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Family Medicine (Expert Forum)
Cause of bilateral arm pain?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
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Cause of bilateral arm pain?
by abcsoup, Feb 16, 2006 12:00AM
Exactly one month ago I began having upper left arm pain the bicep region. It felt as though I had just been given a flu shot. Since then, it has also been in the right upper arm as well, although not as bad as the left arm. I can't sleep at night very well due to the the pain of lying on the arms. It's difficult for me to sit at my desk at work or home and perform clerical tasks, as my arms are fatigued. It's as though I've just lifted weights all day. Simple tasks such as washing the kitchen table or opening a heavy door will also result in pain and muscle fatigue. My neurologist has performed 2 clinical exams which are normal, a cervical spine MRI which was normal, CBC, sed rate, and lyme titer, all of which were normal (thyroid tests normal as well). My orthopedic dr. gave my left shoulder a shot of cortisone, which has not helped at all. I've also had widespread muscle twitches. The neuro says the only test left to do is an EMG test, which I would like to have done. I worry about ALS, even though I'm only 32 (and female). This pain and muscle fatigue is affecting my daily activities, and I'm almost to the point where I'd seek a second opinion at somewhere like Mayo if that would help nail down a diagnosis of some sort. Something is definitely wrong, but my neuro just can't figure out what it is. Any suggestions? Thanks much.
Doctor's Answer
by Kevin Pho, MD, Feb 16, 2006 12:00AM
, Feb 16, 2006 12:00AM
If ALS is a concern, you can consider electrodiagnostic testing (i.e. an EMG) in addition to the MRI you have had.
Other possibilities would be various muscle disorders - such as myositis or myesthenia gravis. Creatinine kinase, as well as aldolase levels can also be considered. The EMG can also help diagnose these muscle conditions as well. The most diagnostic test would be a muscle biopsy - and can be considered if the preliminary testing is non-revealing.
If myesthenia gravis is considered, a Tensilon test can be performed.
These options can be discussed with your neurologist, or in conjunction with another opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
Other possibilities would be various muscle disorders - such as myositis or myesthenia gravis. Creatinine kinase, as well as aldolase levels can also be considered. The EMG can also help diagnose these muscle conditions as well. The most diagnostic test would be a muscle biopsy - and can be considered if the preliminary testing is non-revealing.
If myesthenia gravis is considered, a Tensilon test can be performed.
These options can be discussed with your neurologist, or in conjunction with another opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
It is all muscle pain. It can radiate to my nect shoulder
and into the muscle of my left arm. I have taken Robaxin and
Vicodin and that seems to help a lot. But if I don't take anything the pain is horrendous. Sometimes it feels like
someone hit the funny bone sensation; it twitches and sometimes it feels like a membrane is stretched over it and pops loose.
I am a diabetic, type 2 (60 units insulin) and I take norvac, hydrochorithizide, tenormin and an ace inhibitor.