Question
Hello and thank you sincerely in advance for taking my question. I have been in pain for many years and am just now starting to search for answers, after realising it was not healing or going away on its own.
I work as a life drawing model and am required to hold poses for extended lengths of time without moving. Often you choose a pose, hold for 20 .inutes, get a 5 minute break, and repeat up to 10 in the same pose. My very first night, I took a pose that felt comfortable at first but as the night went on it became clear I had made a devastating choice. I was half siting/laying on my side with my right arm supporting my weight on a small stool. Sorry this is hard to explain but I believe it is important in understanding which muscles couldve been affected. The pose was similar to if you had been laying flat on your side, then sat up slightly, with your legs and body still laying down mostly but your upper torso raised up qnd supported by your bent arm across a little stool....like siting up sideways in bed.
As the night went on, I could feel muscles tearing in my shoulder. I tried to stretch during the breaks and shake it off, worried that if I asked to take another pose this far in I would ruin everyone's paintings. In hindsight, I should not have let anything come before my health, but here I am.
since then, I have had reoccurring pain, fatigue, and discomfort in my back/shoulder. I can go for a week or more without noticing, but then it will come back for several days. I can still move my shoulder and arm fine without sharp pain. It is more like a constant dull fatigue and stress with some pain beneath my shoulder blade. I was looking up muscle diagrams to see which muscle it could be, and its somewhere around the Rhomboid major muscle. When I reach behind my left hand around to my right  shoulder and rub just left of my shoulder blade, I can tell I am rubbing the injured muscle.

Wihin the past 6 months or more, I have also developed a similar reoccurring wrist injury that may be related to a pinched or pressured nerve from the shoulder injury? When my wrist is hurting though, it is extremely painful. Where as the shoulder is a constant nagging but dull pain, the wrist is sharp biting pain when I move my hand too far in any direction. Before using it at all I usually have to stretch it out, getting past the sharp pain when I move it at first, and then the pain becomes more dull and I can use my wrist. When I feel the wrist with my fingers, the pain seems to come from inside, between some of the bones I can feel on the surface. It hurts most on the top of my wrist and directly in the center.

The timing is the same as the shoulder, with several days of pain, and then back to normal for a week or several weeks. One usually follows the other. For example I just phased out of the extreme pain in my wrist a day or two ago, and now my shoulder just began the hurting and fatigue today. Not sure if they are linked but I want to provide all the info I can.

I have tried eating more protein hopefully to give it more fuel to heal, but no amout of rest has seemed to help. I am desperate to find out possible explanations for what happened and ways I can help to repair it and allow it to heal. It is affecting my work and daily life, and I am finding it harder to perform simple, usually non-strenuous activities like sweeping or mopping.

I cannot tell you how much your help or advice will be appreciated. It affects me every day and is making life harder to enjoy, and activities I once loved near unbearable, like hiking, building, and crafting which rely heavily on my arm and wrist. I am 20 years old, if that helps anything. I didnt think I would have injuries like this at such a young age, because I don't do any extreme sports or strenuous activities.

Thank you sincerely,
Haley

Answer
Dear Haley,

A complex question! I do appreciate your detailed explanation of your symptoms, though!

There are several possible reasons for your discomfort. The connection of your shoulder blade to your wrist could be either a neurological connection, a muscle referral type pain, or maybe even no connection at all! Welcome to the life of a diagnosing physician!

From what you have told me, this is what comes to mind:

1) I believe that the shoulder pain is very likely a strain to the rhomboid musculature, though it could also be a levator scapula, lower trapezius, or latisimus dorsi muscle strain. A "strain", by definition, means muscle tearing. Strains are rated as grade one (mild, microfiber tearing), grade two(partial gross tear of the muscle belly), and grade three (complete rupture of the muscle). If you have a strain, it is likely a grade one, since you say that you have not lost movement of the shoulder.
2) Shoulder blade pain can also be caused by problems in the neck. The lower part of the neck is where the C6 nerve root exits the spine. When it is irritated, it can cause pain along the inside border of the shoulder blade. This typically can cause pain that spreads into the thumb, middle finger, and index finger as well. It can cause a weakness in the arm, shoulder, and hand muscles.
3) Shoulder blade pain can also be caused by underlying spinal dysfunction in the mid back region. This can cause pain to spread into the shoulder blade and even into the upper arm.
4) The wrist pain could be the result of number 2 above, or even number 1 above, because both nerves and muscles are pretty good about sending pain to other parts of the body. But the wrist pain could be the result of a separate wrist joint sprain, or even what is known as carpal tunnel syndrome. Do you do any repetitive motions, such as keyboarding/computing, painting, etc?

This is my advise to you.  Find a chiropractor who will do a spinal exam and shoulder examination. A good one can start to sift through the data and start to give you answers. Many will offer a complimentary consultation, and even, at times, a free examination. Once an examination is performed, ask for a complete diagnosis. Ask them how sure they are of the diagnosis, and what other possible causes are in their differential diagnosis (list of alternative diagnostic ideas).  You should only begin treatment once you feel good about the diagnosis given and only if the proposed treatment plan makes sense to you. Give your chiropractor 2-4 weeks, but if you are not getting some benefit, ask for a re-evaluation, or other possible treatment techniques.  If no benefit is obtained, the next step is to see an orthopedic medical doctor. They can look for deep internal shoulder joint abnormalities or injuries.

I personally think that you would respond very well to conservative chiropractic care. Don't settle on taking pain medication, as this will simply cover up your symptoms for the short term and will only hurt you in the long run.

Haley, I know that it is impossible to treat somebody over the internet, but I hope that this gives you some ideas, and more importantly, some hope. You are young, healthy, and likely to respond very well to care. You just have to find the right chiropractor for you. Ask around to friends and family members for referrals. That is the best place to start!

Sincerely,
Keith Biggs, DC