Question
I was interested in a question and answer to a girl called Violet from March last year.  In the answer you made an assumption that she was not suffering from referred pain in the arm and shoulder and was not experiencing any dizziness or nausea.  My question to you would be - what would your advice be if I had similar symptoms to Violet but did also have dizziness and referred problems ??

I am 44 years old and generally have good health.  For a number of years however I have had ongoing problems with pains in my back around the shoulder blade.  They have never really been dealt with but are tolerable.

Four months ago however i began to feel decidedly unwell with mild nausea (which passed) and episodic dizziness and slight unsteadiness (which has carried on).  I was originally diagnosed with an ear infection but this has now been discounted.  Ditto I do not have any brain abnormality or any of the various possible illnesses which can be highlighted by various blood tests.

Around the same time I felt that I had pulled a muscle in my shoulder and upper arm but the problem has not eased and I now find myself with periodic sharp pains down my left arm and in my left shoulder/upper chest as well as pins and needles in my left hand fingers.  The problem is exacerbated when my head is in certain positions.

As I say the mild dizziness/light headedness remains a problem.  I can still function ok but it is very tiring and depressing.

There is a suggestion now from the doctors that I have some kind of muscle spasm issue or perhaps trapped nerve in my neck which is the cause of both problems.  That said the muscle relaxants I have been prescribed have had no effect.  I went to see a physio a couple of times but felt their response / actions were a bit feeble and were certainly ineffective.

So my questions are

1.  Could these two problems be caused by the same thing ?

2.  Is it a trapped nerve or something similar ?

3.  Who should I see next to try and get it sorted ?

Really hope you can help.

Best wishes

Nick

Answer
Nick,

It may be that you have two separate issues.   The neck, shoulder blade thing clearly sounds like it's coming from your neck.  You may have a cervical disc protrusion touching against a nerve or against the membrane that surrounds your spinal cord.   MRI would rule this in or out.   As for dizziness, google "BPPV" or Benign Paroxysmal Positional Vertigo.   If you find that you turn your head, or change positions e.g. sitting to laying down and you get a wave of dizziness that subsides if you hold still for several seconds, then you likely have BPPV.   If this right, then you need to see a vestibular specialist - often a PT - who will put you through various maneuvers to clear out the dizziness (often 90% successful on the first try).  Your neck should be addressed by a chiropractor, with or without a disc lesion, to determine what mechanical issues are there or if there's other problems beyond your neck, e.g. apical lung tumor, rib joint dysfunction, thoracic outlet irritation, etc.  Likely, it's a disc irritation or protrusion and can be treated.  If it's minor, and you have no loss of arm reflexes or strengths, and have no loss of sensation in your arm/hand/fingers, then get treatment and hope for improvement within a week or two.    

'Hope I hit a bullseye on this one...

'Regards,

Dr. G