A ‘T–Bone’ At The
Victoria L. Magown, CMTPT, LMT and
George S. Pellegrino, LMT, CMTPT
Before leaving work, Mark decided to call ahead to his
favorite restaurant and order dinner to go. After picking up
his order, Mark got into his car and made sure the coast was clear
before he started backing out of his parking space.
Unfortunately, another vehicle moving through the parking
lot at an unsafe speed hit Mark’s car. The point of impact
on Mark’s car was between the two doors on the driver’s side.
This type of impact, when one vehicle hits another so that they form
a “T” is called a T-Bone.
Aside from the obvious trauma, a nasty bump on the side
of his head from hitting the driver’s side window, Mark suffered
a lateral whiplash of his neck.
When Mark came to MyoRehab for help, most of his pain complaints
had been adequately addressed. The pain of his shoulders, upper
back, chest, arms, forearms and hands remained.
Mark had already been tested for Carpal Tunnel and Thoracic
Outlet Syndromes. Carpal Tunnel Syndrome is caused by compression
of a nerve in the tunnel through the carpal bones. Carpals
are the bones of the wrist and the tunnel is the space between the
Thoracic Outlet Syndrome is typically caused by the first
rib pressing against the collarbone and compressing the nerves and
blood vessels going into the arms. He was also screened for
a bulging or herniated disc in the neck. All of these tests
Treatment of the shoulder and arm muscles was to no avail.
He was given a variety of exercises some of which were for his neck.
Mark told us that after exercising, he was typically in more pain
which he assumed was from the use of his arms.
After reviewing his medical history, we had Mark perform
Range of Motion Tests looking for areas of restriction and pain.
Although the Range of Motion Tests did not produce neck pain, we
noticed considerable restriction when Mark attempted to bring his
ear to his shoulder.
We asked Mark to hold this position for a few seconds.
The cause of Mark’s shoulder, upper back, chest and arm pain became
clear. There is only one muscle that can cause pain in all
these areas at once.
As you can see from the illustration, the culprit of Mark’s
pain was not in the arms at all. The Scalene muscles, found
on either side of the neck, can become injured when acutely overloaded
during a side to side whiplash injury.
When this happens, Trigger Points can develop in the Scalene
muscles. A Trigger Point is a hypersensitive spot in a muscle
that when stimulated, produces pain that is referred in a predictable
pattern away from the Trigger Point.
When Mark saw the picture of the Scalene muscle and pain
pattern with all the pain he had been experiencing, he exclaimed,
“That’s why I thought I was having a heart problem”.
The Scalene muscles can mimic the pain of angina in the
chest and down into the arm. Also, Mark mentioned how he would
wake up in the morning with his hands puffy and swollen. This
can happen when the tight Scalene muscles compress the subclavian
vein found at the base of the neck.
After treating the Scalene muscles, part of Mark’s Home
Exercise Program included specific neck stretches to retrain the
Scalene muscles to stay at their full, normal length, pain free.
Since it is important to keep the neck in correct alignment
when sleeping, so as not to shorten the Scalene muscles, we gave
Mark a cervical pillow contoured to support his neck weather lying
on his back or side.
We also instructed Mark in the correct ergonomic design
of his computer workstation. Mark had been holding the phone
between his left ear and shoulder, keeping the Scalene muscles in
a shorten position which kept reactivating the Trigger Points.
We suggested the use of a head set to keep the head in a neutral
Has there been a “T-Bone” in your life? Do you have shoulder,
upper back, chest, arm and hand pain?
Give us a call at MyoRehab.