Shoulder and Back Pain: A Comprehensive Guide to Recovery

Sports injuries

My symptoms have persisted for four months, and I have gradually developed some additional related symptoms.
To provide a comprehensive account for professional evaluation, I apologize for the length of this description.
Initially, on May 7 of this year, after a weight training session focused on the chest and shoulders (during which I did not experience any pain indicative of strains or sprains), I noticed a sudden protrusion and swelling at the inner edge and lower corner of my right scapula while reclining in a chair reading after taking a shower.
The next day, during a deadlift, I discovered a decrease in strength and stability in my right shoulder, and my movements felt less natural.
Gradually, I began to experience soreness in the entire right shoulder and scapula.

On June 7, I consulted a rehabilitation physician who diagnosed me with myofascial pain syndrome of the rotator cuff muscles.
The doctor advised me to perform heat therapy, massage, and stretching at home.
Initially, this treatment was effective, but after about a week, the benefits diminished, and the soreness and unnatural sensations in my right shoulder and scapula returned.
After a month and a half (around mid-June), I began to experience tightness and soreness in the left side of my lower back, approximately at the left erector spinae area, and increased pressure in the front of my left knee (sometimes causing slight swelling and pain after prolonged walking).
Additionally, I started to occasionally feel numbness in my right shoulder and scapula.
By mid-July, I began to notice popping sounds near my cervical spine and the junction between the cervical and thoracic vertebrae (all on the posterior side of my body).
The day after experiencing these sounds, I suddenly noticed a popping sensation in my ear when swallowing saliva (as if the eardrum was gently being pressed by gas from the inside, leading to a slight feeling of fullness, but no pain).
The lower corner of my right scapula still felt somewhat protruded (I still felt discomfort when leaning against a chair back, as my right scapula felt more prominent compared to my left).
Later, I consulted other orthopedic and rehabilitation specialists, who suggested that my issues might not be related to the shoulder but rather to nerve compression in the cervical and lumbar spine, or thoracic outlet syndrome.
Consequently, I visited Mackay Memorial Hospital to see a neurosurgeon, who performed an electromyography (EMG) on my right arm.
The results indicated nerve compression at the right side of cervical vertebrae 6 and 7.
The doctor then decided to arrange an MRI, with the imaging results expected to be reviewed during my follow-up appointment on August 12.

Currently, I am also experiencing intermittent sharp pain in the anterior aspect of my left tibia (though this symptom actually occurred before my shoulder issues; I initially thought it was due to the tibia occasionally hitting the barbell during deadlifts, which caused cumulative injury.
After resting and avoiding deadlifts for a period, the symptoms disappeared, but they have recently recurred for unknown reasons).
Additionally, my left knee has started to make popping sounds when straightened, while my right knee remains completely normal.

Benson, 20~29 year old female. Ask Date: 2019/08/10

Dr. Wang Zhaomin reply Rehabilitation

Based on the description, it indeed does not seem to be a simple muscle or ligament strain, sprain, or inflammation.
Possible diagnoses have been listed, including cervical and lumbar nerve root compression or thoracic outlet syndrome.
It remains to be confirmed whether there are additional conditions affecting the left calf and left knee beyond strain and inflammation, such as shin splints, stress fractures, or joint laxity.
Please await the examination results and cooperate with your physician to receive a comprehensive treatment plan.

Reply Date: 2019/08/10

More Info

Understanding shoulder and back pain, especially after a workout or injury, can be quite complex. Your symptoms, which have persisted for four months, indicate a multifaceted issue that may involve not only the shoulder but also the cervical and lumbar spine. Let’s break down your situation and explore potential recovery strategies.

Initial Symptoms and Diagnosis
You mentioned that your symptoms began after a weight training session focused on the chest and shoulders. The sudden swelling and discomfort in the right shoulder blade area, followed by a decrease in strength and stability, suggest a possible muscle strain or overuse injury. The diagnosis of myofascial pain syndrome in the shoulder region aligns with your symptoms, as this condition often arises from repetitive strain or poor posture during activities.

Progression of Symptoms
As time progressed, you experienced additional symptoms, including tightness in the left lumbar region and occasional numbness in the right shoulder. The popping sounds in your neck and the sensation of pressure in your ears when swallowing could indicate cervical spine involvement, particularly if there is nerve compression at the C6-C7 levels, as suggested by your electromyography (EMG) results.

Potential Causes
1. Muscle Imbalance: The initial shoulder injury may have led to compensatory patterns in your body, causing strain in other areas, such as the neck and lower back. This is common in individuals who lift weights without proper form or adequate warm-up.

2. Nerve Compression: The findings from your EMG suggest that there may be nerve compression at the cervical spine, which can lead to referred pain and symptoms in the shoulder and arm.

3. Thoracic Outlet Syndrome: Given the combination of shoulder and neck symptoms, thoracic outlet syndrome could be a possibility. This condition occurs when blood vessels or nerves in the space between your collarbone and your first rib are compressed.

Recommended Recovery Strategies
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can provide targeted exercises to strengthen the shoulder girdle, improve posture, and alleviate muscle tightness. They can also teach you stretching techniques to enhance flexibility and reduce tension in the neck and shoulders.

2. Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. However, it’s essential to consult with your healthcare provider before starting any medication, especially considering your existing health conditions.

3. Posture Correction: Focus on maintaining good posture, especially during weight training and daily activities. Ergonomic adjustments at your workstation and mindful practices during exercise can prevent further strain.

4. Cervical Spine Evaluation: Since your EMG indicated nerve compression, it’s vital to follow up with a neurologist or orthopedic specialist who can assess the cervical spine through MRI or other imaging studies. This will help determine if surgical intervention is necessary or if conservative management is sufficient.

5. Gradual Return to Activity: Once your symptoms begin to improve, gradually reintroduce weight training, focusing on proper form and lighter weights. Avoid exercises that exacerbate your symptoms, and consider working with a trainer who can guide you.

6. Mind-Body Techniques: Incorporating relaxation techniques such as yoga, meditation, or deep breathing exercises can help manage pain and reduce muscle tension.

Conclusion
Your symptoms reflect a complex interplay between muscular, neurological, and possibly structural factors. A comprehensive approach involving physical therapy, pain management, and careful monitoring of your cervical spine will be essential for recovery. It’s crucial to maintain open communication with your healthcare providers and to follow their recommendations closely. With time and appropriate care, you can work towards regaining full function and alleviating your discomfort.

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