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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35430
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have asked before and never got a satisfactory answer. I

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I have asked before and never got a satisfactory answer. I have Spinal stenosis of the cervical spine and well as changes in the cervical spine with a doctor sometime ago telling an xray showed the first cervical vert. was ok but the rest were fusing together. I now have this sore spot in the 3rd or 4th. cerv. vert. area that is just to the right of thise cervical vert. I have had therapy for pain from that one spot to about my shoulder blade and I am constantly told that it is muscular in nature but nothing else. the therapist and my girlfriend both can put their finger right on the spot and it is very painful. The pain from there to my shoulder blade area is like a knife in my shoulder being twisted and it it like a dull toothache. I use pain patches, sprays, and pain pills but they are only temperorary and don"t last. Is this from a bone spur in my spine or something aggravating a nerve? Should a push to see a Orthopedist or get a shot in that area? Why is is so sore on just that one spot? When I stand up and walk a little I have to sit down shortly because the discomfort is so annoying I just can not hankle the discomfort. Help
I am Dr. Arun and will be helping you today.

This is very likelihood to be myofascial trigger point. This can be associated with degenerative disc disease in neck (cervical spondylosis) and spinal canal stenosis. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. When predisposing factors combine with a triggering stress event, activation of a trigger point occurs. Myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression. The nerve underneath it can cause radiculopathy symptoms like pain, burning, spasm etc which aggravate on the pressure on the area / point. A steroid shot in it would help. You may consider consulting an orthopedic specialist or MD in physical medicine and rehabilitation. The comprehensive treatment is following;

1) passive stretching of the affected muscle after application of sprayed vapocoolant

2) physical therapy

3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation

4) local analgesic patch / ointment / spray

5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)

6) ischemic compression therapy; pressure on the point

7) massage

8) steroid shots

9) acupuncture

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer: replied 4 years ago.

Dr. Arun: I think you may have finally diagnosed this problem correctely. I have what you describe with a very sore and tender spot about the size of a quarter or halfdollar I would estimate and the pain and discomfort radiates on a line from that spot right over to just about my shoulder blade. Could you tell me if these trigger points could have pain that wraps around to my chest area that would be right equal to where the pain is on my back near my cervical spine? I have thought for a long time that this upper chest discomfort was costochondritis since it seemd to be in that general area. Also, I have seen mini tens unit on HSN so would that be ok to use? It only lasts about 30 minutes and then shuts off. I think we are finally on the right track. Thanks

You are very welcome, Lawrence.

Trigger points can cause pain which wrap around the chest, due to pressure on the underneath nerve. TENS can be tried and two 30 minutes sitting a day would be good. Though the best therapy is local therapeutic ultrasound which is extremely efficacious.

It is privilege assisting you.

Dr. Arun