Pain in collarbone and down arms

by Sarah
(NYC)

Hi
My pain started 5 months ago; whilst weightlifting I felt something move under my collarbone.

I would then feel pain when lifting overhead or doing push ups etc. It gradually got worse and then I started getting sharp pain down my arm in my hands and up my neck. The pain varies in location but is specific at the time.

I first went to a chiropractor who said I have forward head posture and rounded shoulders. I've done many years of intense rowing and paddling, mainly on my right side where my pain is, and my right shoulder is lower than my left.

I then went to a physical therapist. The first one just treated me for a sprain, did a lot of massage and some shoulder exercises. The next one thought I may have a shoulder impingement, but after the exercises nothing was getting better - only worse. He thought it may be a tear so sent me to an orthopedic doctor.

By the time I got there, the pain was awful and almost constant. Just daily activities such as getting dressed, opening doors was hard. This doctor did a few quick movements and then sent me to a neck/spine doctor. He suspected a herniated disc so did an MRI.

The MRI shows a healthy neck. I took oral cortisone, which eventually eased a lot of the pain. The pain doctor suspects something is coming from the nerves under my collarbone.

I still feel something move under my collarbone now and again, and if I stretch my shoulders back I can sometimes move it on purpose. All doctors so far have ignored this.

I was able to function normally for a couple of weeks, (not exercise, just daily function) and the never pain is much better than it was, but I have had a few flare ups where it's excruciating again. I still can't work out properly, I can't be in the pushup position for long or lift anything heavy. It still hurts if I lean on that arm and quick, sudden movements are painful.

I avoid opening doors with it. There is still a lot of pain under the collarbone with certain movements and if I use my arm the pain travels down it again. Sometimes a movement doesn't hurt at the time, but a few minutes after it will be in pain.

The pain doctor suggested I see a neurologist. I've read up on TOS and it sounds like I have many symptoms. I'm not sure who to go to next.

Hello Sarah,
Thank you for a very full history.

Under the collarbone there are numerous structures, including the first rib, the group of nerves to the arm called the brachial plexus, and the artery that supplies the structures right down into your hand.

Herein lies the tests for thoracic outlet syndrome. Does working with your arm above your head, as in hanging the washing on a line increase, or relieve the pain running the limb?

Then there's a difficult and subjective examination called Adson's test. It measures the pulse in the wrist whilst decreasing the space through which the subclavian artery passes on it's way to the hand. Use the search function at Chiropractic Help to find it.

Do movements of the neck hurt? Does turning to the right and then looking up cause pain in the neck, and does it radiate down the arm?

Then there are various muscles and joints around the collarbone and shoulder that could be at fault. Has anyone tested the muscles isometrically; without movement of the arm?

Have the reflexes and skin sensation been tested? Nerve tension tests?

It seems to me, Sarah, that no one has got to the bottom of this; start looking for a FICS trained chiropractor; that's a sports injury qualification.

I hope this contributes.

Dr B

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