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Scapular pain after an excision

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Scapular pain after an excision - November 30, 2007 5:47:56 PM   


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Joined: November 30, 2007
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First off, forgive me if my post is not entirely clear. Although I am about to graduate from nursing school, and thus have some medical knowledge, I may not be able to articulate mself as clearly as other posters here.

Two weeks ago I had two shallow excisions on my back to remove two moles. One was right over my left medial sacpular edge about halfway down and required two stitches. The other was over the spinal column between the shoulder blades and required 8 stitiches.

Two days after the procedure, I started to get left scapular pain in certain positions and when taking a deep breath. It was a deep muscle ache and I thought I must have strained something holding the neck oddly to avoid strain on the sutures and to keep the bandages from coming off.

The pain got worse and worse. Infection was ruled out. It was not responding to 500 mgs. Naprosyn twice a day. One doctor said it was a "pinched nerve" and another says that it is neuropathic pain of unknown etiology and prescribed Neurontin saying it might get better tomorrow or it might never get better!

I refused the Neurontin and, out of desperation took a loading dose of 1250 mgs. of naprosyn followed by 500 mgs. three times daily. The pain went almost completely away.

The pain originates in the lower medial edge of the scapula, which is an inch or two inferior to the nearest excision, both of which are almost completely healed now. However, the pain only appears in a few positions. When I sit down and my shoulders slump, the pain is excruciating. If I sit up and straighten my back, the pain completely disappears. If I reach down for something, like tying my shoes, the pain is terrible, but disappears as soon as I straighten up. Lastly, if I flex my neck forward, the pain appears at a certain angle, stays for 20-30 degress of the forward flexion, then disappears as I flex even forward.

It has seemed worse in the mornings and evenings the past few days and is starting to break through the high dose of naprosyn. As the day wears on, it starts to encompass the whole scapula at times, moving laterally in a line towards the tricep and down around the curve on the inferior edge of the scapula. For what it's worth, both traps. feel very tight as well, but no pain.

I realize it's difficult to tell by this description, but does this sound like a musculoskeletal issue? I feel like I did something in response to poor positioning after the procedure and that PT or massage may be the best approach. My doctor is very pessimistic and says that he doesn't know what it is and really refuses to do anything other than push the Neurontin. In short, I would really just like to get a consensus on whether or not this sounds like something that falls within the realm of PT or if I should start thinking more along the lines of some sort of Neuro./ chronic pain issue.

I am getting desperate as I can't keep taking the NSAIDS at this dosage forever and at the lower dosage, the pain was so bad that I was effectively disabled. I'm pretty scared at this point and don't know what is going on. Thank you so much for your time. I don't know if this is what this forum is meant for, but it would be EXTERMELY helpful to get your opinion. I know this is long but figure more information is better than not enough.Please let me know if you need any additional information.

Post #: 1
RE: Scapular pain after an excision - November 30, 2007 6:30:37 PM   


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Joined: February 14, 2003
From: Madison WI USA
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It absolutely falls within the realm of PT, and you should call your doc to request an "evaluation and treat as appropriate order" as soon as possible.  It sounds like a case of mechanical tissue strain, which can be quite irritating if there is greater strain on freshly cut/healing superficial nerve tissue.

Steve Hill PT

(in reply to sam5935)
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RE: Scapular pain after an excision - November 30, 2007 7:45:36 PM   


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Joined: November 30, 2007
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Thanks for your reply. You know, one thing I noticed today is that the shoulder on the affected side is much morecurved in toward the chest than the other. It's like the right shoulder is normal or "thrown back" and the left is hunched in towards my chest. It's fairly noticeable. For instance, if I stand looking at profile with my right side towards the mirror, the head of the humerus doesn't extend past the clavicle. However, on the left side, the head of the humerus is curved in well past the clavicle.

I appreciate your input and welcome anyone else's thoughts.


(in reply to sam5935)
Post #: 3
RE: Scapular pain after an excision - December 21, 2007 8:13:23 PM   


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Joined: August 8, 2007
From: Texas
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Does sound MSK soft tissue to me. Various techniques can help w your problem. One you can exp on your own, is whats called preferred pain pattern. You mentioned back straight w erect posture diminishes Sx's. Repeat that procedure few times per day, as well as work on your every day postural habits.
Get yourself to a P.T right away to explore and or continue this further.

Shame on the Dr who refuses to look at alternatives, given P.T Tx's its the obvious choice. Is he a neurologist by any chance??

(in reply to sam5935)
Post #: 4
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