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  1. #1
    Ritual+Dilate Deadliftin's Avatar
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    Shoulder Pain that travels into Pec

    Evening all

    I frequent the supp section but often read other parts of the forum as well. I've been struggling the past month or so with a nagging shoulder injury and it's symptoms I haven't faced before. Before I go on... I totally get that I'm not going to get medical advice here and if it keeps up I'll need to see a doc. But here goes:

    1) The majority of the pain is near the front of my shoulder
    2) I also get pain down into my pectoral muscle as well as right around my collar bone
    3) Slight pain (not nearly as bad) more towards my scapula than the actual shoulder joint.

    My lifts haven't suffered... but the day after heavy upper body it's ridiculously painful. I've backed off the weights and been doing quite a bit of stretching and foam rolling to no avail. I don't recall an actual moment of injury... it just came on over the course of a couple of weeks.

    ROM is worse in this shoulder (left) than the other.

    I guess my main question is... are you aware of any common injury that causes pain both in the shoulder joint as well as upper pec and collarbone?

    Thanks
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  2. #2
    Ritual+Dilate Deadliftin's Avatar
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    bump?
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    Originally Posted by Deadliftin View Post
    Evening all

    I frequent the supp section but often read other parts of the forum as well. I've been struggling the past month or so with a nagging shoulder injury and it's symptoms I haven't faced before. Before I go on... I totally get that I'm not going to get medical advice here and if it keeps up I'll need to see a doc. But here goes:

    1) The majority of the pain is near the front of my shoulder
    2) I also get pain down into my pectoral muscle as well as right around my collar bone
    3) Slight pain (not nearly as bad) more towards my scapula than the actual shoulder joint.

    My lifts haven't suffered... but the day after heavy upper body it's ridiculously painful. I've backed off the weights and been doing quite a bit of stretching and foam rolling to no avail. I don't recall an actual moment of injury... it just came on over the course of a couple of weeks.

    ROM is worse in this shoulder (left) than the other.

    I guess my main question is... are you aware of any common injury that causes pain both in the shoulder joint as well as upper pec and collarbone?

    Thanks
    Hey dude,

    Could be trigger points - I did a search in google and found a good post. Unfortunately, I tried posting a link to a website but it won't let me because I'm new to this forum. The site is not mine but has some good info that might help. If you google 'shoulder injury referred pain pec' it should come up...

    Hpe that helps

    Al
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  4. #4
    Registered User Kjetil1234's Avatar
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    This is nerve pain. Read my thoracic outlet article. Take this seriously and educate yourself - the sooner you get into proper rehab, the better are your odds. There are close to no therapists out there that knows how to address this issue. Once again, educate yourself on this issue - it's your best chance.
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    � Did I answer your injury question? Please supply the following info: 1) EXACT spot of pain(s)? (put a mark on a picture); 2) what type of pain is it? (burning, radiative, lightning, aching, jamming up, etc); 3) EXACTLY what movement(s) provocate the same pain? Specifics matter!

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  5. #5
    Ritual+Dilate Deadliftin's Avatar
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    Originally Posted by Kjetil1234 View Post
    This is nerve pain. Read my thoracic outlet article. Take this seriously and educate yourself - the sooner you get into proper rehab, the better are your odds. There are close to no therapists out there that knows how to address this issue. Once again, educate yourself on this issue - it's your best chance.
    Very interesting... specifically because I'm headed to a neuromuscular disease center next week... I've waited 8 months for the appointment because of where my neurologist wants me to go. Suspected that I have small fiber neuropathy but wants me to get a full workup at a research hospital.

    I hadn't gone to the doc for this because part of me thought it could be related... seems it might be?

    Really appreciate your insight and I'll look for the article.
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  6. #6
    Ritual+Dilate Deadliftin's Avatar
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    I just read your article from start to finish... that's some pretty good stuff man. Thank you.

    Knowing now that it involves the Scalene muscles... the left side of my neck has variable pain... sometimes high up near my ear and bottom of skull and other times all the way down at my collarbone... but it never does feel quite right.

    The research hospital I'm going to looks to have some pretty deep research on TOS so I'm going to mention this to them.

