Shooting scapular and upper back pain

[mes07]

Hi everyone, I am a 24 yo M, and I go to the gym about every other day, and typically do mostly weights. Back in about April or May of 2006, I noticed that when I would use my *left* arm to lift a heavy free weight onto a rack (my arm was typically somewhat extended and I would lean to my right side) I would get a brief tingling sensation at the inferior tip of my *right* scapula. I thought it was strange but thought little of it until over a few weeks the sensation, when it happened, progressed to a needle like pain. Occasionally it would shoot laterally, like a lightning bolt.

Over the next few months, the frequency of the pain would increase, and it would happen with different exercises, particularly back exercises like rows or shoulder exercises. The pain was usually needle-like and shooting, but a few times the pain was so intense that it felt like I had literally just been struck by lightning. However, it was gone again in less than a second. Lately, the pain has actually progressed upward to just below my scapular spine. It has always happened on my right side, and as far as I can tell, never radiates down my arm. Occasionally I do have some burning pains in the area and itching near my spine medial to my right scapula.

I got a C- and T-spine MRI which were read as completely normal (disks all beautifully aligned).  Also I got an EMG of my supraspinatus, infraspinatus, and rhomboids, as well as an NCT on my right arm which was normal.

I see a PT who has been helping but no one has given me a good answer for what might be happening. Thanks for help!

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   The symptoms and story you present is non specific, but is most likely due to position dependent compression of your C4-C5 nerve roots.  When the nerve roots exit the spinal column the pass through a narrow opening called the neural foramina.  The nerves then pass inbetween multiple muscles and under the clavicle on the way to the arm.  When these nerves are compressed briefly there will be a sharp tingling tyoe pain, that can be quite uncomfortable (like hitting your 'funny bone'-which is actually your ulnar nerve).  These brief bumps or compressions do not cause lasting damage (such as demyelination or axon loss) and thus do not show up to the EMG test.  If there is more long term compression of the nerve, such as a slipped disc, etc. then the pain/tingling/weakness will often be longer lasting, but can change in intensity (esp with head/neck movements).  If these pains do not repond completely to PT (which I would also suggest as a first step) then medications such as neurontin, lyrica, elavil etc. can be used for neuropathic pain.
I hope this has been helpful.

[mike1105]

it sounds to me like weakness in the posteror scapula stabilizing muscles-- ie rhomboids, supra/infraspinatus, and also serrtus anterior. at the gym, do you prmarily work the "mirror muscles"? ie pecs. biceps, upper traps? if so, and your back is weak, you are out of balance. your PT should be able to help. it definitely sounds like a soft tissue (muscular) issue and your weight training regimen is probably the cause. perhaps a good certified trainer can also help you.

[mes07]

Absolutely, I was definitely unequal in my workout routine and my PT has been great in giving me back exercises which I am concentrating much more on now.

What concerned me more was the quality of the pain.  My PT has been focusing on trigger points and myofascial pain but I was afraid that my pain (giving the shooting, stabbing quality, as well as burning and itching in the area) represented a peripheral nerve compression.  That is, why would scapular instability cause sudden electric jolt-like pains rather than typical deep muscular pain?

[Sweetater]

I have a condition called Thoracic Outlet Syndrome. I know exactly what you mean by the lightning bolt sensation. I have always said it felt like I was sticking my fingers / hand in an electric outlet.  Unfortunately, Thoracic Outlet is not a readily available diagnosis.  Ask a Neurologist about it.  I would also suggest this site:  http://www.tos-syndrome.com/

Good luck....

[mike1105]

TOS is one entity that can occur (unless it's anatomical TOS ie extra rib) from this muscular issue ie overdeveloped chest out of balance with posterior back muscles. Other names are Pec minor syndrome, scalene syndrome, and Upper Crossed Syndrome, which is probabaly the most accurate verbage because it really defines the problem whereas the others define the symptoms and only part of the actual muscular problem. All this stuff develops from a closed in, tight chest and a lengthened, weak mid back. See a website by Erik Dalton for a detailed explanation. See a book by Jolie Bookspan called "Fix your pain without drugs or surgery" to fix the problem--- she also has a great website. You need not only to strengthen your back, but you need to release trigger points and lengthen the muscles in your chest and neck---pecs, up;er traps, scalenes (BIG culprits) SCMs. I cannot comment on the quality of the pain, except to say that I had that, and it went away rather quickly when I began to properly address my problem. Things must be dome in this order--trigger point relaease then stretch, then strenthen, then strech. You can try to stretch muscles without first relaesing the knots, but it won't get you very far. Pick up a trigger point manual by Clair Davies. The best therapist in the contry, in my opinion, is Sharon Sauer in Chicago. IF you can afford the time to travel and the expense (which is not too bad), I'd go see her. With her hands on help, and Jolie Bookspan's book, I fixed this myself.

[timber1111]

A related discussion, t o s and weight lifting was started.