Midline periscapular pain refractory to PT

[ED50]

How do you manage these patients? Any specific workup you like to preform. IMO usually myofascial and give handout for mid and lower trap strengthening. Curious what everyone else is doing

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[Baron Samedi]

- Eval for atypical cervical radic and/or facet pain.
- Myofascial release techniques
- Talk about stretching and rear delt/rhomboid exercises
- Direct female patients to abrathatfits online calculator
- Dry needling
- Trigger point injections
- Occasionally botox

 

[MD87]

How do you manage these patients? Any specific workup you like to preform. IMO usually myofascial and give handout for mid and lower trap strengthening. Curious what everyone else is doing

MRI cervical to make sure nothing interesting causing scapular pain. Image thoracic to make sure no scoliosis. If nothing mechanical (snapping, clicking of the scapula) I send for acupuncture/OMM. Nothing exciting. Like you said, usually myofascial. Tell them to work on desk ergonomics in addition to traditional stretching/strengthening.

 

[RoloTomassi]

Lower cervical, upper thoracic MBB/RFA

 

[MitchLevi]

Scapulothoracic bursa injections.

3cc local with 40mg Depo

Lay prone with the hand on the small of the back to elevate the scapula. Spray cold spray. Insert needle deep to the scapula but not into the lungs. Inject meds. Drive home in a Ferrari.

 

[Dr. Ice]

How bout Notalgia paresthetica? No pain, or burning, no rash, no upper extremity symptoms. Mild neck pain. Mri c-spine shows small paracentral disc at c5-6 c6-7. Derm work up negative

Thinking of trying cervical esi

 

[Ligament]

C5-7 RFA
C8-T2 RADIOFREQUENCY ABLATION if that does not work
Dorsal scapular nerve hydrodissection
Chiropractic
intercostal n. blocks over the area

 

[nvrsumr]

Agree with cervical mri and possible cesi.

 

[lobelsteve]

How bout Notalgia paresthetica? No pain, or burning, no rash, no upper extremity symptoms. Mild neck pain. Mri c-spine shows small paracentral disc at c5-6 c6-7. Derm work up negative

Thinking of trying cervical esi

Not indicated. Try triple cream.

 

[bedrock]

Just ache or spasm then above suggestions.

If a burning pain component then CESI.

 

[painfree23]

stim?

 

[nerve zapper]

To add to what others have said, consider costotransverse joint or costovertebral joint arthritis. Could do a CTJ CSI under fluoro.

 

[painfree23]

To add to what others have said, consider costotransverse joint or costovertebral joint arthritis. Could do a CTJ CSI under fluoro.

do you have fluoro pics of this?

 

[oreosandsake]

draw on picture where this pain is. curious what you are referring to

 

[SeniorWrangler]

Scapulothoracic bursa injections.

3cc local with 40mg Depo

Lay prone with the hand on the small of the back to elevate the scapula. Spray cold spray. Insert needle deep to the scapula but not into the lungs. Inject meds. Drive home in a Ferrari.

It's the little things that matter in pain medicine.
I got a lady back in her kayak with this technique.