Question
Hello.  I am completely baffled by this pain I have in my shoulder.  It *feels* as if a nerve is pinched near or under my right shoulder blade, but I don't know how to be sure.  I was seen by a physiatrist about 2 months ago for it (didn't go back because they were out of my network) and he referred to it as 'interscapular pain'.  He also noted that my rhomboid muscle was tender.

Things that are specific to this are:
- The pain can be most readily felt when I inhale deeply and also when i lift both arms above my head and stretch forward
- I can often hear a crack or snap when inhaling deeply, and can sometimes feel it right where the pain is


This has been going on about 3-4 months now.  I'm 30, do have a fair amount of back pain from sitting at a computer all day at work, but have never had this kind of shoulder pain.  Could this be a muscle spasm (I have been going through the most stressful time in my life) or perhaps an injury from lifting a heavy object?  What are the ways a doctor would investigate what is going on here?  Would an MRI show what is going on with a shoulder in a case like this?

many thanks for your expertise

Answer
Dear Len,

These issues are are usually pretty easy to fix and you do not need an MRI to address it.  These issues are very common and are the result on muscular and myofascial dysfunction.  The snapping and cracking sounds are heard when the adhesions in the tissue are breaking apart (which is actually a good thing).  Likely sources of the problem are the rhomboid muscles, the subscapularis muscles, the posterior serratus muscles, and the trapezius muscle. Along with the muscular/fascial issues, this problem is usually the result of long term biomechanical dysfunction that will need to be addressed.  Posture, work and daily activities may need to be addressed for the best resolution.

My recommendation is that you seek out the care of a chiropractic physician who additionally performs soft tissue work so that the offending tissue can specifically be targeted through soft tissue mobilization techniques as well as spinal adjustments to reduce muscular tension on a neurological level. Sports certified chiropractic physicians are a great choice for this as they often have advanced training in these areas. The doctor may want to stabilize the shoulder/scapular motion as well with the application of Kinesiotape to further help the condition.   Some good soft tissue techniques to look for are Graston, Active Release Technique, and Sound Assisted Soft Tissue Mobilization technique...there are other as well.

The below resources will all have a physician locator on their respective sites that will give practice locations of doctors who have been trained and certified near your town:

www.acbsp.com
www.grastontechnique.com
www.activerelease.com
www.sastm.com
www.kinesiotaping.com

Hope this helps Len...good luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net