Question
About 8 weeks ago I woke up one morning with what I will call a tightness in my back on the left side. It was bothersome and as the week went on it got worse, finally to the point I was having pain in my upper back and neck area. It got so bad that I suspected I may have a pinched nerve as the only way I could get relief was to raise my left arm over my head. So I went to see a chiropractor that I had seen a year before for similar symptoms, which went away after a few sessions and some PT. He is a practitioner of the activator method. He gave me a brief exam and agreed that it sounded like a pinched nerve and he though he could help me. He recommenced three treatments that week, the first that day, the next the following morning followed by another one two days later. He has a "gun" that he uses, along with the single stroke activator. He used that gun on me the first day, mostly under and on top of my shoulder. After he finished the first day it felt much worse but I know sometimes it has to get worse before it gets better.  The next morning was a similar session. After that one I was really miserable and now had pain in my shoulder, radiating down my arm and some numbness in my fingers (all fingers). When I returned on the for the third treatment I was so miserable from the pain I asked him if maybe I was just too tender to be having him work on me at the moment, I described the pain and how much worse it was now then when I first came in. He said maybe he should just use the single stroke on me for now and not use the gun. So we did that. By the next morning my neck hurt so bad I literally could not be upright for more than 5 minutes without being in incredible neck pain. I found the only relief was laying on my right side in the fetal position, after 5 or 10 minutes in this position the pain would fade away. I finally saw my primary care doc the following Monday who ordered xrays which showed not much of anything then we got an MRI that Friday. The MRI did show a slight disk bulge at c4/c5 and some slight degenerative changes at c6/c7 but nothing that required surgical treatment. I do not have the MRI results with me at this time but can provide the exact details on a follow up email. I went on prednizone for about a month, a tapered dose starting with 6 pills for 5 days, then 5 pills for 5 days, etc. Also took Flexoril 3 times a day and percoset as needed for pain. After about 2 weeks I was able to get up and around again but still had a lot of pain. Started going back to the chiro as my PC doc thought it could help. After a week or two and making no progress we talked some more and I told him how tight I had been on that left side. He said he does not usually recommend massage for anyone in acute pain like I was in but it could help. So we tried that, OMG it hurt so bad when he found some trigger points that were locked up, but the next day I felt so much better. It took about 5 sessions with him but finally the neck pain went away, and the shoulder and hand numbness was almost gone as well. One evening as he was about to give me another massage I mentioned to him that I did now want to dig real deep that session as I wanted to be able to take my wife to dinner afterwards as we had not been able to do anything social for several weeks. So he just rubbed my muscles to kind of "flush" them out, well in doing so he irritated something really badly, I felt a burning sensation in my shoulder that radiated down my arm, really burning badly in the tricep area. It was bothersome more that painful. After that night that feeling faded but was replaced by a new pain that was slightly over to the left of where my original pain was. Now keep in mind that the neck pain has been gone ever since that 5th session. But the new pain just gradually got worse and worse, to the point where we are now finding several trigger points locked up in my back at each session. I will feel better the next day but by the second day I can tell I am starting to "lock up" and the pain gets worse. We have also tried some class 4 laser treatments and some ultrasound without much success. Some folks say this is still all coming from my neck and that I should consider a steroid injection in the c6/c7 area, others think it might have something to do with my shoulder/clavicle area since most of the trigger points that are locked up are right down the clavicle area. Is is possible in using that gun on me at first that we have done something to my shoulder or clavicle that is causing all this pain and trigger point problems or is it more likely something related to my spine? Sorry for being so long winded but wanted you to have the whole picture.

Answer
Tom,

This is a classic situation.  It is coming from your neck.  The nerve root or a nerve in the front "triangle" zone of your neck where the "brachial plexus" is located is getting irritated.   It could be from a disc that is unstable, meaning that it deforms and gives way when you bear weight on it it.  Maybe it is torn internally and the MRI did not show it or the radiologist didn't see it.    Maybe there is an adhesion tethering the nerve at some point in its course.   Either way, you have to make the nerve slack by elevating your arm (this is called Bakody sign).    If neck structures get irritated, you will get the knots in your upper back and traps.   Epidural steroid injection is one avenue, for sure, and the doctor will have to choose a level to inject.   The conservative option is to do more skilled soft tissue work in the neck and anterior cervical triangle area by someone who knows what they're doing.    I'd suggest going to a a provider of:   GrastonTechnique.com  or FAKTR.com, and also someone that does Active Release Technique or similar (or all three).    Also, go to a chiropractor that uses his/her hands and a variety of methods and not just those damn percussion gizmos.   You could find that the combination of manual neck tractioning, carefully performed joint manipulation, and highly skilled soft tissue therapy that releases fascial adhesions could make all the difference.     The doctor of chiropractic should do exam procedures to better determine if the source of your pain is the disc, nerve root irritation, or adhesion in the plexus area, e.g. between the scalene muscles.  Google some of these anatomic terms if you are not familiar with them.

Good luck with this.  I hope this was helpful.

Dr. G