioplasty, etc) but that pain you're feeling won't go away without strengthening and/or physical therapy.  It's probable that you developed the impingement from poor posture, rounded shoulders, weak back, etc.

I hope this makes sense, I've seen a lot of it to include my own shoulder.  I had terrible biceps tendonitis in my shoulder and it went away as soon as I strengthened my back.

Good luck!

Physical Rehabilitation Medicine

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Brian Neville, OTR/L, CWCE

Expertise

I can answer questions about both conservative and post-operative rehabilitation for UPPER extremity injuries. These include but are not limited to: fractures, tendon repairs, tendon transfers, nerve repairs, lacerations, tenolysis procedures, TFCC injuries, repetitive motion disorders, reconstructive procedures. I have an advanced knowledge of UPPER extremity anatomy and industrial rehabilitation. I have extensive splinting skills for injuries to the upper extremity. Although not a physician or a surgeon I have worked closely with world renowned upper extremity specialists for over 10 years. I can give general information on what some of the most common upper extremity surgeries involve. I can reference those procedures as well. PLEASE DON'T ASK ME QUESTIONS ABOUT ANYTHING OTHER THAN THE NECK, SHOULDER, ARM/HAND. I'M NOT QUALIFIED AND KNOW ABSOLUTELY ZERO ABOUT BACKS/HIPS/KNEES/ANKLES/ETC. THANK YOU!!!

Experience

10+ years working closely with orthopedic and hand surgeons and their patients. I have treated patients with small lacerations to major reconstructive procedures. My knowledge base includes both conservative and post-operative rehab protocols and care for upper extremity injuries. I have treated patients all the way from day 1 post-op to return-to-work status.

Organizations
Kentucky Occupational Therapy Association American Society of Hand Therapy National Nurses in Business Association Roy Matheson and Associates

Publications
RSD article

Education/Credentials
Occupational Therapist former Certified Hand Therapist (license currently inactive) Deep Physical Agent Modalities Instructor Certified Work Capacity Evaluator

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