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Second opinion] I am having lots of pain in my upper arm,

Second opinion] I am...

Second opinion] I am having lots of pain in my upper arm, mainly, but can move to my shoulder, my shoulder blade, elbow and thumb area. My movement is restricted. I cannot raise my arm above my shoulder, reach out to side or very far to the back or across my body. This pain can be worse with movement, but also can just be a consistant ache. It is worse in the morning after sleeping (on my back, trying to keep it still).

Doctor's Assistant: What seems to make the symptoms worse or better? Have you noticed any swelling?

No swelling noticed. It all seemed to start with the thumb and grip area of left hand. I was knitting a lot and thought it might be a repetitive movement injury. I did have some consistent tension in that grip while knitting and also notices that I also tilt my neck to the right while knitting It seemed like this pain slowly moved up my arm and now my hand only hurts occasionally and much less. I have looked for trigger points in neck and arm and upper back and have treated them with some success. But pain just seems to move around. As the day goes on it generally improves. If I move wrong where I'm restricted it is very painful for a time. Overuse seems to make it worse.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I had an MRI 10 years ago that showed canal stenosis at C5-C6. At the time I was having some nerve pain in my R shoulder blade. I was seeing a NUCCA chiropractor, but it seemed like the trigger point therapy was what took the pain away. Nothing has been problematic for 10 years since, except that my hands tend to fall asleep when sleeping (not always, but for certain stretches of time) or when using them in slightly elevated positions, ie driving a long time, bike riding, and I noticed it knitting. ____________ I looked up frozen shoulder and I do not think that fits my symptoms totally. This led to lots of internet research and the closest I find is radial nerve pain. I think it is probably coming from radial nerve root damage. I have some symptoms that suggest problems from C4 through C7. I have occasional chest pain that looks like it might be cervical angina. I have pain at times in the shoulder blade region and once felt that area go to sleep (tingle). I have a weak grip and pain and numbness esp. in my wrist and thumb side of hand. I have tricep pain, esp. when pushing object away, or my body off of things and throwing motion. Do you agree with my thoughts on this? What should my next step be?

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Answered in 1 hour by:
3/23/2018
PM&R Doc
PM&R Doc, Board Certified MD
Category: Medical
Satisfied Customers: 6
Experience: Physical Medicine and Rehabilitation Specialist
Verified

Hello. I am a medical doctor specializing in the treatment of musculoskeletal and neurologic disorders. I work with this kind of issue on a daily basis. Hopefully I can help answer your questions. Given the reported symptoms and findings you mentioned on the prior MRI of the cervical spine I would guess that the neck is the most likely source of your current issues. Cervical spinal stenosis can affect more than one nerve root and the symptoms can appear to migrate over time depending on activity and head and neck position. Neck problems are also very common whereas a radial nerve injury would be much less common and there is usually a definite inciting event (direct trauma or use of crutches) for a radial nerve injury. The most useful next step would be to meet with a specialist who deals with this sort of issue and who is skilled in diagnosing and treating such an issue. A Physical Medicine and Rehabilitation specialist (also called Physiatry) would be ideal as they would be able to do a detailed physical exam, order appropriate imaging or even perform EMG and nerve conduction studies (a special test to check on the health of specific nerves or nerve roots) to help make a diagnosis. Your primary care doctor may also feel very comfortable starting the work up and treatment. I feel that an MRI of the cervical spine would be the best test to make a more firm diagnosis. Treatment options would include PT, chiropractic care, medications (NSAIDs or medications for nerve pain such as gabapentin, Lyrica, Cymbalta or nortriptyline, etc...) If more conservative measures fail and the diagnosis is indeed found to be a pinched nerve root or spinal stenosis in the neck a cervical epidural steroid injection could be considered. If all else fails or if there is progressive neurologic decline (meaning worsening weakness or numbness) then surgery may be indicated. I would be happy to discuss this further if you have any additional questions. If you are satisfied with the answer please rate me 5 stars. Thank you.

PM&R Doc
PM&R Doc, Board Certified MD
Category: Medical
Satisfied Customers: 6
Experience: Physical Medicine and Rehabilitation Specialist
Verified
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