Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Referred Pain From The Upper Back

AETIOLOGY

Shoulder injuries often cause pain around the upper back and vice versa. Thoracoscapular instability is an example of a functional problem that causes upper back and shoulder pain. Such dysfunctions can occur after a backwards fall to the ground or after immobilisation. Costo-vertebral dysfunction can also cause similar symptoms. 

CLINICAL FINDINGS

Whenever there is shoulder pain but the shoulder appears normal on examination the cervical spine and upper back must be examined thoroughly. The active range of motion should be tested in all directions and repeated against manual resistance. Gentle compression tests may or may not increase suspicion. A ‘press against the wall test’ will reveal a gradually increasing winged scapula and ‘angel manoeuvres’ will reflect the control of the scapula, comparing left and right. A ‘springing test’ against the costo-vertebral joints may reveal problems that might be treatable with gentle manipulation 

INVESTIGATION 

This is a clinical diagnosis. X-rays should be taken in different planes to rule out bony pathology. MRI is usually normal. Individual discussion with the radiologist is important.

REFERRALS 

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for a functional test of the upper back. A thorough rehabilitation programme including specific treatment,thoraco-scapular control training, strength, flexibility and posture training is required.

EXERCISE PRESCRIPTION 

Most sports and activities are possible but secondary symptoms due to compensatory movements are common and must be addressed. Running and swimming may be possible. The specific rehabilitation should aim to achieve over time a full range of controlled motion, good posture and thoraco-scapular control.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. Previously positive tests should be negative. Functional strength, control and flexibility should be restored.

DIFFERENTIAL DIAGNOSES

Many shoulder injuries can cause back problems and vice versa. The primary cause of the problems must be found. It is important not to forget non-musculo-skeletal causes of back pain, such as pneumonia, tumours, cardiovascular problems or other internal ailments.This is a clinical diagnosis. X-rays should be taken in different planes to rule out bony pathology. MRI is usually normal. Individual discussion with the radiologist is important.

PROGNOSIS 

Excellent-Poor, depending on the underlying problem

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