Breast– (Some Post Mastectomy) & Chest Wall Pains – Easy Fix

Study of Scapulothoracic Bursitis – Though 78.6%  presented with the breast/chest pain, a tender area was found posteriorly on the medial aspect of the shoulder blade(scapula). Injection of steroid to area relieved the breast/chest pain as well in 83.5% of cases – confirming this was a Scapulothoracic bursitis. It was suggested that the bursa irritated nerves posteriorly projecting pain front-ward to the breast.

Ann Surg Oncol. 2010 Oct;17(Suppl 3):321-4.
Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.
Boneti C, Arentz C, Klimberg VS.   abstract here

• Some consider snapping scapula syndrome a similar condition though this group was not reported as snapping.
• 461 patients  with mostly breast/chest pain.
• Average age 53.4 yrs
• 27.2%  had a previous mastectomy
• Incidents such as a Motor Vehicle accident or heavy object moving could be  precipitating factors for the breast pain
• Trigger point(s) found in the medial aspect of the ipsilateral (same side) scapula (shoulder blade)

Presentation:

• 23.5% had moderate (5–7/10) pain and 20.5% (8-10/10) had severe.
• Primary presentation was breast pain  in 71.8 % of cases; 23.4% had breast pain only
• 8.7% just had shoulder pain and 3.4% had just axilla (armpit) pains as their only concern

Ultrasound imaging has demonstrated it though I am not sure if it is reliable:

Injection:

Injection position would either be – on stomach with arm on back:

I often find it easier sitting, with the arm hanging slightly posterior.

Actual needle site is to inject under scapula at  “area maximal tenderness” – this can be mid, higher or lower:

They used : “mixture of shortacting local anesthetic (4.5 cc of xylocaine 1%), a longacting local anesthetic (4.5 cc of bupivicane 0.5%), and a corticosteroid (40 mg of methylprednisolone)”

Results:

• 83.5% immediate relief
• 12.6% partial relief
• 3.9% Non-responders –  younger and thinner.

Complications – one wound infection easily treated

Comments – some scapulothoracic bursas can also be top or bottom on scapula lying cases:

(from: http://ajs.sagepub.com/content/28/4/587/F11.small.gif)

I have a case that has a very tight levator scapula, probably from C4-5 disc disease. This causes it to snap superiorly and it responds nicely to steroid though can return due to tight Levator scap. I have another case where the pain is just at the lower end of the scapula and responds to injection.

The mid portion ones are more complex. The anterior and posterior rib areas are tender (and of course this runs into the breast especially at T5). I will massage (with lady’s permission) the intercostals rib muscles  from anterior axilla to sternum and the anterior spasm/pains will remit at that level  – and surprisingly the posterior pains will be some better as well. They may not feel much improvement until all levels sore are done. There is always a paraspinal component with a twisted facet – I will use my activator “thumper” to loosen up the joints at those levels and massage up and down paraspinously until the rotatories strum free. This can temporarily remit much of the muscle triggers but things recur – I suspect because the underlying bursitis needs attention to.

There is a certain proportion of the cases of interscapular pain that is related to the neck.  A test I do, is to attempt massage of the interscapular tender muscles – often too tight for much relief. Then I will apply a collar cervical traction device:

(discussed getting this device here:

Neck Cheap Home Cervical Traction

Then I will massage the same muscles and see – a dramatic improvement suggests radiculitis or facet syndrome from neck. – This is more likely to respond to neck work,  cervical steroid epidurals or local/ botox injections to facet joints.

The muscles on the medial border of the scapular are all very tight. I’ve seen Dr. Chen Gunn pick away at these spots with Intramusclular Stimulation (IMS)  (probably hitting dorsal scapular nerve at scapular border) and dramatically release the length of the scapula so even frozen shoulders can be much better.

I feel this is a dramatic find that can help so many women left with breast pain not determined or left with breast pain after mastectomy they are told to just live with…

I hope the word gets out..

Any comments?