Soft tissue pain, between scapula and spine.

[solvay]

Having ruled out spinal involvment by CT and MRI, what treatment options are there for variant pain in thoracic area medial of scapula? I've experienced mild to severe pain in region, enervated by standing and active hand and arm motions over time while working under stress.. Corftisone and short/long acting lidocaine facet and area injections (T4-6) have yielded a maximum of 8 days relief. Radio Frequency Ablation , repeated twice, yielded 4-5 days relief per treatment.
My occupation does not permit CNS active agents. NSAIDS provide some relief, indomethacin works best (though one doc emphasized it is NOT a maintenance med).
Duration 3 years, with previous interval 8 years ago which spontaneously resolved within 4 months.
Some boards refer to rhomboid and/or lattisimus involvment which to me seems to fit symptoms, being a sore spot by my judgement about 1.5-2 inches deep.

[Michael L Gross, MD]

Usually pain of the type and location you describe, is a result of cervical radiculopathy.  It sounds like you've had a great deal of spinal treatment, but all directed toward your thoracic spine and not your cervical spine.  An MRI of your C-spine would be a good idea.

[Jon_E]

It could be a posterior rib dysfunction.  Is the pain on one side, any loss of motion of the arm or torso,any relief with pressure on the spot (such as leaning on the corner of a doorway or lying on a tennis ball; may hurt but gradually decrease), any change with full inhalation/exhalation.  Did they also look at the c-spine with the MRI; typically refers the mid scap region?

Muscle pain should resolve in 6-8 weeks, but sometimes other problems mimic muscle pain or cause muscle spasm/guarding.  In treating scapular pain, I have not once found the muscles to be the real problem but rather an issue of the c-spine, t-spine and/or the ribs.