I am 41 year old male. Generally fit and in good physical health, perfect height/weight ratio, no past medical history.
Since January 2002 I have a chronic pain of a variable intensity, character and distribution. First symptoms were triggered from time to time (once a day to few times a day) by a sudden and rapid movements of my RIGHT arm e.g. fast reaching for a book on a high shelf. The pain had a very sharp shooting character radiating to my biceps and brachial muscle - almost visualising the musculocutaneus nerve. It was shortlasting (seconds) leaving a residual discomfort for few minutes later. The frequency increased through the next month up to few times a day and it was caused by much less pronounced movement of the arm. The arm's strength was not affected, no sensory loss in the limb, no visible muscle atrophy. The range of movement was affected by knowing that the pain will appear if for exmple I will try to reach with my right hand to the left armpit or try to scratch my back.
After two month (March/April) the pain described above started to be accompanied by periods of constant duller pain in front of my shoulder joint, sometimes around elbow or the wrist. In scale 1-10 i would describe it around 5. Of the counter pain killers (up to 2g Ibuprofen dailY) did not change the pain.
After another month (April/May) the similiar symptoms started to affect my LEFT arm. However recently end of May I noticed a significant improvement on the right side but the symptoms on the Left side are much worse than it was ever on the right side. I am still cautious an subcounciousely limit the right arm movement but I can reach now further without triggering the pain, and in last two weeks all strong shooting attacks were only on the left side. Since a week I have a constant pain on the left side that is disturbing my sleep and causing a strong discomfort. The pain centers are in the back deep under the top edge of my scapula, the brachial/biceps muscle and the wrist around base of the thumb area. The medium pain in front of brachial joint is present all the time. From time to time there are strong shooting sensations between these areas.
I have to stress that I have a full Cervical spine mobility and I can't trigger the pain by any cervical movement. I could not also find any point on the neck, beck and arms and armpits where a strong pressure applied by the other person would trigger the pain. There are however some points along the upper edge of scapula that are more tender and pressure applied there is increasing the pain.
There was also no injury in the past that could explain all the symptoms.
1. Does it look consistent with my self-diagnosis of Brachial plexus neuritis? I understand that in such a case practicaly there is not much to do as the opinions about using high doses of corticosterides are contradicting in the sources I could find. I simply can not afford any advanced neurological diagnostic procedures as I am not insured.
2. What other neurological condition could mimic my symptoms?
3. Is it possible that some of this symptoms are in connection with TB test and Measles, Mumps and Rubbella immunization that i received in July 2001 ?
4. What painkilers would be reccomended?
I have learned to live with this knowing that it will hurt MORE every time I twist my arm to fit it in my shirt sleeve or to towel my back. Every sneeze or other rapid movement triggers the pain. I can't exercise and had to cut a lot of usual activities. The strongest, shooting pains would be bearable as they come and go, big boys do not cry, I just bite my lips, groan and after a minute or two I can live again - what really lowers my life standard is THAT CONSTANT pain in my left arm and under shoulder blade, not allowing to concentrate on my creative work and seriously disturbing my sleeping pattern. Lately it hurts almost all the time (5-7 in my 10 point scale)
5. What would be a typical diagnostic pathway in my case? As I would have to pay for it by myself I would like to skip all the unnecessary procedures.
6. Are there any readers of this forum who have similar experience and learned how to keep the joy of life despite a chronic pain? I will welcome any advice...
1.ALthough the location of your pain is typical of brachial neuritis, the isolated symptom of pain without any associated weakness or sensory changes is NOT consistent with brachial neuritis. There is treatment now for brachial neuritis otherwise known as Parsonage-Turner syndrome or neuralgic amyotrophy. We recently treated a brother and sister here who had the syndrome with IV immuneglobulin (very expensive if you are self-pay) and both experienced improvement. It does go away on its own in most cases.
2.Again, isolated pain without objective weakness or sensory changes is difficult to localize to a specific site. If it's primarily joint pain, then it could be arthritic. If it's muscle pain it could be a myopathy or fibromyalgia. FInally, a spinal cord problem is possible, too. Need more info and physical exam for more accurate comments.
3.Probably not as it's too far out from onset of symptoms. FOr example, brachial neuritis can occur within a few weeks after immunizations.
4.Over the counter meds that may help include alternating doses of tylenol and motrin. Be careful as too much tylenol affects your liver and too much motrin affects your stomach lining and kidneys. Aspirin may also be helpful. For patients with brachial neuritis, narcotics are often used for pain relief as the pain can be quite excrutiating.
5.A neurological exam to look for objective weakness and sensory loss followed by an EMG to look for specific nerve or muscle damage would be among the main procedures I'd recommend.
I know healthcare is very expensive especially when out of pocket. But consider at least seeing a neurologist for help just to make sure nothing else is going on. GOod luck
I just don't know how to post a new question and looked for something that was close to mine. Can someone refer this to a knowledgable person....
