can anyone advise please

[I Love Emergency Medicine]

Hi HPers My husband was unable to get out of bed on thursday morning. He had a pain in his back, neck and down his left arm. Needless to say he thought he was having a heart attack. He had great difficulty getting up and after I eventually managed to get him out and in to the car I got him seen to in the local clinic. He was in a lot of pain and had to keep his arm up over his head. He described the pain as if his chest and arm were being pulled out of him. The doctor did an ecg and thankfully it was fine, she then diagnosed him with a muscular problem, saying that it seemed he had damaged the muscle under the scapula. She gave him an injection of Diffene and prescribed diffene and solpodal. She said legally she had to advise him to see a physiotherapist but as his wife is a massage therapist she should be able to do it instead, (so no pressure there then). He is unable to lie down, sit up and only seems to get relieve when in his recliner chair when it is straight back. I gave him a chair massage on fri, and sat and he definitley has more movement. However he says the pain is really bad and it feels like his arm is being pulled out of him. I brought him back to the clinic yesterday morning and the doctor said it is getting better but will take time and prescribed more pain relief and told him to stay off work for the week. Initially it seemed that the problem was under the scapula in the rhomboid area however today I noticed that he seems to have a small lump which will move around sort of in the area of the teres major, near the edge of the scapula at the spine side (i hope that makes sense). I dont know what this is, its about the size of a smartie, (only thing i can think of sorry). would that be adding to the pain? He doesnt remember lifting anything heavy or pulling it. Should I continue to massage the area, is there anything specific i should or shouldnt do. I have tried to get him to do some gentle stretches which he can do but says its sore. It seems that his arm is "killing" him now and he says the pain runs down his arm to the elbow. He hasnt been able to sleep since Wednesday. Any help or advice would be greatly appreciated.

 

[gibytzgj]

Hi D

Normally I would say just get in there, but my gut reaction says that your husband should go to the physio. You can at least find out from the physiotherapist what type of techniques would be suitable and hopefully a better diagnosis. If you don't want to see a physio, then an equivalent professional like an osteopath.

Best wishes

RP

 

[WCCanuck]

The last case I saw with those symptoms, and so severe, yet 'for no apparent reason', had had a flu jab in the left arm a week earlier. She wasn't happy that I was wondering if the two matters were related, so I suggested she discuss this possibility with her GP instead. At this time I still have that in my mind as possible adverse reaction to vaccination, but I guess I'll never know.

What to do if that is the case, well that's another story. My point is, you are right not to assume in the first instance that this is definitely a musculoskeletal problem.

As for lumps on teres, the axilla has many lymph nodes, is that perhaps what you noticed?

 

[Igggy]

I would be on my way to the GP or out of hours service if necessary. Any persistant pain that is noticeable and is affecting your lifestyle needs checking by someone who knows what they are doing. Better safe than sorry it's said xxx

 

[Technerd_Shawn]

Ripleykatz (however many z's), I'm inclined to agree that this is not one for the physio, at least without a few more answers.

I'd want to dig deep with this, ruling out a few more nasties is probably a good idea. And whilst it may be muscles and joints showing the problem (my lady with the vaccine reaction had been previously diagnosed as 'musculoskeletal' by the GP), if this is caused by some other problem then rubbing muscles etc will at best be only an element of the treatment.

 

[knocked up]

thanks for your replies. He is a lot better, more movement, but unfortunatley still very sore, pain more down his arm now, very strange as it would seem he didnt pull or at least remember hurting himself. I think it could be an accumulation of things, work etc. If it doesnt improve over the next few days I think he will be returning to the clinic.

 

[KatC]

I'd explore serratus anterior, serratus posterior inferior, quadratus lumborum, supraspinatus and especially pect minor and scalenes as brachial plexus impingement may be an issue.

Does he get stiff around the back of the neck?

 

[Ask and Answer]

Hi All

I'm new to the Healthy Pages Forum and thought I'd join in on the discussion.

My general advice when working with any client is to only treat someone if you are confident and feel you have the skills to provide the appropriate massage techniques.

As your husband has already been checked out at the clinic and advised by the doctor that it is a muscular problem I would proceed with that advice.

The symptoms that you have described do support that diagnosis and the radiating pain suggests that the tension in the muscles around the shoulder and scapula is causing referred pain down the ulnar nerve.

I think that your husband could be very affectively treated with massage therapy but by a therapist that has confidence and experience treating someone with such an injury.

I think that it's very important as therapists that we feel okay to admit when we don't feel confident to treat a particular ailment.

There are so many different levels, styles and techniques to massage generally people don't understand that we all work in different ways and have different strengths and abilities.

Perhaps is there another therapist in the area that you could refer onto?

I hope this is of help

Rachael Hibberd

 

[Isha]

hi kevin, thanks for your advice. yes he is stiff around back of neck, more so today. I noticed yesterday that the muscle in bicep area was very tight and got red when massaged its not as tight today. The muscles in the trapezius area are definitley looser today and he was able to tolerate a massage on my massage chair this evening. I have been rubbing some tiger balm into the areas most affected. He is still sore but definitley on the road to recovery I think.
Cheers

 

[ahcfcgkp]

Good for you doolin, hope he makes a full recovery soon

 

[Daniii.]

