Sharp stabbing intermittent occasional pain inside shoulder

by PersistentLifter
(Rennes, France)

Locate the wrist pulse; turn your head left, look up and take in a deep breath. Does it affect the pulse?

Locate the wrist pulse; turn your head left, look up and take in a deep breath. Does it affect the pulse?

Sharp stabbing intermittent occasional pain inside shoulder is near the insertion of the subscapularis muscle.

I have been researching my problem on Google and Webmd and have attempted to use the wonderful videos on youtube.com to self-diagnose my problem: simply put, a sharp stabbing near-crippling pain similar to an electric shock, that is fortunately occasional (a couple times a day) but completely unexpected INSIDE the left shoulder (left side only, trap-clavicle-deltoid region but INSIDE if that makes sense. The pain does not radiate anywhere else.

From the hours spent googling similar conditions I have narrowed it down to either a suprascapular nerve entrapment (intermittent) on the notch (most likely) or thoracic outlet syndrome (less obvious).

The pain is near-crippling but has a duration around a second or so, not more and is UNexpected. I can somewhat pre-empt these "attacks" but either tilting my head/neck to the left side and placing it plum along the left trap muscle for a few seconds or by pulling my scapulae and shoulders back AND "packing" my neck and head in the so-called double-chin position for a few seconds and contracting forcefully.

I have been working out with weights for several years at this point, but I used to suffer from said "electric shock" back when I was a kid way before I began lifting, albeit very less frequently, say once a year.

My GP said its a nerve issue not tendinal and recommended I learn to "live with the pain". I visited a good osteopath in France who told me to focus aggressively on horizontal rowing movements, focusing on the COMPLETE movement with retraction of scapulae and reduce bench pressing a bit. He said my shoulders were too far forward and that I should focus on perfect posture. He did not recommend much else, but after he "cracked" my upper back the pain vanished completely for a few weeks, and then returned.

So here I am, I know that if I keep my scapulae pulled back with an externally rotated humerus and head in the "packed" position and contract forcefully for 15 seconds the pain strikes much less frequently, but it can and does if I slip up and try to reach for something on the other side across my body. ONLY ON THE LEFT SIDE, that is.

Any insight would help. I'll be following your site and comments. I am guessing arthroscopic surgery (to remove any possible cysts in the scapular notch) would be the logical solution.

Good morning Atlas,
You have focused on what prevents the pain, but much more significant is what provokes the pain; it's interesting that if you reach across your body to the right then you'll get a stab; that's very significant.

So is the fact that the manipulation of your upper back completely relieved the pain for a few weeks; why didn't you continue for a course of treatment? Rome wasn't built in a day, nor a shoulder fixed that goes back to your childhood.

Do any movements of your neck provoke the pain? Probably not, I suspect.

With your left elbow at your side and the lower arm jutting forwards at right angles, grasp your left wrist with your right hand. Press inwards against the right hand using your shoulder muscles, then pull outwards. What happens?

With your left arm straight out in front of you, palm up, followed by thumb down, lift your left arm against the resistance of your right hand, using the left shoulder muscles. Again, what happens?

Other tests are more complicated. Obviously I can't examine you, and so all of this is very speculative, but my suspicion despite your GP's opinion, I suspect this is a tendinitis; biceps and subscapularis are big contenders for the prize.

An ultrasound scan would be a great help in making the diagnosis, but only in the hands of a free experienced radiologist; difficult to interpret the results.

I hope this contributes.

Dr B



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Nov 20, 2016
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Response to Dr.B from PersistentLifter
by: PersistentLifter

Roger again, Doc.

One piece of information that may be helpful for anyone else having thoracic outlet syndrome (assuming that I have an intermittent form of TOS) - face pulls (video below)

Ever since I reintegrated this movement my scapulae flow fluidly and my T spine seems more stable (stopped clicking it manually as well)

https://www.youtube.com/watch?v=u9TvW5bvXxE

I even practise the movement at home without any additional load. My posture is also way better, I just keep the pulley a bit higher.

Hello Roger, this position of the pulley changes everything, good that you're thinking.


To keep balance in your exercise regimen, remember that using a pair of garden clippers, turning a compost heap, swimming and tennis for example make for a more complete athlete; also being in the great outdoors does wonders for the psyche.

Dr B

Nov 16, 2016
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Response to Dr.B from PersistentLifter
by: PersistentLifter

Roger that, I'll ask my osteopath to perform the Adson's test.So the brachial plexus could be affected by either the clavicle, the anterior scalene or the first rib. That information alone is worth its weight in gold. The info about Adson's test is worth even more.

http://humananatomy.co/wp-content/uploads/2016/07/scalene-muscle-the-scalene-trigger-points-upper-body-troublemakers.jpg

The shock is around the same level as the clavicle in the general vicinity of the point labeled in the figure.

I don't perform any real manipulation, my upper T-spine (maybe T1 to T2 or T3) seems to bulge out slightly whenever I get the "shock" and I simply push it back in place with my index finger and light pressure (light crack). If I walk around with my chest thrust out like a peacock (with shoulders pulled back à la perfect posture, the T-spine does not shift)

The "thoracic outlet" is a space between these structures in which the subclavian artery and brachial plexus can be affected. Look up thoracic outlet syndrome at chiropractic help.

