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Old 09-16-2011, 03:20 PM   #1
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Pain in back under shoulder that radiates around to chest

Hi everyone. I have a question... I have pain in my upperback and in my chest as well. I havew had ecg and xrays and lots of tests to make sure it isn't heart or lung related. It is a constant widespread dull ache that has been there for about 6 months but only recently is getting much worse for no obvious reason. There are certain spots where there is a "sharp" shooting pain that comes and goes.. Mostly on the left side of my chest ( outside and lower left pec) and up high on my right pec where my muscle meets my collar bone. Under my right shoulder blade in the back, is where the worst of the constant dull pain is at. It never gets any better, but occasionally gets worse. I have no Idea what causes this pain and so far my doctor doesn't either. I have tried to not be pushy towards my doctor about it, and she has taken it as if I am worried something is wrong with my heart or lungs. She doesn't seem very worried about it, but I don't think she understands that the main issue I have is that I am in CONSTANT pain... Anyways, what I am wondering is what I can do about this? What are some options I have or what is some advise from others who may have been in this or a similar situation? I am on no prescription medication btw, but I have tried flexiril from a left over bottle and it did nothing at all. I do take a lot of tylenol however, especially these last 4 or 5 weeks when the pain has been worse. 2 extra strength every 5 or 6 hours, but that doesnt help at all it seems. I dont know what else I can do.

 
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Old 09-17-2011, 07:20 AM   #2
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Re: Pain in back under shoulder that radiates around to chest

Welcome to the board.

Since you have ruled out heart and lung issues, it seems to me the next logical choice is your spine. Sometimes people aren't aware that a problem in the spine can cause pain that radiates out to the limbs or in the case of the thoracic spine, the pain pattern is a ring that runs around the chest. If interested, these predictable patterns are called dermatomes and you can find online a dermatome map that will better explain this.

You might have a bulging disc in the thoracic spine, or some stenosis, or something similar that is either irritating or compressing one of these spinal nerves.

To check out this possibility you would probably want to make an appointment with a spine specialist. This would be either an orthopedic spine or neuro surgeon who limits his/her practice to issues of the back and neck. If they felt your symptoms might be spine-related, they would probably want a CT scan or MRI to get a better idea of what is going on.

 
Old 09-17-2011, 08:26 AM   #3
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Re: Pain in back under shoulder that radiates around to chest

Thanks for the reply tetonteri66. I will ask my doctor about it at my next appointment on the first. I had an appointment today and She gave me some medicine for my anxiety and told me to just take tylenol for the pain. The only problem is I dont want to be constantly taking tylenol and I would rather figure out whats wrong with me... I have been taking 2 extra strength tylenol every 4-6 hours and it isn't working all that great anymore. It is not masking the pain like it used to..I dont know what to do to manage the pain now. I am kind of out of options as I cant up the dose on the tylenol according to my doctor..

 
Old 09-17-2011, 11:00 AM   #4
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Re: Pain in back under shoulder that radiates around to chest

fantastic advice terri. once you have ruled out the front, the logical thing is go to the back. you most definitely at this point NEED a good and if possible contrasted type of MRI done preferrably on at least the T and even C spine levels to find out what is generating something that esp is at a 24/7 lev3el basis. that just kind of indicates that the underlying generator is present always, more than what someone would feel as a more reoccurring type pain which would/could be 'something simply 'hitting' a nerve or spinal level from time to time? this just could be like a solid herniation that is sitting either at the cord level or onto an actual nerve that never ever moves kinda thing.

i would actually just ask your primary here to begin with for that referral for the MRI and see what does or does not actually show itself. THEN, depending upon what is there, that would determine who you really should be referred to see as far as an ortho or an actual neurosurgeon.

trust me when i say here that if you have NEVER actually ever had an MRI in that c thru t area, you can be born with certain abnormalities within either the structual aspects of the spine itself or even within or on the cord as well as i found out the hard way. no one truely just 'knows' what is going on inside their own bodies til some type of more in depth scanning gets performed and it shows itself on film(or other deeper testing that 'sees' into our bodies in that 'right' place). considering your symptomology, i am thinking an MRI would indeed show at least "something' going on within that dermatome of the coverage from THAT particular spinal level it simply innervates with your ability to feel/sensory ability. its like i mentioned above? just the ongoing and 24/7 nature of this that really makes me think this is a 'something more" just underlying there and generating what you are feeling at all. if nothing was there, i doubt you would feel what you are feeling, ya know?

