Upper Back Pain and tingling/numbness in fingers

Hi!  My story is that I am a 32 year old and very active.  I ride horses competitively; however, this summer I started having trouble with my left shoulder.  To be honest the pain that stopped me from riding was between my shoulder blades and would become so intense that I was having trouble taking a breath.  So, went to the doctor, had MRI, showed some strain to my rotator cuff, had PT and was discharged.  Treated the back pain as well during that time, which was assumed to be related to the way I had compensated for the shoulder.  Over the past month I have started developing increasing pain in the neck/upper back which has been radiating down my left arm to the elbow.  Definitely not the same pain I was having with my shoulder.  Went to the doctor, another MRI of my neck which showed some mild changes, refered to neurosurgeon.  Last week I developed symptoms so severe that I ended up back in the doctors office (severe neck pain, that extended into my head, photophobia, nausea, and total fatigue).  Family doc said it was a muscle spasm.  Rested for two days and seemed to feel a little better.  Went to the neurosurgeon on Wed who said my MRI was unremarkable so I am scheduled for a myelogram and nerve conduction test on my left arm.  I am having on and off weakness, numbness, tingling in the fingers of my left hand as well as significant pain in the 4th and 5th finger.  The pain seems to have migrated from my neck to right between my shoulder blades, and now I am starting to have symptoms in the right arm. Also noting shorthness of breath and extreme fatigue and depression

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

While it is possible that a pinched nerve could contribute to the symtpoms you are experiencing, usually this is apparent on the MRI scan, which in you case seesm to be unremarkable. Before embarking on any surgery you need to be sure that the symptoms are caused by pinched nerves/spinal cord etc - this is the main indication for surgery, surgery does not treat the musckuloskeletal aspect of the pain, and may make it worse. Nerve conduction studies and needle EMG when jusy pain is present and not actual neurological signs such as sensory loss or weakness is likely to be unremarkable. You need a multimodal approach to your problem so that your muscles, ligaments etc heal, and you avoid developing hypersensitivity to pain and dependene on pain medications. This could be coordinated from a pain management center perhaps, along with physical therapy, massage etc. Taking a break from the horseriding might be advisable also.

[denise dp]

Hi, welcome to the world of chronic pain. Are you on any mussle relaxers cause it sounds like the pain I get when I'm in spasam.Does it get worse when you are in a car and accelerate? I would talk to your dr. about that and if you are already on some get better ones. And when you are in pain like that try not to wait till you are in alot of pain before you take something. God bless you.

[missmellie]

My sister is or should say avid horse rider, she currently is in chronic pain due to herniated disc.  It certainly sounds like you have chronic pain due to some wear and tear from horse riding.  Not everyone does well with muscle relaxers, so I would be careful with those, as they cause fatigue, read side effects.  Certainly go through with the nerve tests as this will show whether you have nerve damage etc.  Like the last post do take something for the pain, but I would recommend trying to see a doctor getting a second opinion, stick to the symptoms that bother you the most.  good luck

[denise dp]

I am so sorry I meant to say you should talk to your Dr. I've got remember to proof read. Sorry again.

[mike1105]

hi. read your post. sounds to me like your problems are muscular. I know that sounds very non descript and vague (I thought the same thing too and was not able to believe it-it seemed like a copout/ wastebasket diagnosis) but it fits considering your unimpressive MRI and your occupational history as a rider. I would guess that your nerve conduction tests will also be unimpressive, at least as it relates to your pain. I was diagnosed with Myofascial Pain Syndrome after 2+ years of tests, three surgeries that didn't do much and daily muscle pain between my scapulas, into my neck, in my arms, and in my pectoral muscles and shoulder attachments. the pain seemed to move around. For a few days the left side would hurt, I would work it out, and then the right side would go into spasm. some days my left arm hurt, sometimes the right. when my left scapula muscles would hurt, i could feel it in my left pec. Right scapaula-right shoulder and arm. When my chest would tighten up it was difficult to breathe. Do some reading on the syndrome (check out The Rosomoff Pain and Rehab Center website and also a guy named John Barnes who is a myofascial release guru) and don't be discouraged when your doctors tell you they don't know what's wrong (you should praise them for their honesty as it may help you avoid unnecessary surgery) as myofacial pain is not a problem they can fix and not generally a problem that is diagnosed-- most doctors are not in tune with this syndrome. I tried muscle relaxers and pain meds and gave them up. they made me feel like **** and I knew I was not addressing my problem. They did not work in relieving my pain anyway.
You may also want to find some literature on Upper Cross Syndrome which is basically a syndrome of pain and dysfunction due to an imbalance betwwen posterior upper trunk muscles (ie rhomboids,traps, lev scapulae etc) and the anterior upper trunk muscles (ie pectorals, ant scalenes etc). This can easily come about in a rider due to your hunched, closed position when riding. this problem is also myofacial in nature and is fixable but it takes a long long time and dedication to  a daily exercise and stretching program designed for you by a qualified PT in tune with these problems. you may even need massages often. they do help by making muscles more susceptible to the good things that come from stretching and exercise. Remember, nerves can become entrapped and pinched in soft (muscle, connective) tissue as well as in hard (bone) tissue. if muscles are in a constant state of imbalance/spasm, the nerves that run throgh them will be entrapped and pinched, and can cause some really weird sensations (numbness, pain, tingling) far away from where he actual pinching or entrapment is. Good Luck. If this is your problem the above info should help.

