Two years after graduating from chiropractic school and while already working full time in Cannon Falls, I received a strange phone call from a person who identified as a chiropractic student working at the same school clinic in South Minneapolis where I had worked as an intern. She seemed to be relieved to have tracked me down and explained to me that she needed me to urgently answer one simple question: how the heck did I resolve Linda’s breast pain?
As it turns out, Linda was my second official patient in my budding chiropractic career. She was assigned to me as I was kicked out of the student clinic and into the “real world”, real green and real scared. She was a hairdresser with chronic neck pain and hands that frequently fell asleep at the end of her workday. She did well with her chiropractic care, which incorporated manual adjustments to the neck and upper back and lot of soft tissue work to the anterior shoulder.
The funny thing is that Linda never told me that the breast pain she had had for years had also resolved with her care. I found out about it from the frazzled student who called me that day. Linda had apparently had multiple breast imaging, examinations, some pretty invasive stuff for persistent breast pain. It went away along with her neck pain and arm tingling but she never bothered to tell me that. A year later, it returned, and the new intern assigned to her case was struggling to get a handle on it and Linda had suggested she track me down.
Breast pain can obviously come from many places, not the least one being of course the breast itself. I would never work up a case without getting breast tissue pathology ruled out (being married to an oncologist, the stats are always vivid in my mind). But once breast tissue pathology has been ruled out, and the patient is still struggling, we need to put on the detective hat and start looking the source of the pain.
Referred pain to the breast is not that uncommon. If you look at the basic anatomy and neurology of the area, there are a few common sources that are easy to evaluate:
Midthoracic spine at the rib junction: The intercostal nerves exit that area and are subject to irritation from a spinal functional lesion. Patients may or may not have thoracic pain along with breast pain. Most commonly, the area around T4-6 is involved.
The brachial nerve plexus, originating from the cervical spinal nerves, will radiate in the upper breast area just below the clavicle. Pressure over the area of the plexus entrapped by the scalenes will usually reproduce the pain. There is often a history of cervical anterior injury.
Myofascial soft tissues of the anterior shoulder and pectoralis group. If you look at charts of trigger points, you will see a surprising number of points that radiate to the breast area. This is common in patients with shoulder injuries, repetitive use injuries of the arm and shoulder or occupations origin. Incidentally, this was the problem causing Linda’s breast pain.
Anterior rib cartilage to sternum injuries. The cartilage junction between the anterior rib and the sternum is just underneath the medial aspect of the breast tissues. Those are often easy to palpate when you move the overlying breast tissue out of the way.
The moral of the story: once you have ruled out breast tissue pathology, get your rear to your chiropractor and see where the breast pain is coming from.
