Question
QUESTION: I am a 56 year old male Graphic Designer, and spend most of my working days and, nights, at the computer.  I am in good health, but started having pain issues in my neck, spine and left shoulder blade back in September. It became constant with the pain radiating down my left arm, elbow and hand and causing momentary tingling and numbness, but quickly went away if I changed the position of my arm.  I sought the services of a chiropractor in early October and was evaluated, having a full spine/neck X-Ray which revealed moderate to severe vertical misalignment of my spine, and severe curvature and subluxation in the vertebrae of my neck. I started a program of regular adjustments 3 times a week and the pain started to lessen within a week or two. About 4 weeks ago, I started feeling increasingly severe pain in the same area, what seemed somewhere between the left shoulder blade area and my spine going up my neck. When I mentioned this to my chiropractor he started making specific adjustments to that general area and suggested applying moist heat and rest.  While that brought some temporary relief, the pain started to increase getting to  the point of becoming unbearable and debilitating last Wednesday. It became so intense that my wife took me to our family physician who examined my back and shoulder. He found no range of motion issues since I don't experience any pain in the normal arm/shoulder movement. He suspected an issue in the spine/neck and scheduled an MRI which I am having don Friday, more than a full week later.  The pain has subsided greatly since, but there is still a twinge and occasional spike of pain in the area.  My question how effective will the MRI still be in locating the source of the pain if it has diminished since last week?  What further treatment might I expect for this condition?  The thought of that severe pain returning worries me as well.

ANSWER: Hi Ron,

More than likely the heat was a HUGE mistake causing the exacerbation after application. I realize it temporarily offered some relief as it often does, but it also increases inflammation, hence you won't see any professional athletes use heat on anything that hurts. It is only indicated in Chronic Osteoarthritis, otherwise use ice!

My immediate concern with the symptoms you exhibit is mediastinal mass, ( a benign or malignant space occupying lesion in the compartment between the lungs.)

A Chest CT with contrast is indicated if the MRI is inconclusive or doesn't explain the mid-scapular pain. Your DC should try towel traction, this decompresses the spinal nerve roots that can commonly cause arm, neck and mid-scapular pain.

I would only worry about a mass if you can't find a comfortable position and/or the pain progressively worsens regardless of position. This is a rare condition but is a concern and must be ruled out. I am confident that if this is brought up on your next visit, your doctor can definitely tell you whether it is a viable concern since I don't have the liberty of direct examination. I only relay this as a concern because I have personally seen it in practice twice. The towel traction should also elicit a light going on in the Chiro's bag of tools. Let me know how it goes and feel free to ask additional questions as needed.


Good Luck!

Dr. Timothy Durnin

---------- FOLLOW-UP ----------

QUESTION: After doing some research on mediastinal mass, I must say, it is an ominous looking condition.  But as you said, let's see what the MRI reveals.

As for your comment about asking my chiropractor about "towel traction" I cannot find any information about that specific method of treatment, is it fairly common?  What is it exactly? is there any reason why he may not have suggested or used it in my situation?

Thanks again.

Answer
Towel traction is a commonly taught diversified technique to decompress herniated discs in the cervical spine. A thin fiber towel is wound up 4 or more feet in length and cupped under the base of the skull, the doctor applies traction and ends with a slight thrust creating a vacuum drawing the disc material back into place. It is extremely effective and widely used, if your DC doesn't know about it, I would look for one that does. It would be hard to believe he wouldn't regularly use it in practice since it is the most effective way of treating cervical disc herniations. It is a published technique in States Manual, which is the "bible" for diversified technique taught to 99% of Chiropractors.

Dr. T