Help, what is going on

[lilwe]

I don't know where to began so here goes.  I had feminine surgery last Aug..for removal of fibroids. I had never had any problems before this,I was quite active and healthy.  After this surgeryI ended up with a knotlike feeling in my lumbar area. I couldn't sit or lay flat.  Well afterthis surgery and 3 more, thinking that they knew what was causing it I had a complete hysto and still have theproblem.  I also then began experiencing buttock/flank/lumbar pain and muscle aches.  With each surgery things got worse.  I know sometimes the way you are on thetable and with these surgeries being laps youare tilted that perhaps something was out ofwhack.  I had many test mris, ct scans and bloodwork etc done. Allwere normal. My one mri in the lumbar  came back with mild disc bulging/facet hypertrophy in L4/5 and a schmorrl's node. My neuro doc didn't seem to think this could be it, even though I know itwas still poss.  But here is my other problem which is related to you.  Ialso began experiencing upper arm discomfort in both arms.  They both were slightly swollenthe tendons feltswollen.  My fingers felt swollen/stiff also and the knuckles closet to my fingernail felts achy.  I went to my doc who thought tendonitis/bursitis.  He gave me prednisone and it really didn't help. I then went to a ortho doc and he did an mri and a regular xray and they were ok.  My right arm now I cannot lift up high or behind my back.  My neuro doc says its not a neuro prob but a shoulderproblem. He is going to do a bone scan for me though to make sure of any inflammation.  My ortho doc wanted to put me under anestesia to manipulate the arm.  I declined because I asked him what about my other arm, I was concerned that there was an underlying problem.  He didn't seem to want to hear that, just the arm with less motion.  I also had blood tests for RA that haven't come back yet.  I know if it tests positive it doesn't necess mean I haveit, but something is wrong.  My symptoms are upper arm discomfort both arms.  My hands and fingers feel stiff.  My right hand middle finder is more swollen than the rest.  I do believe that all these surgeries has brought on trauma to my body and I have read that it can bring on autoimmunediseases from this.  My legs are stiff also.  I can't do much physically.  The problem I am having with my buttock/flank/lumbar area I do believe is a back problem and it feels inflammed and irritated.  Could this be causing all these other symptoms in my body.  I have also read if you have trauma or a muscle damage in your body it can reveberate through your body and cause really weird symptoms.  I am a little scared especially since I don't know whats going on and noone has yet to help.  I have seen so many specialists and had so many tests that your head would spin.  I have been thinking about going for physical therapy to help me since I cannot even go to the gym.What kind of tests would you suggest and what are your thoughts?

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note several symptoms including upper arm discomfort and stiffness in your fingers.  MRI on your back showed mild disk bulging in the L4-5 region.  You also note several referrals including to a neurologist and orthopedic surgeon.  

Without examining your, it is difficult for me to say what is going on.  

It is possible that the back problem may be causing all the other symptoms.  However, because the symptoms are so generalized (i.e. affecting your legs, hands, fingers), the reasonable step (as you are doing) is to make sure that there is no rheumatological disease going on.  

If not already performed, I would perform an MRI of the shoulder to make sure there is no tendon tear preventing you from raising your arm.

As for evaluating for rheumatological diseases, possibilities include fibromyalgia, rheumatoid arthritis, lupus, hypothyroidism, or inflammatory myositis.  I would obtain a sed rate (looking for inflammation), ANA level (screening for lupus and other rheumatological diseases), rheumatoid factor (screening for rheumatoid arthritis), muscle enzymes (looking for diseases causing muscle inflammation), thyroid panel and  electrolytes.   A rheumatologist can coordinate these tests.

Further specialized testing including electrodiagnostic testing can be discussed with your neurologist or personal physician.

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.

Thanks,
Kevin, M.D.