You can see them exiting via the interscalene triangle in the graphic you sent before entering the thoracic outlet.

If T1 clicks like that, must be unstable. Especially avoid pull downs.

Dr B

Nov 15, 2016
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Ultrasound results
by: PersistentLifter

Here I am again.

Ultrasound was inconclusive - found no pathology in biceps, shoulder, subscapularis etc. The radiologist feels it could be a projection of a spinal issue.

my Opinion: i dont think there is any nerve pinching in the spine, but the pain seems to occur whenever I "lose" the spinal curve in the thoracic region (T-spine bulges out below the C-spine before I crack it back). However it could simply be that the brachial plexus is severely constrained for space and one of the following (scapulae, clavicle, pec minor, bicep tendon etc) compresses it briefly since the whole scapular region probably shifts a bit forward when I lose the T-spine curve. I could have a slight morphological irregularity in the scap etc that causes the intermittent compression

I will ask for a scan of the upper thoracic region (ultrasound) to see if any of the discs are herniated or arthritic? Since IF i can easily maintain the T-spine curve without effort, I can avoid the nerve compression no matter where it is happening.

This could also explain why the spinal manipulation works well - post manipulation the vertebrae are in the right spot and so is the left scapula.

Is there any way to ensure a tight T spine curve? Hydration an heavy face pulls probably? YTWLs?

A biokineticist could answer these questions better.

You talk about a manipulation you do; is that with your finger, or do you physically crack the joint?

If the brachial plexus is affected by structures like the clavicle or first rib, or anterior scalane muscle, then the radial wrist pulse will be affected. As your chiropractor to Do Adson's test.

I'm afraid that without examining you myself, which ain't gonna happen, I don't think I have a great deal more to contribute.

Don't deliberately click your neck; it just becomes more and more unstable.

Dr B


Nov 11, 2016
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Response to Dr.B from PersistentLifter
by: PersistentLifter

Perfect posture (packed neck, slight external rotation and scapulae pulled slightly back) pre-empts the shock, as does tilting my head and laying it sidewise plum along the left shoulder. Whenever I do get the shock, I run my hand along the T-spine and voilà, its slightly out of alignment and I push it "back in".

The good news is I live in France, so I can get as many scans as I need! I'll get right on the tests you recommended, Dr.B.

You don't have a practice in France, do you?

Alas not. Let me know. Second opinion never a bad thing.

It's good you can move your head like that without pain; a disc injury would immediately provoke.

Dr B

Nov 09, 2016
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New diagnosis
by: PersistentLifter

Hello

I had a second examination by my osteopath and I asked him point blank what is impinged and where?

is answer: A pinching electric shock sensation is a sign of an intermitten nerve compression and the location is in the "brachial plexus" group of nerves.

Whats causing the intermittent pinching? the ultraound will hopefully tell the story and we wont need an MRI.

True but I would have expected symptoms down the arm.


Nov 06, 2016
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Post-Scriptum
by: PersistentLifter

I do agree with the need for an ultrasound and MRI. Ill get right on that. Thanks for everything, Doctor.

Start with the ultrasound of the shoulder, rotator cuff, biceps muscles. Cheap.

An MRI is very expensive.

Dr B

Nov 06, 2016
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Response to Dr.B from PersistentLifter
by: PersistentLifter

Hello Dr.B

Thank you so much for your insight. The movements you suggested cause me no pain. I have not lost any strength in pressing or pulling exercises in the gym, other than detraining by avoiding certain variations of the power movements to improve my posture.

Movements of the neck typically do NOT provoke the "shock". To be honest,I am never guaranteed the "shock" even if I reach to the other side, or let the left shoulder move forward. I go some days never getting the "stabbing sensation" at all, even weeks. It pops up without warning, however, usually only when my left shoulder is slightly "ahead" and/or internally rotated.

I have worked out that

(1) By reaching behind me and feeling my upper thoracic spine, if the top few discs feel "out of place" (happens more than occasionally - osteoarthritis perhaps? I am only 37) anyway I can usually with very very slight palm pressure and slightly rotating my neck to the left and right, MOVE the "top spine" back into position with a tiny crack. The "forward head" position usually causes this "displacement" of my upper thoracic spine and if I maintain a slight "packed neck" position (double chin) I avoid the upper spine going out of place and then I do not get the shock no matter what.

(2) The other solution to "avoid" the pain is keeping the left shoulder behind with a chest out position and in slight "external rotation".

SO basically if I keep perfect posture I do not get the sensation. If I DO slip up I do not necessarily get the "shock". I sometimes do, sometimes do not - which suggested some kind of neuropathy.

I'm trying to follow you, but it's not clear; certainly it sounds like an upper thoracic spine problem, but I'm also thinking shoulder.

Try this Yergason's test. Any click or pain in the bicipital groove where the long head biceps tendon is located?

A brachial plexus will give you distinct neurological changes in the arm. Tingling? Use a pin - any numbness, or increased sensation?

Type upper limb tension test into the search site function in the nav bar at Chiropractic Help. You need a friend. Is there much greater tension, even pain in the lower arm? Were reflexes tested?

You need to locate where the pinching is occurring; you can't have scans of the neck, upper back, and shoulder.

Confess I'm unsure.

Dr B




http://www.pthaven.com/page/show/157396-yergason-s-test

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