I know that the things I am asking may not be answerable because because as a doctor you cannot prescrbe or diagnose long distance. But any general guidance you can provide will be helpful.
I presented with severe chest pain 4 months ago and gradually discovered that I have cervical radioculopathy in two of my vertebrae. (Prior to this, I found I have some areteriosclerosis and will have an angioplasty next month, but he is certain the pain is NOT due to the heart (did catheterization, isotope exercise test).Also, my cardio helth nmow is pretty good in the cholesterol department, though not great (55 hdl, 115 ldl, 211 total and 185 triglycerides...wants to get the tris down and the ldl below 100. He thinks my near vegetarian diet has helped reverse effects of my childhood diet and is a counterbalance to inherited heart risk from my father.
I am 49.
I took Ibuprofen on top of heart medications and gave myself an ulcer and severe anemia (hemoglobin 5.7). But in the hospital they asked a neruologist, who said I was spastic and
had clonus, some loss of muscle..
WHY DO WE LOSE MUSCLE WITH NERVE CONDITIONS?
Later X-ray showed detrioration of the vertebrae and a spur. 6 6 years ago, when doing knee surgery, another hospital found surgical spondylosis (a different set of vertebrae) and it caused numbness, but exercise seems to have held that at bay.
With the B-12, for the first two weeks, I see little change, but maybe less intense pain. It comes 1-5 times a day, and is relieved by leaning the UPPER back against a wall,for example, for as little as30-60 seconds. Sex makes it worse, as does holding an umbrealla, or walking after being at rest (as in the morning or after work). I just STARTED going back to exercise, and I hear aerobics is a good adjunct to stretching and helps to recondition. So maybe this will have the same positive effect as in the sponylosis. I hope so...
Oh, I have always had a chronic tic where I feel I have to stretch the neck muscle. It is rarely ever necessary for me to do it, but at times of stress, I may get the urge, and this may come and go.
Before I went to the heart doctor and way before the pain meds put me in the hospital with anemia (it has gone back to near normal in less than 3 months-with the help of two blood units), I went to my old orthooedic surgeon, who found no evidence of the cervical spondylosis getting worse, but I wonder how come he missed the radiculopathy???
In any case, I am here, wondering what to do if the B-12 therapy does not work.
Japanese doctors seem less interested in things like physiotherapy and more in medications and surgery...and there are a number of people who call themselves physiotherapists or chiropractors, etc. who can do as much harm as help, so I hope to be able to get my doctor to explore other modalities and then recommend me to some other practioner if necessary. Your help
in guiding me to guide him is most appreciated.
Now taking vitamin B12. Today asked for B-12 serus blood test. Results two weeks from today. Amount here is 500 mcg times
3 a day,limited by japanese health insurace. I COULD get more from the US. He seems to feel dubious about it, but I see amounts much higher there. I wonder what is an optimal level and
what is needed to get it there in clincal experience..
For example, injections are common there as is Nascopal (nasal form) usually done less often than the oral type and in lower
dosages. But I have access to a U.S. (an allergist,
not a neurosurgeon) physician who can write the presscrition, which Japan will aloow me to import. I just need to know if there is good clinical experience with higher doages of the oral type or with the nasal type.
I will have the B-12 results next week or so, and wonder what
would be a level indicating I need more than the 1500 mcgs I
am getting daily.
Other things under consideration--Chinese/Japanese
Acupuncture (pain medicne gave me an ulcer and did not seem to work). Also Chinese herbal medicine.
This is what I read at a sports medicine website--
"Isokinetic exercises of the neck and upper extremities are not functional and are not recommended as a strengthening tool"
NOT SURE WHAT THIS IS
And "Isolated strengthening of weakened muscle secondary to the radiculopathy is important before beginning more complex activities involving multiple muscles.
OK. IF SO, HOW DO I FIND SOMEONE WHO IS QUALIFIED TO DO THIS? A SPORTS DOCTOR? CHIROPRACTOR?
In the initial phases of treatment, strengthening should be limited to isometric exercises in the involved extremity.
Once all radicular symptoms have resolved, then progressive isotonic strengthening may begin. This should initially stress low weight and high repetitions (15-20 repetitions). Closed kinetic chain activities can be very helpful in rehabilitating weak shoulder girdle muscles."
"Cardiovascular conditioning should be started as soon as possible to prevent deconditioning. These exercises also serve as a great warm-up prior to a stretching program. Finally, the patient should be told that these exercises (stretches and strengthening) should be continued indefinitely with the hope of preventing recurrences."
WELL, I JUST STARTED GOING BACK TO THE GYM. I DO NOT DETECT ANY
ABNORMAL PAIN, BUT I AM GOING SLOW. THE NEXT DAY, THERE MAY BE SOME MORE PAIN THAN USUAL.
Any comments on what I read from one practioner on the Net?
If surgery is needed, microdiscectomy is recommended compared to other types (less invasive) and that
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