[Jewel529]

ACB, I read your post and was shocked! I could have written it myself. I have the same symptoms as you going on 2 yrs, yes 2 yrs, now. I have pain on my right side, neck, shoulder, upper back between shoulder blades and around scapula, upper chest, armpit, down arm to the 4th and 5th fingers. I know what you mean when you say sometimes you can't breathe. When the pain started it was very sporadic and tolerable, but it has progressed into something I now have regularly and something I cannot tolerate. I have been to a spine doc, sports med doc, physiatrist, physical therapy and massage therapy. The massage therapist tells me my upper back is in knots and works them out and it helps for 4-5 days. I would like to go to her every week, but not at $70 a visit. Just today I saw a neurologist which offered little help. I have had a normal cervical MRI, normal chest xray and an EMG that found I have mild carpal and moderate cubital tunnel. I thought for sure it was a nerve exiting my neck that was being pinched, but all normal there. The docs are puzzled I can tell. I have had several 'thoughts' as to what it might be from thoracic outlet, a cervical radiculopathy, fibromyalgia, irritation from my cubital tunnel, and on and on. The neurologist today thought it might be something to do with my cubital tunnel and the rest muscular. I have been told to take anti-inflam drugs around the clock and a muscle relaxer to help me sleep (I wake up several times a night.) I don't like how the muscle relaxer makes me feel though and the anti-inflam drugs offer no relief. I am in good physical shape and good health. I am still young and I run/walk about 1hr every day, but this discomfort is starting to interfere with my exercise routine. I go back to physical therapy tomorrow for round 2. We will see how it goes. My internist wants me to see a vascular surgeon next. I am not expecting much though. I am suspicious this has something to do with working on the computer, like a repetitive stress injury where I have pinched the nerves, muscles, ligaments in the brachial plexus area, but I can't get anyone to go along with that. I have changed my computer/desk set up to make it more ergonomically correct, but haven't seen any improvement yet. Good luck to you. I know what you are going through. I am anxious to see what response you get to your problem.

[Jewel529]

Wanted to add I am thinking of going to a chiropractor. My massage therapist is highly recommending someone. I am from a family of doctors, so needless to say, they would not be especially thrilled about me doing this. I am going to do it anhyhow though. I feel I don't have much to lose at this point. Also, I am going to check out the info that dr mike gave. Thanks!

[mike1105]

jewel, please read my post to ACB. My pain patterns match more closely with you than with ACB. I also thought i had thoracic outlet or brachial plexus issues--but the plexus issues would show up on a nerve conduction test or an MRI and are usually brought about with a specific, identifiable injury, and there is usually weakness.     If your symptoms are due to thoracic outlet compression, you can probably assume that it is due to muscular imbalance/dysfunction/poor posture.  computer slouching is notorious for causing these problems.. when the posture is slouched and forward, the tissues around the outlet collapse and muscles (anterior scalenes especially) shorten and compress it. Read up on TOS. There are many web sites that address it. But your treatment/remedy should not be surgical unless there is an extra rib or unless your syptoms (symptoms) are more definitive and include venous and arterial problems as well ( I doubt your vascular specialist will be able to help you-----arterial and venous (true thoracic outlet) tos is rare.) You are on the right track with reposturing yourself. You may want to buy a clavicle retractor which opens up your chest and helps to keep you from slouching. It keeps your shoulders back. It's all about posture/stretching/exercise. Believe me, it takes a long long long time. I've been working on it for 8 months and only now am beginning to see progress. my chest (pectoral) pain is now very infrequent and short lived, as is my arm and shoulder pain. all that remains is scapular/neck pain and it is much more tolerable. again, read my previous post to ACB for 2 excellent referrals.   let's hope it's only muscular-- it is fixable. Palpate your neck muscles and see how sore they are. especilly your anterior /middle scalenes. use an anatomy book to find them. If they are sore, especially bilaterally, think muscular, and realize that doctors may not be able to help... which is a good thing.  good luck