    Thanks again.
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  7. #7
    Objective optimist Xuaxace's Avatar
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    A differential diagnosis to TOS would be cervical radiculopathy. I would expect a bit more symptoms down the arm if it was TOS (usually 3/4 people have some numbness in the hand area).
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    Registered User Kjetil1234's Avatar
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    Originally Posted by Xuaxace View Post
    A differential diagnosis to TOS would be cervical radiculopathy. I would expect a bit more symptoms down the arm if it was TOS (usually 3/4 people have some numbness in the hand area).
    Expecting is what makes people unable to treat this issue

    This article is concerned with thoracic outlet compression syndrome (TOCS), one of the most controversial subjects in medicine. It may also be the most underrated, overlooked, misdiagnosed, and probably the most important and difficult to manage peripheral nerve compression in the upper extremity. – Atasoy, 1996

    This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. Thoracic outlet syndrome is one of the most controversial diagnoses in clinical medicine. – Povlsen et al., 2014

    The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique – Sanders et al., 2008

    Conversely, no valid standard diagnostic test is available for disputed neurogenic TOS, resulting in controversies in the frequency of TOS diagnosis – Hooper et al., 2010

    Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. – Kknel, 2005

    The most commonly recommended interventions are strengthening and stretching of the shoulder girdle musculature.2,7,19,21 However, little agreement exists on which muscles need strengthening and which ones need lengthening.5 These types of exercises do not detail how they address functional TOS as a result of respiratory alterations and they do not aim to inhibit muscle.1,5,19 – Robey & Boyle, 2009
    Kjetil Larsen
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    � Did I answer your injury question? Please supply the following info: 1) EXACT spot of pain(s)? (put a mark on a picture); 2) what type of pain is it? (burning, radiative, lightning, aching, jamming up, etc); 3) EXACTLY what movement(s) provocate the same pain? Specifics matter!

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    Registered User Kjetil1234's Avatar
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    If this was a cervical hernia, I really doubt it would ray only into chest and shoulder. Typical TOS - and I treat TOS in my clinic almost every day. But sure, until he has an MRI it's hard to say for sure. IMO not necessary though.
    Kjetil Larsen
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    Owner of Trainingandrehabilitation.com

    � Did I answer your injury question? Please supply the following info: 1) EXACT spot of pain(s)? (put a mark on a picture); 2) what type of pain is it? (burning, radiative, lightning, aching, jamming up, etc); 3) EXACTLY what movement(s) provocate the same pain? Specifics matter!

    � Read my articles - https://treningogrehab.no/category/articles-in-english/
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  10. #10
    Ritual+Dilate Deadliftin's Avatar
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    Originally Posted by Kjetil1234 View Post
    If this was a cervical hernia, I really doubt it would ray only into chest and shoulder. Typical TOS - and I treat TOS in my clinic almost every day. But sure, until he has an MRI it's hard to say for sure. IMO not necessary though.
    I've actually had a cervical MRI as they were trying to narrow down what they now suspect is small fiber neuropathy. It was clear. A couple of small bone spurs but no pinching of spinal cord, narrowing of canal or herniated discs.
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  11. #11
    Objective optimist Xuaxace's Avatar
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    Originally Posted by Kjetil1234 View Post
    Expecting is what makes people unable to treat this issue

    This article is concerned with thoracic outlet compression syndrome (TOCS), one of the most controversial subjects in medicine. It may also be the most underrated, overlooked, misdiagnosed, and probably the most important and difficult to manage peripheral nerve compression in the upper extremity. Atasoy, 1996

    This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. Thoracic outlet syndrome is one of the most controversial diagnoses in clinical medicine. Povlsen et al., 2014

    The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique Sanders et al., 2008

    Conversely, no valid standard diagnostic test is available for disputed neurogenic TOS, resulting in controversies in the frequency of TOS diagnosis Hooper et al., 2010

    Diagnosis and treatment of thoracic outlet syndrome (TOS) involves neurologists, physiatrists, family physicians, orthopedic surgeons, vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists. Kknel, 2005

    The most commonly recommended interventions are strengthening and stretching of the shoulder girdle musculature.2,7,19,21 However, little agreement exists on which muscles need strengthening and which ones need lengthening.5 These types of exercises do not detail how they address functional TOS as a result of respiratory alterations and they do not aim to inhibit muscle.1,5,19 Robey & Boyle, 2009
    Fair point, I had TOS with ulnar pattern so I am a bit biased to link TOS with some arm symtoms.

