Question
Hello, I am a 41 yr old female and was not involved in any accident. I have had a golf ball sized mass (as my Dr. calls it) in my rhomboid muscle for a few months now. I had a cervical and thoracic MRI two weeks ago. The MRI (w/o contrast) revealed arthritis in my neck and nothing else. The Dr. spent alot of time feeling my back and ascertained that it was within or underneath my muscle. It does not move like a knot would, and told me it must be a muscle spasm. I have had pain every minute of every day and the muscle relaxers I have been taking (Methocarbamol 750mg x 4/day x 3 weeks) have not helped at all. My upper back burns constantly, so I have been stretching, but cannot exercise due to the pain. I don't sleep very well anymore either. Do you believe this could be a spasm? If not, what could it be? Thanks and appreciate any feedback.

Answer
Dear Cheryl,

Yes this could be a spasm, or a trigger point in the trapezius or the rhomboid muscles.  The best way to differentiate between the two is by pressing into the mass and seeing if the pain is just local, or if it refers outward with pressure.  A muscle spasm will not refer pain away from the source, but a trigger point will.  A muscle spasm and trigger point will both move a bit when pushed around as they are not actually connected to the chest wall, and are truly in the soft tissue.  If the mass is pressed and it does not move, then you start to think about tumors...mostly benign when in the peripheral tissue.

If moveable and painful, then I would seek out the care of a good massage therapist to work the tissue, but this is not a "feel good" massage.  You will need deep tissue work done, and some myofascial release techniques, and it will likely take a few sessions with the therapist to get significant improvement.  It will be somewhat painful, but you should see improvement in active ranges of motion, and a reduction in your overall pain experience.  If it is a trigger point, it will take longer to alleviate, and you may want to consider some trigger point injections to release the muscle fibers a few days before the massage.  Often therapeutic ultrasound will help to break up the mass as well, but you will have to go to a chiropractor to get that as massage therapists are not trained on it in their college curriculums.

If the mass is not moveable, then I would suggest that you get a needle biopsy to classify the tissue.  The sample would need to be sent to a pathologist for microscopic identification of the cell types to make sure that it doesn't need to be removed.  This procedure is really just as easy as getting a shot, and can be performed in your family physicians office.

Hope this helps Cheryl!  Please feel free to write back with any further comments or questions if you need to.

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