Repetitive Strain Injury/Strain/tendinitis Rhomboid/Levator
QUESTION: I went to PT for a sharp pain at top of left shoulder whenever I would reach across porta crib or take off my long strapped purse ...with right hand. I thought how weird reaching with right hand would cause left pain in trapezius area.
So started PT that was too much too soon. Within days, the pain would come whenever I reached out or up with left arm also..in same place..top of left shoulder. I also feel sharp pain in same place when I press down with left arm to do Cat Camel stretch or get off floor but I can put arm behind me and push down..weird...but has something to do with what position the arm is in and what muscles you are using.
Been to numerous docs. Did rotator cuff MRI..no tears but mild tendinosis. Also did neck MRI..mild to moderate right sided herniation. Physiatrist yesterday thought myofacial pain of either Rhomboids, Levator or other small muscles that the PT overused cause they were underdeveloped. He didn't think neck or rotator cuff issues other than rotator cuff weak which caused rhomboids and levator to pick up slack.
It has been two months of this pain. I couldn't even bend over to pick up something off floor without this left shoulder pain. That has gotten better but the pressing down has not. I have weakness of shoulder and upper back muscles that could use strengthening but I am afraid to aggravate the issue. Do you have any suggestions for me to try?
ANSWER: Hi Pam,
It was good that you went to your physician to eliminate anything serious, this makes it be a much higher possibility that you have muscle tension causing the problem. There aren't any tests for tight muscles, so they are commonly overlooked.
Your situation took me a little while to think about each of the muscles that could be involved. One that makes sense is your infraspinatus muscle. The infraspinatus originates on your shoulder blade and inserts into the tip of your shoulder, and when it contracts you bring your arm back (like you're going to hit a tennis ball). When you reach your arm forward, a tight infraspinatus will prevent your scapula from moving properly and a tiny piece of the bone will press into the nerves that pass beneath it and then go to your arm and hand. This would cause an impingement that would cause the sharp pain you are describing. It also wouldn't hurt when you bring your arm back behind you or push down. However, this would be felt on the same side as the spasm. It wouldn't hurt you to treat the both infraspinatus to see if they are involved.
You have already considered the trapezius. The way this would make sense is, if the right trapezius is tight and getting pulled when you move your arm forward,it could be putting pressure on your spine, and by referral be pressing onto the nerve on your left side.
You mentioned the levator scapulae, but this muscle would primarily cause pain if you were pulling your shoulder down, not lifting it up. It could cause a problem if you are turning your head in the opposite direction. If you go to http://www.julstro.com/what_happens_exactly/
you can read a lot of other ways that muscles cause joint pain, and also ways that you can learn how to do some self-applied treatments to release the tight muscles.
I don't suggest you do any strengthening exercises, the odds are the muscles are weak because the nerves are being impinged by tight muscles, or by bones that are pressing into the nerve because the muscle is tight and moving the bones.
Have you gone for a massage? I suggest you find someone who is trained to do a technique called trigger point therapy, or myofascial release.
After you have gone for a massage, please feel free to write again if you would like to give me an update.
Wishing you well,
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QUESTION: Hi Julie, i went for one massage. Can't tell if it helped but the LMT is good and. I sent her your response. She will get back to me on it. She did state that my muscles were over used and I am tight. I will go for some more to see what happens. You are correct in stating that the physiatrists, primary care, orthopedics, etc. don't really know what to do with me. A friend told me to try a sports doctor or chiropractor. Do you think either would help? The pain when bending over to pick something up is much better but I have new pain right at C8, T1 if I over work the rhomboids in daily living. Yesterday I was making a bed & felt that pain right there. Got a trigger point injection for it the other day. Didn't do much good. Pain mgmt. doc has suggested epidural steroid shots but I am not having other symptoms down my arms. I have had a tremendous amount of stress in dealing with an ailing father as primary caregiver so tight muscles are not surprising. You can spend quite a fortune in doctor bills trying to fix a tight muscle problem. Would your upper back video address this are?
I'm glad you found a good LMT, on many levels (stress being one of them) it's good for you to get deep muscle therapy to release all the tight muscles. I agree, I've heard of people spending thousands of dollars seeing doctors about pain relief, and still living in pain.
In answer to your question, yes, my Upper Body DVD will show you how to work on the muscles, as will my book "Treat Yourself to Pain-Free Living." Also, if you have 45 minutes of free time somewhere in your day I would also suggest you consider getting "Focused Flexibility Training," a program I developed with a yoga teacher. If you go to http://www.FlexibleAthlete.com
you can read about it. Basically it has one DVD that teaches you how to self-treat all of the muscles in your body, and then two DVDs that start out with 15 minutes of self-treatment, and then 30 minutes of yoga-type stretches of the muscles you just released. It's a really balanced program, and I believe it will help you with your stress level, as well as your tight muscles.
I can't tell you not to see a sports doctor or chiropractor, but I do think that since you have eliminated all the serious possibilities when you went to your physician, that I'd make sure the muscles were released before trying to move bones with chiropractic care. Although, it could be helpful as long as your muscles are not in spasm.
I'm interested in knowing what finally gives you relief, so please feel free to post again as you find your solution.
Wishing you well,