You're welcome Doolin, glad things are looking up. I usually find that stiffness around the back of the neck comes as a result of the posterior muscles being overworked as a result of opposing shortened scalenes, he may have a head forward posture. I often get into the deep neck flexors too, longus capitis and longus colli. I also find occipital work useful when scalenes are in trouble, especially if the problem is chronic, this area becomes a secondary issue.

I saw a client who had been diagnosed as having a torn pectoral muscle by his GP. It was brachial plexus impingement by the scalenes. Chest pain had gone completely by the end of the session and I hadn't done any work on it. It is an area that is too often overlooked. Biceps pain can come from supraspinatus trigger points and also, again, scalenes. I tend to rule out the possible remote causes before treating an area directly.

Oh well, massage can take you on some fascinating journeys!!

 

[Death.Before.Dishonor]

Yes but you still need to work out why this has happened.

Nothing happens for 'no reason', we're all subject to the laws of nature, so unless you are sure the cause has gone away, local treatment of the affected area can mean a repeat episode awhile later, or the problem popping up again elsewhere in the body. Either way, it can appear as a more serious matter.

This is not trying to scare anybody, just a plea to think more widely than the symptomatic tissues, and you can think as far away as you like in the body or environment, cause can be quite remote. Strain arrives in the body for a reason, and when it leaves, it often does so visibly. I'm wary when problems come for no apparent reason and melt away again apparently without consequence.

 

[weowhwmd]

I have just offered a few pointers, starting points really. There was no intention of providing a comprehensive treatment plan. I don't need to work anything out.

 

[hoqxzqvg]

My apologies, I'll rephrase that - one still needs to consider cause.

For some, pain in one muscle may be caused by tension in another. An interesting referral pattern may be due to a trigger point, say. That's okay, but then what has caused that?

It's very seductive treating the musculoskeletal system as a discrete entity, whereby anything that happens in one part can be linked and limited to something in another part. Sadly, due to the nature of viscero-somatic and somato-visceral reflexes, nothing is quite so simple. The whole posture, locally and globally does twists and turns around the needs and activities of the organs, and the mind.

It's easy enough to demonstrate these things, just go and yell at somebody in the street and observe their posture change before your eyes (please don't actually do this!). Or drink two bottles of wine every night and stay up until sunrise for a week, and watch your weight-bearing shift as the liver swells. You may well experience right shoulder pain and even injury to soft tissue as the needs of the liver act by reflex to disturb the nutrition of the tissues of the shoulder area, C3-5.

Notice how the hair falls off the left forearm following a heart attack. It may be preceeded by left arm and jaw pain, with postural changes. It may even be misdiagnosed as a shoulder injury. How many times is right arm pain caused by a very irritated liver or gall bladder. It may not start as a muscle strain, but it may go on to become one.

It is said that when the seventh domino falls, many are satisfied to think that it is because of the sixth domino, but we all know it isn't the whole story. How to handle the actual complexity of the situation takes a whole different set of considerations.

It's not wrong, but there's more. If we don't step back and consider the wider context, we risk spreading the trouble.

 

[Waken]

kevin im afraid I had to look up scalenes, and its interesting what you said about the head forward posture as i had recently noticed he was doing this. Soreness still there but definitley not as bad.
I agree with you Kdvp as to "work out why it happened", to be honest I feel it is an accumulation of things, his work sometimes involves a lot of bending and lifting, (he's a printer) also as he hasnt been that busy in work he has spent long periods sitting on a stool reading, again, probably with his head forward. Also (and I think this is the main contributor, though he wont hear anything of it) a few months ago he bought a new motorbike which is taller than any ones he has had in the past, he is sitting straighter and as he is 5.4 he has to use his tippy toes to balance when stopped at lights etc, and leaning to one side.
Rachael I would gladly send him to another therapist with experience with this type of problem if i thought he would go, but he wont. Maybe he puts too much faith in my ability to help him and sure if nothing else at least I am gaining experience ha ha, but seriously I am confident in my technique and there has definitley been a huge imrovement.
Starr thanks for your comment

 

[Thamain P]

Motorbike may be an important factor, if the bike is taller but the bars are still low, then there may be a lot of weight on the front of the shoulders. Problems at the back of the shoulder are often caused by shortening of tissues at the front (pec minor, pec major) and a more protracted posture of the shoulder itself (rolled forward).

Generalised shortening of the anterior chain of muscles causes a poking forward of the chin with contraction of sternocleidomastoid. This is a stress or startle posture, may be associated with high adrenaline, or the flip-side, fatigue. Or simply sitting on a bike with a high seat and low bars.

Lastly, shoulder problems also often originate in a sway-back posture, which is the appearance of shortening of the latissimus dorsi. How often do we as adults hold our arms over our heads and allow this muscle to elongate? Not often in some cases. However, the role of the lats also involves balance of the pelvis, so the function of the lumbar spine and pelvis can easily be involved, and in turn, the big groups of stabilising muscles in the thighs.

In short, it's a whole-body problem, but hopefully those clues will help.