if this is "only' mostly one sided, how are the shoulder ROMS doing? any pain upon moving that more affected side/shoulder/arm or does everything in THAT relm appear to be non affected with ROM issues? i am only mentioning this because when there is a bigger level of potential rotator cuff issues(torn tendons are usually the biggest most commonly seen, esp that very top one) going on, it can hurt like a mother at times too. depending upon if you have suffered ANY real true loss of ANY of the shoulder movements or feeling pain upon any arm/shoulder movements, the rotator cuff are(that whole shoulder) should be looked into. otherwise, start with getting that one c and t level spinal MRI and at least rule that in or out as a possible here. but this does 'sound' more like something at least somehow related to spinal. this is exactly what i would do first if this were me, with the MRI, before anything else gets done so you just 'know' whats going on within your spinal and can go from there depending on results. that just really DOES need a deeper look just considering your 24/7 level pain, and how its playing out(becoming much more impactful in showing itself now). hopefully you can simply get that MRI done from your primary since it should not be a problem just given your ongoing symptoms, whats already been ruled out in the front levels and also being in that more of a 'diagnostic mode' here too. please DO keep us posted, good luck, marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 09-17-2011, 11:15 AM   #5
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Re: Pain in back under shoulder that radiates around to chest

Thanks for the posts guys! I will definitely talk to my doctor next app on the first. I went today and saw her and tried to focus the visit on the pain, and mentioned that I cant run or excersize because of the pain, and that is one of my main ways of treating my anxiety, so they started to focus the whole visit on my anxiety instead, and gave me some SSRI and klonopin and told me to keep taking tylenol for the pain.. Problem is, I have been taking 2 extra strength tylenol every 4-6 hours every day for a while now, and it is not helping like it once did... I still feel the pain very much after taking the tylenol and I cannot up the dose anymore due to liver toxicity. I do not know what else I can do to manage the pain... I have to wait until oct. 1st before seeing the doc again, and that seems like a long time of being in pain... I am become very distracted by the pain and it is starting to disrupt my daily life. I dont know how to make my doctor more focused on the pain. The chest x rays showed nothing, so I think she is dismissing my pain as nothing, but it surely is not. I will request MRI next visit, and I will keep you all posted for sure! I just hope the 1st comes quick because I really can not keep dealing with this pain!!! Thanks again for the replies!

 
Old 09-17-2011, 05:45 PM   #6
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Re: Pain in back under shoulder that radiates around to chest

Well I keep trying to reply but none of them will show... anyways... I went in this morning and they basically focused on my anxiety as it was time for review and refill, and still didn't do much to address the fact that I am in pain... I was told to just keep taking tylenol, but I am already taking 2 extra strength every 4 hours or so with little relief and I cannot take anymore due to liver toxicity... I do not know what I can do to manage the pain if I can't up the tylenol dosage... I dont know why my doctor wont focus on the pain. I have another appt on ot. 1st and I will bring up the MRI. Thanks for the replies guys I appreciate it. Its gonna be another long 2 weeks...

Last edited by Rustyb1; 09-17-2011 at 05:51 PM.

 
Old 09-18-2011, 09:35 AM   #7
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Re: Pain in back under shoulder that radiates around to chest

sorry you cannot get proper pain relief rusty. we have ALL gone thru THAT crap, and it just plain sucks. have you ever tried ANY level of actual NSAIDS for this like even aleeve(i like this as you only have to dose it twice a day) or any actual Rx level NSAID like a higher does of ibu like the 800mg? i DO think at least "some' of your pain IS inflammatory in which these types of meds just really CAN help to at least take the edge off and keep flares more minimal.

you also can try like tylenol in the morning, then when it comes time for what your 'next' dose of tylenol would normally be, try interspersing an NSAID of some kind instead of the tylenol, so you are just alternating one pain killer with a good anti inflam? this can help in some cases. and it "breaks up' the string of constant tylenol too. but you always have to be kinda careful using any of the OTC meds too. like you mentioned with your liver among other things,they too can create their own problems in other areas. how many total mgs per day are you actually taking in of the tylenol? not everyones 'day' is the same as far as how many actual hours are in 'their' day, ya know what i mean?

another thing i was wondering is has your doc ever rxed prednisone to see how much relief you may get? pred, while it really should NOT be used longterm, has wonderful anti inflam properties that makes this med a highly 'multi use' type of med for even what my son HAS to take this for as well, antirejection of a transplanted liver. just one 5mg pred, along with his main anti rejection med is enough to keep his body from recognizing that liver and trying to reject by buliding up the inflammatory process. we found out the hard way that he is one of those patients who when he is off just even that little pred amount, his body starts the rejection process. its just THAT strong when it comes to helping keep down inflammation. if you have not tried this, ask your doc about giving it a good run and just see how you feel. it may help alot, or not at all. but it WOULD better define the inner components of what is actually generating pain for you and rule in or out certain areas/possibles too. but i DO have a very strong feeling here given what you described that pred would probably help some in certain areas.