    Originally Posted by Kjetil1234 View Post
    If this was a cervical hernia, I really doubt it would ray only into chest and shoulder. Typical TOS - and I treat TOS in my clinic almost every day. But sure, until he has an MRI it's hard to say for sure. IMO not necessary though.
    Shoulder referral is quite common for cervical radiculopathy, back scapular pattern is also relatively common. The upper chest pattern considerably less. I would still do a quick cervical neuro assesment just to rule it out, doesn't take long.


    Originally Posted by Deadliftin View Post
    I've actually had a cervical MRI as they were trying to narrow down what they now suspect is small fiber neuropathy. It was clear. A couple of small bone spurs but no pinching of spinal cord, narrowing of canal or herniated discs.
    Ops i missed this, I guess that is ruled out then.
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    Registered User rage1605's Avatar
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    Originally Posted by Deadliftin View Post
    I've actually had a cervical MRI as they were trying to narrow down what they now suspect is small fiber neuropathy. It was clear. A couple of small bone spurs but no pinching of spinal cord, narrowing of canal or herniated discs.
    I know this is an old article and I am dredging it up from the past but I thought I would share my experience in case anyone else is looking up TOS. I am hoping this helps someone out there and avoid the nightmare I lived through along with a misdiagnosis from well educated doctors.

    I lifted for four years before this happened and I never had an issue with weightlifting or a lot of pain after lifting. I will make this story as short as possible:

    One night after lifting I came home and started to make dinner and my shoulder started to throb, not a big deal, I took some advil and continued on. The pain kept increasing for the next hour and my hand/arm went numb and my shoulder started to swell. I tried sticking it out for another hour but the pain became intolerable (and I have a high pain tolerance) so I went to the E.R. near my house. At this time the pain was so bad I started to hyperventilate and I couldn't take the pain in my shoulder any longer. I was put on Dilaudid HP via IV and it did nothing to even take the edge off, so I was given another dose and blood tests were run.

    The doc came back and said my CPK level was at 19,000 (yes, 19k) which is Rhabdomyolysis levels and my kidneys started to become affected by it. I was rushed to the hospital and spent two days with a full IV drip among other things so my kidneys would not be damaged (luckily they were not). The doc's conclusion was that I over did it at the gym which is total BS because I have ran through the same program for a year now but I took his opinion and took six months off from the gym.

    I went back to the gym and cut the weights I lifted by 70% and I cut the reps in half. I started to work out again and I felt good, no pain or anything, so I thought I was out of the woods. Long story short, I got home and had the same issue...and back to the ER I went! This time, my CPK level was 29,000 something (close to 30k) and I was immediately sent to the hospital which I stayed for three days. A group of docs suggested I get a EMG test because they have only seen CPK levels this high with ALS patients or line workers that were electrocuted. Which is awesome to go through for three to four weeks when waiting for an EMG spot to open up, my family was devastated because the doc seemed pretty sure but wouldn't say so without tests. EMG came back fine along with every other test that was given to me over the course of three years and seeing 10+ doctors.

    I finally went to Rush University Hospital in Chicago and the head of the Neuromuscular Disease department couldn't figure out what was wrong. She attributed it to a rare muscular dystrophy disease that I probably inherited (no one in my family including my parents have ever had any issues with MD). I argued with her because I was tired of seeing clueless doctors and not caring about what was wrong with me. The doc finally gave in and had me do a blood test before I left her office and I was instructed to run on the treadmill for thirty minutes in the hospital gym (which I did) I was then ordered to get a blood test the next morning and if I had a rare form of MD, my CPK level should spike. A week later when I went back to my doc, to her surprise, my CPK levels were just fine, and in fact, it actually went down between my first and last blood test. My current doc was stumped so she sent me to the ex-white sox doctor, Dr. Charles Bush-Joseph. In 15 minutes (10 of which were recapping the three years of my ordeal) he figured out my condition. He held my wrist to feel my pulse as I moved my head from left to right, he couldn't feel my pulse when my head was in a certain position, I had TOS.

    Besides when I worked out, I never had any other symptoms besides maybe my arms falling asleep once in a while when I first wake up in the morning. I am a programmer so I use the keyboard a lot and I just chalked it up to a case of carpal tunnel.