[Jewel529]

Thanks for the info dr mike. I started PT again today. I am trying a different facility this time because the last one did not take my insurance. I like my new therapist. I feel like he has really made a big effort to research what is going with me and what he can do to make me feel better. He is determined to help me and told me there is no quick fix for my problem. He gave me scalene and ulnar nerve stretches, breathing exercises, and neck stretches to do and also gave me something called Biofreeze. It certainly has made my shoulder and arm feel better since he applied it a few hours ago. Great stuff. I do know TOS is rare and also hard to diagnose. It has been mentioned to me several times in the last 2yrs, but no one seems to want to definitely say that is what it is. One thing I did not mention in my original post was that a few months before my first episode of pain, I was hit from behind while stopped at a traffic light. I was not injured at the time. The doctors seem to think there is no correlation since my pain started 2-3 months later. They seem to think the pain would have started sooner, within a few weeks. I am going to stick with this therapist and work through this, even if it takes several months. This pain really does not make me feel good overall and I don't like not feeling good! I am also going to limit my computer use and take frequent breaks. Hopefully the changes will help.

[mike1105]

i think you are on the right track. remember it can take a long long time before you see reults. your postural problems/ muscle dysfunction  did not develop overnight and they will not go away overnight. we're talking about reprogramming your body and healing ancient wounds. go to John Barnes website and read. stretch often-- 3 or 4 times daily, and do it gently. rome was not built in a day. like i said it took me 8 months to even notice progress after 20+ months of disabling pain. don't get discouraged.. and good luck.

[wolfdame]

I am a 50 year old woman and in good physical shape.  Aerobics, weights, and running and eating properly have kept me that way.  I have been exercising regularly since I was 28 years old.  About 5 years ago as I was bending over trying to open a cupboard door that was sticking, I developed what felt like a knot under my shoulder blade on my left side.  Within a week my whole back was in spasms and I could not lay down or even get into a slight incline position without major pain in my upper back, and chest.  I slept in a lazyboy chair in an upright position for over 6 weeks.  I went to my GP who thought it might be a herniated disc in my neck. He sent me for bone scans, an MRI, and Xrays and nothing remarkable was noted.  At about the 5 week mark I started getting massage from an excellent massuese who specialized in massage for whiplash.  I did a series of 6 one hour massage sessions within a two week period.  After receiving these treatments I was at least able to lay down (although still uncomfortable it was not excrutiating like it had been).  I was popping between 4 and 6 Tylenol #4's a day for over a year just to cope (I work full time at a computer).  I have seen a PT and was given some exercises (I was already doing most of them anyway).  I stopped PT because of the cost and continued to exercise on my own.  The symptoms I have now are pain down my left arm, numbness in my forefinger (which never goes away) and thumb and intermittant tingling and pain sometime in my whole hand (especially on the thumb side).  I feel like I have a giant knot under my scapula and all around the scapula and back I feel like I have trigger points.  My scalenes mainly on my left side are very sore and tight and sometimes I feel like I am being choked.  I have done all kinds of research on the internet to see if I can find any solutions as I wasn't convinced it was a herniated disc.  I am nagged daily with these symptoms and am wondering where I should turn.  Any thoughts"?

[suzyrjohnson!]

Several months ago I was hospitalized for a cold/spasm in my left neck and back muscles.  When it happened, there was chronic pain and knots in my back, as well as neck stiffness and pain.  Now, three months later, I am still getting about four knots or so in my upper back - only on the left side.  It hurts to even breathe! It is very painful - about 2 months ago when i was finishing PT, my therapist informed me that I could live with this type of pain for the rest of my life.  What is going on?!?!

