QuestionQUESTION: 1 week ago my 18 year old son developed shoulder pain following exercise.
He went to the immediate care center where they found nothing on the xrays
and sent him home with naproxin and told him to ice/rest the shoulder. Last
night he sat up from the couch and felt and heard a popping sound in his
upper back. He now has terrible pain in his back, shoulder, pectoral area, He
is also experiencing tingling in his 4 fingers and forearm area. He is unable to
move without extreme pain. The pain gets worse if he tries to raise his arm so
we thought it might be a rotator cuff problem but I'm worried that the
popping sound he heard and the fact that most of the pain now is in his
upper back along with the shooting/tingling pain in his arm could be a
herniated disc. Do you believe this could all be related to a shoulder injury or
does the upper back pain sound more like a back injury? The pain is just to
the left of the spine and the height of the mid shoulder blade area. Thank
you so much for your opinion... he is missing school/work and I'm very
worried.
ANSWER: "pinched nerve", sprain/strain, herniated disc
Hello Terri,
I am sorry to hear your son has injured himself.
I am glad to hear he is physically active, but even at 18y/o we can injure ourselves - even doing things correctly!
"...He went to the immediate care center where they found nothing on the xrays and sent him home with naproxin and told him to ice/rest the shoulder....", Xrays are not very informative in an injury as described here. It is not likely that your son fractured/ dislocated a bone or joint while exercising. If he had sustained a blow to the area, then yes, Xrays may have been more appropriate.
Xrays look at hard tissue- bones. Other testing is more appropriate to evaluate soft tissue- to look for sprains/ strains/ muscle- ligament- nerve injuries.
"....He is also experiencing tingling in his 4 fingers and forearm area.....", he has some type of irritation to the nerves- he probably has a 'pinched nerve'.
You can return to the facility where the Xray was taken. You may/ may not be given MRI and EMG recommendations. You may be given prescriptions for anti-inflammatories, pain killers, perhaps even muscle relaxants. These treatments may provide symptomatic relief, but, in my opinion, do not get at the cause of the problem.
The Xrays show no medical pathology. This is good, there is no fracture, dislocation, probably no occult (hidden) pathology. They did the correct thing from the medical evaluative perspective- "sent him home with naproxin and told him to ice/rest the shoulder."
Now his condition warrants a more thorough investigation, and I would recommend a local Doctor of Chiropractic, preferably with sports injury, orthopedic or neurology credentials. Yes, just as medical doctors have specialties, so do chiropractic doctors have additional credentials- see: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf
Pain radiating to his fingertips usually indicates an irritated 'pinched nerve'. This term- 'pinched nerve' is NOT very helpful. We must arrive at WHAT is causing the 'pinch'. Is it a fracture (unlikely), dislocation (unlikely), tumor (unlikely), herniated disc (possible), sprain/ strain/ muscle spasm (likely), sprain-strain-spasm- subluxation (very likely).
Your local Doctor of Chiropractic (DC) will examine the patient, possibly take additional Xray views, possibly- due to exam findings- order MRI and EMG studies; to evaluate for soft tissue damage (ie herniated disc) and the extent of damage from the 'pinched nerve'.
Depending upon exam findings, depending upon test results, the doctor may then begin a course of chiropractic, refer out to an MD for concurrent care, or possibly refer for ortho or neuro care- without chiropractic! But physical exam, perhaps Xray, MRI and EMG will be necessary.
In my Staten Island Chiropractic office I give information to explain the problem to the patient, treatment options, possible diagnosis, possible treatment; here is one on Pain meds:
Be careful of relying upon pain medications:
PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?
Pain, pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?
Pain,
do you cover up the pain by taking a painkiller?
Take a painkiller, mask the pain, and allow a problem to progress in your body?
NOTICE ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition.
Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
++++++++++++++++++++++++++++++++++++++++++++
揚inched Nerve? ( Also Known As- neuritis, neuralgia, brachial-neuritis )
Sometimes we can wake up with a 憄inched nerve? or a muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a 憄inched nerve? Ultimately- the true c a u s e of the pinched nerve, pain in the neck and/ or shoulder and/ or arm and/ or hand; can be a misalignment, a 慿ink?in the neck- more properly termed a Vertebral Subluxation.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
This is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
ONLY a Doctor of Chiropactic will evaluate you for a Vertebral Subluxation, along with other pathology.
Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment. For good health- Treat the Cause, not just the Symptoms.
++++++++++++++++++++++++++++++++++++++++++
Disk Herniation
Herniated disk is actually a quite common condition. However, the course of the condition is highly variable. Some patients with a herniated disk literally cannot walk, yet other patients with similar MRI findings may be able to run marathons or lift heavy weights. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Although the course is highly variable, there are certain steps that are always helpful to follow: Ice the area when painful- 10/ 15minutes on, 30/ 45 minutes off; avoid certain postures and movements; bend the knees when coughing or sneezing; bend the knees when lifting anything; do not extend legs straight out when sitting, laying down, lifting, or driving. Avoiding certain movements and postures will prevent aggravation of the condition. Practicing good postures and movement patterns will help the condition heal and be less painful.
