FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER NEEDS MEDICAL TESTS TO PINPOINT CAUSE OF NECK PAIN

Question: I have been having episodes of pain in my neck just under the left collarbone for about five weeks. The pain episodes usually last five minutes but have lasted as long as four hours. It isn't like the arthritis pain I occasionally have in other joints. Could this be a clogged artery? What must I do to find out?

Answer: Pain is the body's signal that something isn't working the way it should be. Unfortunately, pain is a rather non-specific signal. That is, the body uses pain to alert us to a large variety of problems without specifically signaling what is wrong. In some situations it isn't even very good at identifying "where" the problem is located. Your discomfort may be an example of pain that doesn't give a good indication of "what" or "where" the true problem resides. Angina, pain caused from the heart receiving inadequate nourishment through the coronary arteries, can be perceived as coming from many different locations. Angina is typically described by my patients as pain or pressure that's felt behind or under the breastbone. However, not too infrequently patients experience angina as pain in the shoulder, neck or jaw. This pain is often brought on by emotional stress or physical exertion and subsides after a few minutes. Perhaps angina is the cause of your discomfort.

Arthritis in the shoulder or in the joints at either end of the collarbone can cause pain "under the collarbone." This can usually be diagnosed easily by feeling the joint as the shoulder is moved. It will have a "grinding" sensation instead of moving smoothly, and this will simultaneously cause pain.

Pneumonia and other lung disorders can also cause pain like yours. These conditions typically have coughing, shortness of breath, and other symptoms associated with them.

The aorta, the large artery carrying blood away from the heart, passes fairly close to the shoulder. Problems with it, however, would not cause the kind of discomfort you describe. Smaller blood vessels -- named the carotid arteries -- branch off from the aorta to carry blood to the brain. The subclavian artery is another branch that goes to the arm. Both of these arteries run close to the area of your pain. Problems with either of these vessels could produce the discomfort you experience, but I think it is unlikely that they are the true culprit because I would expect other significant symptoms associated with their blockage.

The most common cause of pain under the collarbone, as you have experienced, is a disorder involving the muscles or bones in the area. The first and second ribs are located under the collarbone. Numerous powerful muscles attach to them. These muscles are involved in moving the neck, collarbone and the arm. In addition to this, these muscles also move the ribs to assist in deep breathing. A strain to any of the muscles, or a brief episode of spasm in one, can cause the pain you experience.

Some conditions, such as heart disease, are serious and must be ruled out. An electrocardiogram, stress test or other "high-tech" tests may be necessary to do this. The carotid arteries can be checked for blockage quite easily by a painless ultrasound test. Determining whether you have arthritis or other bone or muscle problems may involve X-rays or other tests. Therefore, you should see your family doctor. He or she is experienced in solving this type of mystery.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.