Bad Arm Pain

[redkim]

I went to Urgent Care on 7/30 for right arm pain.  The doctor and I discussed two bulging dics in my neck and said he didn't think they were causing the pain.  He decided to test this and put both hands on top of my head and pressed down to compress the nerve.  

Now my left arm has been very painful, it hurts to sleep.  I get this shooting pain down it which causes weakness.  I have to actually drop my arm and let it hang while this is happening.  I have an appointment with Nuerology in mid September.

Any idea what this is (I am sure he compressed or irratated the nerve) and what I can do in the meantime to help with the pain.  My right arm is still in pain as well.  But I am not getting the same type of pain.

My right arm has been in pain for 8 years and I have recently had an MRI and X-Ray, one doctor said I have Complex Regional Pain Syndrome, but I don't think I do.  I have been looking into Keinbock's.

Several doctors have evaluated me and said they don't know what is wrong with my right arm.

[redkim]

Wow, thanks for such the long and very informative reply!  I actually have Chiari Malformation and had surgery 1.5 years ago (decompression).  I do have disc degeneration in my lower back.  My PCP at first didn't think I needed to see a Neurologist and her nurse said she would need to evaluate me - to which I asked if Brain Surgery didn't qualify me to see a Neurologist, lol.

The physical medicine doctor I saw wouldn't reffer me to Physical Therapy for my arm, she said it wouldn't do any good.  My diagnosis so far "arm pain" which seems more like a symptoms then a diagnosis, lol!

That my arm wouldn't get better.  This was prior to any testing.  I have had a bone scan (normal), x-ray (normal - except my PCP thought my ulna and radius look far apart), MRI (ganglion cyst and something about my lunate).  The ortho doctor told me he can't help me further...he doesn't see anything he can operate on.

There are people on the Chiari website who do talk about traction.  I will have to post on there to see what they have traction for.

Yeah, the doctor pushed on my head and asked me if my hand went numb, to which I replied I always have a loss of feeling in my arm - with out consistent tingling (right arm).  My left arm was fine before this.

The physical medicine doctor did prescribe Nortruptyline, I got up to 50mg and stopped taking it because the side effects were worse then the minor relief I had in my arm.

I am low Vid D, take supplements and have a stress fracture in my lower spine - maybe this can contribute to arthritic deterioration?

You have me a lot to think about and research, which I greatly appreciate.

I should add my middle finger has been swollen for eight years.  They originally treated me for tendonitis.  Pretty much every visit the last eight years consisted of them telling me to take Motrin.

[caregiver222]

Hmmmm...

The doctor had the protocol for differential diagnosis backwards. You never press downwards on the head. You pull the head upwards along the axis of the spine. This is called applying axial traction.

The situation is this.

You have a compressed nerve in the cervical area. It is being squished and there is inflammation. That is what is causing the pain in the arm.  Often this is a result of an old sudden flexing of the neck. Perhaps from an automobile crash. Perhaps from a boxing injury. Maybe a fall. A co-factor may involve an element of arthritic degeneration. It is probably what is called a subluxion injury.

This is pretty simple. I think even tribal witch doctors in Afghanistan could figure this out. Were these real doctors? Could they be space aliens? Hmmmmmm.

Now we come to square two.

What to do?

There is always a surgical option.  Scarey. It may have to be done.

The general; drill is (a) to relieve inflammation and to (b) to try to allow the disc to return to some semblance or normality. Sometimes this is possible. Other times it is not. The only way to do this is through application of axial traction.

The discs are not very vascular and do not heal well. You have had the injury a long time without proper treatment and sometimes the nerve deteriorates. Hopefully this is not the situation.

Treatment involved gentle axial traction with a harness for fifteen minutes at a time, with a break several times a day. This for several weeks. A cervical collar is contraindicated because it causes loss of muscle tone. Muscle relaxants are commonly prescribed, but these also cause loss of muscle tone. This should have been done eight years ago.

The axial traction devices are available without a prescription for about $40 U.S. Throw away the water bag and attach a harness to a hook in a doorway. Set up a seat so you lower youself (do not hang yourself) and feel gentle upward pressure along the axis of the spine. Maintain this for ten or fifteen minutes. The take a break of an hour or two. Then do it again. Recommendations as to how many sessions a day and how many ways are "six-of-one-and-a-half-dozen of the other".

Usually a steroid such as oral prednisone is prescribed.

After a time, range of motion exercises are performed, through the limits of pain. Generally after three weeks. This involves moving the head (rolling it around) 360 degrees. Psychologically this is hard to do, because you believe you will be doing damage.

Now here is a caveat. Never follow any of my advice unless you have run it by your own M.D.

Then you do sit-ups to improve muscle tone. And isometric exercises putting a hand against the right side of the head and forcing the head against the hand, and doing the same with the left, forehead and back of head.

And you have to keep well hydrated. Avoid high glucose levels because they affect osmolality of the tissues and increase pressure on the nerve complex.

The big question is whether at this point there is too much deterioration to recover.

Maybe yes. Maybe no.

The pain at this point is from glial cell activation, which does not respond well to opiates. Check the Scientific American for pain suggestions. Currently a third generation tetracycline has been found to reduce glial cell inflammation, curiously enough.