Disk Herniation is often caused by, or often concurrent with the Vertebral Subluxation Complex.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
+++++++++++++++++++++++++++++++++++++++
P.R.I.C.E. = P protection. R rest. I ice.
C compression. E elevation.
Hurt yourself ?? injury/ trauma/ bruise/ not even sure - - a broken bone ??
You should certainly get to the Doctor or trained health professional to be examined if you think it is bad enough. BUT in the meantime, some simple steps may help. PRICE.
The PRICE protocol will usually help just about any musculoskeletal injury.
P = Protection; protect the area from further injury- stop what you are doing, can you pad or bandage the area ? Tape the area? Do something to protect the area !
R = Rest; rest the area as much as possible, if a part is damaged, give the body time to repair the area
I = Ice; ice is a potent anti-inflammatory; it will slow swelling, help with pain control (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the injured area for 30 minutes; then back on again
C = Compression; to help prevent swelling compression may be helpful- for example if it is an ankle, wrap the ankle with an ace bandage and ice the area. Many body parts may not be applicable to compression.
E = Elevation; again to fight swelling and pain, raising the injured body part above the heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part
PRICE may help : Sprains, Strains, musculo-skeletal injury, bruise, contusion
Sometimes a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain. Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction). In the spine, a sprain/strain is a misalignment, a 慿ink?in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation. Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!
Spinal = Vertebral Subluxation Complex (a.k.a. 憇ubluxation? ; ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment. For good health- Treat the Cause, not just the Symptoms. Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint. CORRECT the subluxation !!!!
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
++++++++++++++++++++++++++++++++++++++++++++++++
I hope all this information helps.
I recommend you bring your son to the local DC to get to the cause of these complaints.
If you need further information, do not hesitate to re-contact me here at AllExperts.com @
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm
Good Luck and I wish you Good Health Naturally,
Dr. Victor Dolan, DC, DACBSP
http://drvictordolan.chiroweb.com (Email newsletter)
---------- FOLLOW-UP ----------
QUESTION: First, thank you so much for your response! My son had an MRI yesterday on
his shoulder and it showed only inflammation. Orthopedic doctor is thinking
it is tendonitis and prescribed PT for 4 weeks. Our insurance would not
approve a cervical MRI until conservative treatment was tried first, so we do
not know if it could be a herniation. My question is: Do you think it is a
conflict for us to be under the care of the orthopedic doctor and go to PT
along with also seeing a chiropractor for care? Do we need to choose one
over the other? By the way, the pain/tingling in his arm is gone but now he
has clicking/popping in his shoulder blade when he yawns, coughs, etc.
Thank you again for your help!!
Terri
AnswerHello Terri,
Thank you for your followup question.
"My son had an MRI yesterday on
his shoulder and it showed only inflammation. Orthopedic doctor is thinking it is tendonitis and prescribed PT for 4 weeks.....", this sounds okay, as far as it goes. But what did cuse the pain/ tingling into the arm down to the fingers?
When we hurt ourselves, we may have many aspects to the injury. Having a proven tendinitis of the shoulder on MRI does not mean there cannot also be a spinal problem. Having a spinal problem does not mean we do not have a shoulder problem. People with diabetes can get athlete's foot. You see my point, having one condition does NOT prevent another condition.
I am content with the ortho/ PT care for the shoulder. They will do a great job there. But, a chiropractic evaluation could (in my opinion- should) be performed to rule out any cervical/ thoracic involvement.
I do not think it is a conflict to CONCURRENTLY see an Orthopedic MD, Neurologic MD, Internist MD, Chiropractic Doctor, Physical Therapist- all at once.
I see patients concurrently with many disciplines. Sometimes we are treating the SAME condition, but from different aspects. Sometimes the patient has several problems from one incident and gets care from various specialists at once. I have referred to, and received referrals from all types of MD.
I do not think it a conflict with the health professionals involved. I do see a problem- perhaps- with insurance. I would contact the Doctor of Chiropractic, have an evaluation, and if there is spinal involvement- then the DC should be able to treat the spine while the ortho/ pt treat the shoulder. If you call the insco first---- they will probably tell you to forget the chiropractic evaluation, because they do not want to find out if there is a spinal involvement- that they will have to pay for!
I hope this help.
Thanks for the followup.
Again- If you need further information, do not hesitate to re-contact me here at AllExperts.com @
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm
I wish you Good Health Naturally,
Dr. Victor Dolan, DC, DACBSP
http://drvictordolan.chiroweb.com -- -- (Email newsletter)
