Doctor Alice M. Martinson gives us a perspective on this complex upper back injury. We often hear about lower back pain, but upper back pain can be just as troublesome.
Persistent burning discomfort between the shoulder blades is a common complaints and one that is frequently behind excessive evaluator and treatment efforts. When muscles are put on stretch and then subjected to tension, the result is burning pain that has an almost-vibratory character. Cervical disc disease can refer to the medial scapular area and should be easily distinguishable from postural strain complaints on a clinical basis alone.
Individuals with this condition typically spend long hours working with their hands and arms in front of them and are usually concentrating on what they are doing. Examples of these types of occupations are clerical workers, fruit sorters/packers, newspaper editors, Pentagon staffers and tax accountants (for the several months prior to April 15).
In the office a stoop-shouldered posture is visible and the patient may not be able to actively reverse it upon command. In addition to a typical job history, obese individuals and women with macromastia, frequently present with these complaints. A thorough physical exam will show no evidence of nerve root dysfunction. Tenderness is usually present in the rhomboids and levator scapulae.
The only treatment found to benefit individuals with this problem is frequent active stretching of the anterior chest muscles to allow retraction of the scapulae. Attempting to bring the flexed elbows together behind the back for 30-60 seconds every 10 to 15 minutes will relieve the complaints. Rarely the symptoms will be severe enough so that a single xylocaine/corticosteroid injection will be helpful in both establishing the diagnosis and beginning improvement.
Imaging evaluation is not indicated, except in older individuals when a true fixed thoracic kyphosis is present. In these cases plain films of the thoracic spine confirms the clinical situation. Since there will be no specific objective physical findings pointing to the cervical spine as the source of pathology, MRI should not be done, especially in young individuals with no history of specific injury. “Trigger point” injections will not provide lasting benefit in these cases. Lasting benefit comes only from a commitment by the patient to a self-directed program of frequent short periods of shoulder girdle stretching.
Author: Alice M. Martinson, MD has practiced for 40 years as a board-certified orthopaedic surgeon, 25 of which were as a Naval Medical Officer. Relying on her extensive military experience with injury evaluation, she performs IMEs and consults on loss control issues. Contact: 870-480-7475 or docalice@aol.com. To read more about “Doc Alice,” go to our Directory at: http://reduceyourworkerscomp.com/workerscomp-medical-doctor-advisors.php.
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