Pain in collarbone and down arms

by Sarah

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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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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Greetings, Dr B.
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