A ‘T–Bone’ At The Takeout

By

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 bones.

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 proved negative.

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 position.

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.