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Neurology (Expert Forum)
Jaw, face, and left shoulder pain - nerve or muscle related?
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Jaw, face, and left shoulder pain - nerve or muscle related?
by PED, Aug 12, 2006 12:00AM
Late last year I started to notice occasional shooting pains along the bottom line of my jaw and into my arms. Not real intense but bothersome. Since that time they have progressed quite a bit. In May I noticed that what I assumed were the muscles in my neck under my jaw were "tight" from time to time and the jaw pain contined to increase in pain and duration. The shooting pains still occured, but now more of a lasting ache at times. Can be at rest or exercise etc. Now the pains and aches can be throughout my face and at times I get some tingling and numbness on the left side of my face that extend down through my "Trap" muscle and into my shoulder. The shoulder pinch seems to be there a lot and it feels like someone is literally pinching that muscle.
At times I can turn my head to the right and extend my left arm outward - this produces a tingling/ache from my left temple into my shoulder. I've tried ice over that shoulder and it seems to make that pathway worse.
I've been evaluated extensively for any potential cardiac problems and every test is clean as a whistle.
The jaw pain can be along the base of my jaw, or at the elbow of the jaw on either side, and at times all the way up to my temple etc.
Passed a brain MRI for MS. Bite guard for TMJ didn't help.
Does this sound neuro? Any suggestions on what it could be? Could it be in a disc in my neck pinching something? Could the muscles be so tight they are impinging a nerve?
Are there tests a neurologist could do to pinpoint this? It is REALLY affecting my life.
At times I can turn my head to the right and extend my left arm outward - this produces a tingling/ache from my left temple into my shoulder. I've tried ice over that shoulder and it seems to make that pathway worse.
I've been evaluated extensively for any potential cardiac problems and every test is clean as a whistle.
The jaw pain can be along the base of my jaw, or at the elbow of the jaw on either side, and at times all the way up to my temple etc.
Passed a brain MRI for MS. Bite guard for TMJ didn't help.
Does this sound neuro? Any suggestions on what it could be? Could it be in a disc in my neck pinching something? Could the muscles be so tight they are impinging a nerve?
Are there tests a neurologist could do to pinpoint this? It is REALLY affecting my life.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Aug 14, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes. The symptoms you describe are not classic for any single disorder, but you may have several things going on.
The pain in the Jaw and numbness in the face are signals carried by the trigeminal nerve. This nerve can be impinged by other structures such as blood vessels, muscles, tumors etc. and cause a condition called trigeminal neuralgia, which leads to shooting electric type pain in the face that can be very severe. This pain is often triggered by eating, touching the face and often occurs without provocation as well. This condition is diagnosed clinically by a neurologist, with the aid of tests such as an MRI with contrast and an MRA. Nerves that are irritated will often light up with contrast and an MRA may show a vessel that is overlapping an irritated nerve. Medications used to treat this condition include Tegretol and Neurontin, etc. For medically refractive pain, surgery is sometimes helpful in isolating the nerve away from the irritating vessel/mass etc.
Another possibility is cervicogenic disease (neck problems) such as disc herniation, osteophytes (from arthritis) pushing on spinal cord/nerves, syrinx, etc. Neck problems may explain the shoulder pain and muscle stiffness, but it cannot explain the facial pain. For the neck I would recommend an MRI of the cervical spine with contrast. An EMG of the brachial plexus may also be useful if the MRI is negative.
Finally, if the above test are negative, then I would recommend an LP (lumbar puncture-spinal tap) to test for encephalitis, lyme, west nile, HIV, demyelination etc. (Your neurologist will be able to tell you more about these test if they are needed) Although these possibilities are less likely, you should pursue this aggressively so that you can get back to your life.
I hope this has been helpful.
The pain in the Jaw and numbness in the face are signals carried by the trigeminal nerve. This nerve can be impinged by other structures such as blood vessels, muscles, tumors etc. and cause a condition called trigeminal neuralgia, which leads to shooting electric type pain in the face that can be very severe. This pain is often triggered by eating, touching the face and often occurs without provocation as well. This condition is diagnosed clinically by a neurologist, with the aid of tests such as an MRI with contrast and an MRA. Nerves that are irritated will often light up with contrast and an MRA may show a vessel that is overlapping an irritated nerve. Medications used to treat this condition include Tegretol and Neurontin, etc. For medically refractive pain, surgery is sometimes helpful in isolating the nerve away from the irritating vessel/mass etc.
Another possibility is cervicogenic disease (neck problems) such as disc herniation, osteophytes (from arthritis) pushing on spinal cord/nerves, syrinx, etc. Neck problems may explain the shoulder pain and muscle stiffness, but it cannot explain the facial pain. For the neck I would recommend an MRI of the cervical spine with contrast. An EMG of the brachial plexus may also be useful if the MRI is negative.
Finally, if the above test are negative, then I would recommend an LP (lumbar puncture-spinal tap) to test for encephalitis, lyme, west nile, HIV, demyelination etc. (Your neurologist will be able to tell you more about these test if they are needed) Although these possibilities are less likely, you should pursue this aggressively so that you can get back to your life.
I hope this has been helpful.
But otherwise, I don't get the bug like feeling, but the neck, jaw, face, and shoulder stuff is dead on. It stinks. Might request PT>