    Anyway, I hope this helps someone out there because I believe a lot of people who are diagnosed with a RARE MD disorder (and are weightlifters) may be misdiagnosed. Most insurance companies will not pay for a test to find out what rare MD you have because most are not fatal and there are no treatments for the majority of them. Now, granted, my situation is rare with being hospitalized and having a high CPK level that nearly killed my kidneys twice but I hope this helps someone.

    As a side note, I say muscular dystrophy but the Rush doctors were referring to metabolic diseases of the muscle which I just lumped together with MD.
    Last edited by rage1605; 06-22-2021 at 01:02 PM.
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    Originally Posted by rage1605 View Post
    I know this is an old article and I am dredging it up from the past but I thought I would share my experience in case anyone else is looking up TOS. I am hoping this helps someone out there and avoid the nightmare I lived through along with a misdiagnosis from well educated doctors.

    I lifted for four years before this happened and I never had an issue with weightlifting or a lot of pain after lifting. I will make this story as short as possible:

    One night after lifting I came home and started to make dinner and my shoulder started to throb, not a big deal, I took some advil and continued on. The pain kept increasing for the next hour and my hand/arm went numb and my shoulder started to swell. I tried sticking it out for another hour but the pain became intolerable (and I have a high pain tolerance) so I went to the E.R. near my house. At this time the pain was so bad I started to hyperventilate and I couldn't take the pain in my shoulder any longer. I was put on Dilaudid HP via IV and it did nothing to even take the edge off, so I was given another dose and blood tests were run.

    The doc came back and said my CPK level was at 19,000 (yes, 19k) which is Rhabdomyolysis levels and my kidneys started to become affected by it. I was rushed to the hospital and spent two days with a full IV drip among other things so my kidneys would not be damaged (luckily they were not). The doc's conclusion was that I over did it at the gym which is total BS because I have ran through the same program for a year now but I took his opinion and took six months off from the gym.

    I went back to the gym and cut the weights I lifted by 70% and I cut the reps in half. I started to work out again and I felt good, no pain or anything, so I thought I was out of the woods. Long story short, I got home and had the same issue...and back to the ER I went! This time, my CPK level was 29,000 something (close to 30k) and I was immediately sent to the hospital which I stayed for three days. A group of docs suggested I get a EMG test because they have only seen CPK levels this high with ALS patients or line workers that were electrocuted. Which is awesome to go through for three to four weeks when waiting for an EMG spot to open up, my family was devastated because the doc seemed pretty sure but wouldn't say so without tests. EMG came back fine along with every other test that was given to me over the course of three years and seeing 10+ doctors.

    I finally went to Rush University Hospital in Chicago and the head of the Neuromuscular Disease department couldn't figure out what was wrong. She attributed it to a rare muscular dystrophy disease that I probably inherited (no one in my family including my parents have ever had any issues with MD). I argued with her because I was tired of seeing clueless doctors and not caring about what was wrong with me. The doc finally gave in and had me do a blood test before I left her office and I was instructed to run on the treadmill for thirty minutes in the hospital gym (which I did) I was then ordered to get a blood test the next morning and if I had a rare form of MD, my CPK level should spike. A week later when I went back to my doc, to her surprise, my CPK levels were just fine, and in fact, it actually went down between my first and last blood test. My current doc was stumped so she sent me to the ex-white sox doctor, Dr. Charles Bush-Joseph. In 15 minutes (10 of which were recapping the three years of my ordeal) he figured out my condition. He held my wrist to feel my pulse as I moved my head from left to right, he couldn't feel my pulse when my head was in a certain position, I had TOS.

    Besides when I worked out, I never had any other symptoms besides maybe my arms falling asleep once in a while when I first wake up in the morning. I am a programmer so I use the keyboard a lot and I just chalked it up to a case of carpal tunnel.

    Anyway, I hope this helps someone out there because I believe a lot of people who are diagnosed with a RARE MD disorder (and are weightlifters) may be misdiagnosed. Most insurance companies will not pay for a test to find out what rare MD you have because most are not fatal and there are no treatments for the majority of them. Now, granted, my situation is rare with being hospitalized and having a high CPK level that nearly killed my kidneys twice but I hope this helps someone.

    As a side note, I say muscular dystrophy but the Rush doctors were referring to metabolic diseases of the muscle which I just lumped together with MD.
    So uh..what you do with it?
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