Check the Trunk Before the Branches

I want to share a quick patient history that perhaps will save you from wasting your time and money in the future.

This is about a forty five year-old female with complaints of acute onset right shoulder and neck pain that had developed while snow boarding in Utah.  She had already been in my care for a left ankle issue when she texted from her trip alerting me to her new intense pain.  She was intent on coming back to New York to be seen immediately by her doctor.  In short order, she convinced her doctor to order an MRI and received an injection to the shoulder.  But she was NEVER ASSESSED BY THE DOCTOR!

Three days after receiving the injection, my patient was back in my clinic in the same level of pain.

After I put her through a series of muscle tests, there was ZERO pain provocation surrounding the shoulder.  However, both palpation (touch) and cervical (neck) motions caused pain to radiate into the spots in her shoulder and arm that she had reported to her doctor.  This afternoon, her MRI report came back which revealed that absolutely nothing was unusual.

The pain was felt by my patient primarily in her shoulder and arm, but in her case it was not where the issue originated.  Yet she underwent an expensive imaging examination and misguided injection with no positive results.

What's the point?  Your pain is a symptom that does not necessarily correlate to tissue damage in that same spot.  It can be referred from somewhere else.  Here's a quote about pain that I recently ready in Tom Myer's "Anatomy Trains":

"When a crime is committed, it's the victim that cries out, not the criminal."

If you find yourself with pain in your arms or legs, check the spine first.  Then work your way down from proximal (close to trunk) to distal (away from trunk).  The nerves that emanate from your spine branch out to reach all aspects of your body, providing both sensory and motor function.  Think of it as your body's switchboard.  Going right to the point of pain to treat would be like changing the bulb in darkened room without first checking the circuit breaker.  Check the source first, or you'll wind up frustrated, in pain, and in the dark.

A basic orthopedic examination ought to be the norm when you visit your doctor in pain.  But in today's hyper kinetic health care environment, you can't assume that will happen.  Instead, you've got to be your own biggest advocate.  Demand to be thoroughly assessed by your doctor.  If they don't lay a hand on you, consider that to be a red flag.  You will save yourself a lot of time, frustration and unnecessary costs by doing so.