[pd245]

Dr. Mike - I have the exact symptoms that you describe above - the same muscle patterns that switch sides (sometimes on the same day but usually on the next day). I'm to the point where I can't exercise without setting off the pain patterns and tightness/spasm. I've been searching for a name for this problem for 8 years - you've finally given it to me - upper crossed syndrome. Thank you so very much. This is huge for me.

The thing that bothers me the most is the migraines that I get, in my TMJ area. These headaches have been getting slightly better after I started working on my posture. But my muscles are really upset with the posture changes. I know posture is part of the answer for me. Looks like PT, massage, and stretches, too.

I was interested in your opinion, though - computer work and bad posture has caused this problem for me. Do I have to give up computer work completely while I heal, or is it possible to still work using excellent ergonomics and breaks? My pecs are so tight and spastic, if I stretch them at all I get a migraine on that side of my head (in the TMJ area). thank you!

[smh78]

my L4 or L5 was fractured back in 1997 and I have had pain in my neck and back ever since. My new worry is that all of my fingers and thumbs have been numb for the last 7 1/2 hours. I don't feel any new pains in my neck or back (still in pain as usual). Should I be worried? I don't like going to the emergency room, but want to know what to watch for... I will go if 100% necessary, but probably not until then. My fingers were numb like this back in November as well...

[trinidadiangirl]

IM 25 YEARS OLD AND I CANT UNDERSTAND WHY IN GETTING THIS PAINS IN BOTH HANDS. IT ALL STARTED WHEN I GOT INTO AN ACCIDENT IN FEBUARY OF LAST YEAR. THE NUMBNESS UED TO COME EVER SO OFTEN ONLY IN ONE HAND, SO THOUGHT IT WAS FROM THE DIABETERS THAT I HAD OCCURED WHILE IWAS PREGNANT.BUT FOR THE LAST COUPLE OF MOMTHS IT HAS BEEN MY BOTH HANDS.IT PAIN ALOT AND I DONT KNOW WHAT TO DO.PLEASE HELP ME

[Jane Pat]

I am 64 and beginning to wonder if I can continue my 20 hour a week position as a hospital biller.  I seem to be continually either spending money on massage therapists or going to physical therapy.  Now my HR Dept has sent me an email saying that they believe me to have arthritis, so will not pay for more physical therapy. I'm really well regarded in my job, and have a sort of sweet situation, choosing my own hours, etc.  But it has been nothing but trouble for the past two years.  If it isn't arm problems, it is very bad strong aching in my scapula region.  I have been doing some exercises off the web to strengthen that area, but wonder if my body isn't signaling that it simply cannot "take it any longer."  I have gone back to Celebrex which I must admit helps a great deal with the pain, and one night I even took a Vicodin.  Heat seems to exacerbate it.  I'm getting awfully tired of this routine.

I work for a very fine medical facility and have been visited twice by an ergonomics specialist who has been a great help.  But, careful as I may be, these problems creep up again. Any thoughts?

Jane

[blackastra]

I am a computer worker , and I have had back pains from spasms, pinched nerves, bone spurs, pulled muscles etc. etc. on and off for 5 years, and I have always cured it myself in 4 to 6 weeks. A knowledge of the muscular and nervous system helps. There aren't that many muscles in the back. Its pretty easy to work out what you've done. Then use pileates exercises to stretch your muscles . Start gently , and use exercises on other muscles, like lower back to pull back your upper back muscles if they are injured. Walking and hydrotherapy like spa and floating in pool are good. Freestyle is bad , I find breastroke OK. Use menthol rubs like Deepheat and Dencorub. And most of all , STOP doing what your doing. Don't bend over and dry your hair after a hot shower. Don't sit in the same position watching TV for hours. Dont slouch when you eat and work. Don't sit up in bed leaning on pillows. That will streatch your muscles and put you into spasm faster than anything I know.  I do 5-10 minutes of pilates in the morning and after work only,  'cause I am a lazy sod. But prevention is better than the cure . No-one can fix your muscular problems but you. So stop bitching about it - no-one wants to hear it , as you know, and start putting the work in. The doctors here will not prescribe pain killers or muscle relaxants etc, so we have to learn to do it all ourselves.

[blackastra]

Forgot the most important thing. For me at least,  magnesium supplements are the miracle cure for muscle spasms and cramps. Wish I had discovered them years ago. Worth a shot.