i would also be keeping a pain journal to show to your doc that gives numbers(pain scale from 1-10) and what set it off and what made it better, or when IT simply decided to go down. and what your pain possibly responded to as well. most docs in general do not like to have to Rx narcotics even moreso when there just is no real solid reason/dx yet to justify them, but others do. it all depends upon THAT particular doc. tho it is kinda sick, sometimes our 'complaints' of having pain are unfortunetly not enough with some docs. but the more actual documented by YOU reasons for possibly rxing some form of narcotics helps the doc alot since anytime a doc rxes any narcotics, 'they' also have to fully documant the reasons for doing it too just to satisfy the DEA. thats the part that alot of docs do not like to do, so you can help yourself alot by keeping a pain journal that she can copy and put into your file. it may just help you to get some better relief. but i would ask about the stuff i mentioned and also ask if there is anything your doc could possibly rx to help with at least your more acute onset pain flares while you are simply trying to FIND the reason for this to even be there at all inside your body. it cannot hurt since you ARE trying hard to find that generator here and need relief too.

i have to say tho, the more i reread your symptoms, this really could be possibly related to moreso your rotator/shoulder area than spinal. there IS simply alot of real 'crossover" in the areas you are having pain since all the c spine nerves that run to the fingers also have to run thru that rotator too? and that c 5 nerve runs right out and stops at just below the crux of where the main shoulder joint starts to run down the arm(along that clavicle and also innervates that top supra tendon in rotator too). that one gives ME some pretty horrid pain alone from disc deterioration. my top rotator tendon(supraspinatus and most commonly torn of all tendons in the rotator/shoulder) actually snapped on me back in 07 one fine morning and all hell broke loose up more around the top of the shoulder and to that clavicle(i already had pain and muscle crap in my upper back and under my blade on that side from spinal reasons so i don't know just what was coming from what totally). my main damage was the top of course and also the tendon that runs directly under it over the upper chest level? the pain you are describing just appears to be more heavy on one side with 'some'(and this is NOT unusual to get with certain types of rotator cuff damage, the bilateral type of pain but usually much worse on the most damaged side). but i had been already suffering many years of pain before that one day when it presented itself in such a nasty way it sent me directly to my primary who after running my ROMS with oh so much pain with certain ones and in some cases inability to even MOVE my arm into certain posistions either, sent me for that much needed MRI. it revealed inflammatory crap and alot of other damage too. i had also immediately lost that ROM i had been using to lift up something with that hand off my fridge too when it happened. i just dropped what i was holding onto, it was NOT my call, but that ROM just being gone cuz the whole connecting tendon snapped in half, so my hand just 'opened up' all by itself.

just how old are you rusty? age also factors into alot of what is simply years of ongoing daily wear and tear ON/IN that whole shoulder levels within the tendons, ligaments and muscles and the joints that are almost constantly utilized all day long(just really think how MUCH and often we use our arms and shoulders all day long and what we simply 'do' that can create wear and tear). it DOES take its toll eventually depending upon any particular sports you may have played or are playing, jobs that just require ALOT of more heavy lifting, and even certain types of hobbies too. or injuries that you may have suffered way back when that are now starting to simply show themselves along with that ongoing wear and tear, and just age itself.

but the specific areas where you are describing this seem to totally encompass that large shoulder/rotator area, in the front and in the back too where you just do have a ton of structures that can be damaged at all in there in front and back TO that blade? we also have a few different joints within that rotator cuff as well, and not only the main one on the outside that allows us to swing or move our arms. so there just is alot of areas there that could be much more responsible for what you are feeling too, not 'only' spinal related.

i would talk to your doc about either ruling in or out that rotaor along with looking at that c and t spine too with MRI. i just think BOTH areas, given your pain levels and symptoms 'could be' the generator here. if i had not already had my ongoing spinal crap and also suffered alot of rotaotor damage that required surgery, i seriously would not have given that possible rotaor a thought. but knowing just how it can even present itself when certain areas are just damaged or torn and inflammed, this just could be the area of your bigger pain. alot really depends upon what YOU yourself are feeling upon moving that arm/shoulder in various ways and of course, actually 'seeing" it and the spinal upon MRI to really just 'know' for certain. but DO discuss this with your primary. most primarys DO know how to check the rotator cuff ROMS right in their office and can kind of tell when one of them is simply not 'right" or you just cannot actually move it, or moving it produces very definitive pain at all. and DO well document your pain as much as possible for the doc too. it may finally get you some better relief. and DO mention to her that your very concerned about having to take so much tylenol as well, and that it is NOT working anymore. just do NOT raise your overall 'at a time' dosage since it would be too much at one time for your liver to keep on managing in any ongoing way. there ARE limits set with tylenol for very good reasons. good luck rusty, see if you can get that appt moved up mostly becasue you simply cannot stand the pain and need 'some type' of real solid help sooner, not later. it may work. marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
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