Question
I've had severe pain in the back of my shoulder for a few years and I've been to a lot of doctors and tried many painkillers and nothing works. Its a burning stinging pain and is so sensitive to the touch that if you blew on it i'd feel pain. I can almost pinpoint the epicenter of the pain with a needle and the pain radiates out from that point. I guessed that it was nerve related but have never been confirmed. I imagine it has something to do with the fact that I was a shotputter a few years ago. Have you seen other people with symptoms like mine and if so what do you think the best treatment would be?

Answer
Dear Talya,

Your symptoms are communion and is describes a condition known as called trigger points. trigger points are tiny contraction knots that develop in a muscle when it is injured or overworked.  These knots tend to refer pain outward from their origin to specific areas, and they have been mapped out over time.  All muscles and myofacial structures of the body can form trigger points, and the pain patterns have been known for years.  Specifically, the authors Janet Travell and David Simmons have even written a textbook on the subject that is widely quoted in medical textbooks titled:  Myofascial Pain and Dysfunction: The Trigger Point Manual Volumes 1 and 2.

Again, the defining symptom of a trigger point is referred pain. This can be an extremely misleading phenomenon for doctors and clinicians and is the reason conventional treatments for pain so often fail. It抯 a mistake to assume that the problem is at the place that hurts!

Travell and Simons' research has shown that trigger points are the primary cause of pain 75% of the time and are at least a part of nearly every pain problem.

Trigger points cause headaches, neck and jaw pain, low back pain, tennis elbow, and carpal tunnel syndrome. They are the source of the pain in such joints as the shoulder, wrist, hip, knee, and ankle that is so often mistaken for arthritis, tendinitis, bursitis, or ligament injury.

Trigger points also cause symptoms as diverse as dizziness, earaches, sinusitis, nausea, heartburn, false heart pain, heart arrhythmia, genital pain, and numbness in the hands and feet. Even fibromyalgia may have its beginnings with myofascial trigger points.  With the location you described, I would suggest that you have trigger points in either the upper fibers of the trapezius, the levator scapulae, or the rhomboid musculature.

I would suggest that you find a good massage therapist, or a chiropractic physician who has tanning in deep tissue techniques such as Graston, Active Release, or SASTM technique.  Trigger points are easily treated when the clinician or doctor understands the causative mechanism, although deep tissue work on the trigger point will be very tender and sometimes quite painful.  You should see significant results in 3-4 visits if addressed appropriately.  If not, you may want to explore the option of acupuncture, as this has shown good results as well.

Good Luck Talya.

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