[Plankspanker]

1st visit to forum. I have MILD numbness in my left thumb, 1st and 2nd fingertips. No significant pain, up my arm, but have had neck pain, now completely gone after 2 visits to an oesteopath (chiropractor) C4 was badly inflammed, but that has been completely reduced now. Disc herniation has been ruled out at C4 as the inflammation has gone. Symptoms are mild but worrying as I am  professional Guitarist, and concerned that any nerve restriction, be it nuerological or vascular will lead to permanent damage to the sensitivity of my fingertips. My Oesteopath has looked further down my back where the pain in my neck ran down to, and explained that another nerve controlling the vascular dialation and blood flow to the nerves in my hand could be affected by significant inflammation around this area, he has now released the tightness in this area with manipulation, and so I am hoping for some improvement. I am concerned that the motor neurones to my fingers will become affected,as this would obviously jeopardise my profession. Can Anyone shed any light or offer a prognosis? Thank You.

[brokenback]

I typed in my symptoms and did a search and landed here. I am 46 years old and already suffer from 3 herniated disc in my low back. I was disabled as a police officer and now work part time in an office enviroment. The past two weeks I started suffering from what I would discribe as a knot under my right shoulder blade. The pain progressed down to my elbow and now down my right forearm. Now my right index finger and middle finger are numb!! Sleep has been impossible and I'm at my wits end of dealing with pain! Gonna see the doc tomorrow and I'm guessing its a herniated disc. I also noticed that the pain intensifies when drinking alcohol, anyone else experience this?

[thomasthomas1]

Im 59 - male.  5 years ago I started having stabbing pains between my shoulder blades but only when I walked up stairs or a long inclined road and sometimes riding a bicycle.  If I slumped my shoulders and concentrated on relaxing my back the pain disappeared in 15-20 seconds.  Now the pain comes more often and takes a little longer to go away.  Rarely the pain starts while I am sitting on my recliner in the morning for no reason.  Doctors cant find anything abnormal on xrays or MRI.  Muscle relaxants don't help.  Naproxen helps a little.  If pain is not stopped by my relaxing my shoulders, the pain will radiate down th back of both arms to the elbows but no further.  Im looking for a lazy mans cure - anybody got a pill I can take. (joke)Someone has suggested coenzyme10, or coloidal(sp), or magnesium.  Anybod got any suggestions.

[4Periquitos]

Hello, I hope someone can shed some light on this for me.  I am 48, female, and the week after Christmas 2005 I had a small pain in my upper back.  I thought I had pulled a muscle in aerobics or slept on it wrong.  It quickly became like a deep, constant fire, starting to the right of my upper spine, across my shoulder blade, and radiating down to my right elbow.  The pain is down the back of the arm only, with no numbness, tingling, or weakness.  It became intolerable to stand up or sit.  Sitting is the worst.  Lying flat on my back is the only time I get relief.  It will go away after a few minutes of that.  I hate to get out of bed in the morning.  I have a normal neuro exam, normal chest xray, normal Tspine xray, normal lab.  I am waiting for an MRI right now.  I have tried Lidoderm patches and capsazin cream, which did nothing.  I tried Lyrica which had too many side effects and I had to stop t.  I tried Neurontin and it did nothing.  Today I started Cymbalta.  I have been taking Vicodin and oxycodone but have to take it in large doses to relieve the pain and the doctor is insinuating that I'm abusing it.  I am not.  I am in misery.  He said it's possible it could be post-herpetic neuralgia.  I have no diagnosis yet.  I can sleep flat on my back, but if I roll onto my side I wake up.  I have perfectly normal range of motion.  I have been dealing with this for 3-1/2 months.  It has taken over my life.  I can't work, can't sit for long, am getting quite depressed.  I am terrified of being without pain medicine.  I also wonder if I did something wrong ergonomically at the computer, since it's the arm that I stretch out to use the mouse and that position is the most painful of all.  I'm very frustrated at the amount of time it's taking to find out what's wrong as well as the neurologist's attitude about my pain.  I am wondering, after reading others' stories here, why I haven't been offered a nerve test also?  Doesn't that make sense?  The doctor thinks I also could be "somaticizing" and has actually said I am "high-maintenance" and a "pain in the neck".  I have never had any trouble with this before in my life.  If anyone can give me some suggestions, Please Help!  Thanks in advance.

[Kat0723]

A related discussion, Muscle knots, back, neck and shoulder joint injuries was started.