Back & neck pain (Rhomboid & Scalene)

by Rob

Hi there,

I recently saw a neurologist with regard to a 9-month long pain in my neck and upper back - After a lengthy consultation a possible cause for these hellish symptoms has been highlighted. He studied my cervical MRI but as the images weren’t clear enough for him to give me a firm diagnosis he suggested I have a higher quality MRI scan of my cervical spine.

He said he is 99% sure that the pain is being caused by 'foraminal stenosis' between the C5 & C6 vertebrae causing the entrapment of a nerve in my neck.

The issue is; he cannot diagnose whether the entrapment is being caused by the cervical vertebrae itself or if the compression is taking place in the scalene muscles within the neck and apparently the only way to diagnose this correctly would be to have an EMG nerve test and to then have a high-quality MRI scan of the cervical spine.

As my pain is constantly present in between the spine and right scapula and also in the front-right side of my neck with occasional tinging and coldness in my right hand there could be potential damage / entrapment of the Dorsal Scapula Nerve as my rhomboid is very problematic.

Can you recommend anything to ease the pain until I'm able to get these tests done / find a solution? Currently just started taking Naproxen, I was prescribed Diazepam, trying light stretches and light weights to keep the back muscles active (the pain isn't causing a loss of strength to what I can tell).

Many thanks,
London, UK

Hello Rob,
Yes, hellish is the word; this hurts.

A few important things:

1. Exactly where in the tingling in your hand; which fingers. This is vital.

2. If you turn to the right and then look up, do you get pain in the neck, midback or arm? Be specific.

3. Type Upper Limb Tension Test into the search function in the navigation bar. Do the test and tell me exactly what you feel.

4. Has anyone done Adson's test on you? Search for it too; testing the pulse in your wrist with certain specific movements of the neck. It's the definitive test for a pinched nerve between the scalenes. But a difficult test only be done by someone experienced with doing it regularly. You get many false positives; in normal people.

The dorsal scapular nerve is a C5 nerve, thus exiting between C4-C5, not C5-C6.

Added to those woes, is that the pain is sometimes caused by a joint in the midback; also one of the ribs.

Give me some answers; keep to this thread.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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