Pain around the thoracic/chest region in the back, and occasionally referring around the chest, can be very difficult to diagnose. The pain can be variable – burning, stinging, electric, sharp and aching. There can occasionally be muscle tightness which can also contribute to shoulder or neck pain as well as the pain in the upper back. There are several possible causes for pain in this region – but one possible cause that we may be considering is entrapment of a nerve in this area called the dorsal scapular nerve and another nerve underneath called the accessory nerve.
This nerve is increasingly recognised as a possible cause of pain in this region. It is often seen in those people who do physical exercise such as gym or boxing and build muscles around their upper back, and also in those who do repetitive motions such as using computers or their arms for repeat activities. It is often seen in younger people but can occur at any age.
It is not commonly thought of as a cause which may be why it has not been discussed before. The nerve is too small to be seen on imaging such as an MRI, and it can be difficult to examine as it is just off to the side of the middle of the spine. We can try and apply pressure over the nerve to see if it is very sensitive but even this does not always confirm or deny the diagnosis.
We suggest the best way to try and diagnose whether this is a problem for you or not is performing a simple diagnostic block of local anaesthetic next to the nerve. This is placed under the skin under ultrasound so we can see your anatomy clearly and put the anaesthetic in the right place. If your pain is taken away for as long as that local anaesthetic lasts, then it helps confirm the diagnosis.
If we can confirm this as the cause, then we can explain more about the condition to you, and you will have some certainty about what is contributing to your pain. Further options include intensive physiotherapy to work on the muscles around the rhomboids, trapezius and latissimus dorsi and pulsed radiofrequency ablation – a minimally invasive option that aims to dampen pain in the nerve for a period to allow you to move more normally, not require as much medication, and allow you to perform physiotherapy exercises without experiencing significant flares of pain.
Pain around the thoracic/chest region in the back, and occasionally referring around the chest, can be very difficult to diagnose. The pain can be variable – burning, stinging, electric, sharp and aching. There can occasionally be muscle tightness which can also contribute to shoulder or neck pain as well as the pain in the upper back. There are several possible causes for pain in this region – but one possible cause that we may be considering is entrapment of a nerve in this area called the dorsal scapular nerve and another nerve underneath called the accessory nerve.
This nerve is increasingly recognized as a possible cause of pain in this region. It is often seen in those people who do physical exercise such as gym or boxing and build muscles around their upper back, and also in those who do repetitive motions such as using computers or their arms for repeat activities. It is often seen in younger people but can occur at any age.
It is not commonly thought of as a cause which may be why it has not been discussed before. The nerve is too small to be seen on imaging such as an MRI, and it can be difficult to examine as it is just off to the side of the middle of the spine. We can try and apply pressure over the nerve to see if it is very sensitive but even this does not always confirm or deny the diagnosis.
We suggest the best way to try and diagnose whether this is a problem for you or not is performing a simple diagnostic block of local anaesthetic next to the nerve. This is placed under the skin under ultrasound so we can see your anatomy clearly and put the anaesthetic in the right place. If your pain is taken away for as long as that local anaesthetic lasts, then it helps confirm the diagnosis.
If we can confirm this as the cause, then we can explain more about the condition to you, and you will have some certainty about what is contributing to your pain. Further options include intensive physiotherapy to work on the muscles around the rhomboids, trapezius and latissimus dorsi and pulsed radiofrequency ablation – a minimally invasive option that aims to dampen pain in the nerve for a period to allow you to move more normally, not require as much medication, and allow you to perform physiotherapy exercises without experiencing significant flares of pain.
Your team and Resolve Pain can help you diagnose and manage this condition. Contact us below to find out how to see our health professionals.
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