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Spine and Back Health

Pinched Nerve

04/12/2000

Question:

I have been having a sharp pain that feels like it is under my right shoulder blade. It causes me pain when I breath in deeply and is making it hard for me to do heavy lifting with my right arm. Since it has persisted for almost 2 week and does not feel like muscle soreness, I am assuming it is due to a pinched nerve in my back.

I am waiting for my primary HMO physician to change to one I can trust, so I am trying to find some relief on my own until the change becomes effective. Does this sound like a pinched nerve? Is there anything I can do to treat it or relieve the pain on my own? Thank you!!!

Answer:

Your symptoms could be related to a pinched nerve at the neck (or less likely, across the shoulder blade) - although the pain with deep breath is not typical, unless you are holding that breath.

It may be appropriate to get a chest X-ray if you are a smoker, or have respiratory symptoms, weight loss, or fever. If it is related to degenerative arthritis of the neck, it is best to avoid aggravating activities, and aim for best head and neck posture, as well as looking at any possible repetitive strain activities ( like prolonged typing with awkward or static neck positioning). Avoid heavy or frequent lifting or overhead work.

If you are experiencing weakness or numbness into the shoulder or arm, it would be important to get diagnostic tests, such as MRI or EMG to better evaluate and guide treatment. Things you can do include the above + trying over-the-counter anti-inflammatory medicines ( Aspirin, ibuprofen, etc.), if these are safe for you to take. You can also try applying moist heat via a towel or heating pad, possibly alternating with ice packs, if it is very sore. These are usually applied to the neck for 15-20 minutes up to several times per day. Gentle range of motion is helpful to avoid stiffness. You may also get some relief of muscle spasm or soreness from a topical ointment or balm ( like Bengay, aspercreme, or Icy Hot), if these don`t irritate your skin.

If you find that you do have a pinched nerve, possibly from a degenerated disk, or vertebra, you might still avoid surgery if Physical therapy including cervical traction and isometric exercises, or stronger medications, such as oral steroids or stronger anti-inflammatory pills +/- muscle relaxants (possibly even limited narcotic pain medicines) are feasible. Chiropractors or osteopathic doctors (D.O.`s) can sometimes improve symptoms by careful spinal manipulations, if they are done when appropriate and cautiously.

If your symptoms persist, or worsen, it would be appropriate to see a spine specialist ( eg, physiatrist, Orthopaedic or Neurosurgeon, or Pain specialist) to consider injection procedures or surgery. I wish you good luck with your pain!

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Response by:

James Plunkett, MD
Assistant Professor of Physical Medicine & Rehab.
College of Medicine
University of Cincinnati