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Forum Name: Spinal problems and back pain

Question: pain around/under the left shoulder blade


 ashenfang - Thu Dec 03, 2009 10:14 am

This pain started in February 2008. It was not caused by injury or accident. One morning while driving I noticed a pain in my left shoulder blade. It was a dull somewhat aching pain like I had slept wrong. However this pain never went away. Now some history of this pain. The pain is located on the side of the left shoulder blade. Sometimes the pain feels somewhat "underneath" the shoulder blade. The pain will also extend to between the shoulder blade and spine as well as up to the shoulder or down to the tip of the shoulder blade but always "feels" localized to the side or underneath the blade. Very seldom it will radiate to the front of the chest.

The pain is a constant dull ache with occasional "spikes" of sharp pain. The oddity of the pain is that I am for the most part unable to make the pain worse intentionally. Some movements, such as sitting down, and then arching my back forward and my head down will intensify the pain slightly. Pulling my left shoulder forward while leaning forward while breathing deeply will intensify the pain as well. However, sitting up straight will most of the time provide some relief. Deep breathing sitting up straight provides no pain. Over the last two years the pain has never become worse, it has always remained as explained above. On the 1-10 pain scale, the pain all the time is a 2-3 with the quick spikes being a 4-5. The pain doesn't interfere with regular activity, exercise, or lifting. Although after some activities (like painting) the pain seems to become aggravated, raising the dull aching pain to a 4-5 for a day or two. Range of motion is not affected and no normal movements, push ups, extending the arm ect do not make the pain worse.

This pain actually led me to quit smoking. I smoked on and off for about 8 years, at most 1 pack per day. However when I was smoking, smoking a cigarette in the morning would make the pain worse within a few minutes which led me to quit.

Dealing with this issue over the last two years has given me a certain level of anxiety as well, not knowing exactly what it is. Since February of 2008 I have seen multiple doctors. I saw my primary doctor who did a bi-lat chest xray as well as a back x-ray which were clear. She said muscular-skeletal issue and put me on ibprophen and muscle relaxers with no relief. Tried another doctor, another chest x-ray, clear. He then sent me off for an MRI. MRI of the cervical spine had to findings. Doctor suggested physical therapy. One session seemed to make the pain worse. I refereed myself to a spine specialist. The specialist sent me for another MRI of the thoracic spine. Results were all normal except he noted a "left renal cyst - likely simple" Again, left without answers, the specialist told me that he says this some sort of small muscle group within the back left shoulder blade that is muscular skeletal and that there really is nothing that could be done. Now 1.5 years into the issue with no real answers, I kept having anxiety about the pain and its cause, and of course the horror stories you read on the internet about back and shoulder pain could be lung cancer. The imaging center was offering free chest screenings so I went for one. The low dose, helical CT scan was normal. Radiologist only reported mild fatty liver, no suspicious nodules, and no adrenal gland issues.

Now that you know the history, my basic questions.

What is this pain and its cause? I have had 3 chest/back x-rays, 2 MRI's, and a Chest CT all with normal findings, yet I still freak out about cancer. I do suffer from mild OCD and sometimes think all these scans have missed something, or the tech's mixed up my results with someone else, is that possible?

My doctor keeps telling me that two years with a pain - if serious - would have developed into something something more by now. True?

Is there anything that I have not tried that I should?
 Dr.M.Aroon kamath - Thu Dec 17, 2009 8:33 am

User avatar Hi,
Musculo skeletal problems and pains arising from the vertebral column can be frequenty frustating for the patient as well as for the clinician.

There are times when major vertebral anomalies are discovered incidentally in an asymptomatic individual (and severely symptomatic individuals at times have no identifiable abnormality!- Perhaps, you may belong to this category).

The shoulder girdle is very complex in its construction and function.It involves movements at the
- shoulder joint
- acromio-clavicular joint and
- the sterno-clavicular joint.

Many muscles have to work in a co-ordinated fashion for optimal function.
Conditions that affect this girdle (muscles, joints, nerve supply etc) can result in pain and functional impairment.Apart from these, pain may be referred to the (Rt)scapula from the biliary tree.

As all your investigations have come back negative, the odds favour a diagnosis of musculoskeletal pain.I feel that you should (in consultation with your doctor) consult an experienced physiotherapist and put yourself through a program for chronic pain relief. If you comply with regular physio, you have a fair chance of recovery.Also, if you quit worrying about this being lung cancer, it would certainly speed up your recovery.
Best wishes!

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