Shoulder/neck injury & Axillary pain

[meechieRN]

In May of 2012, I injured what I thought was just my shoulder while turning a 250lb quad with very minimal help.  I felt odd sensations that seemed to originate from the shoulder, both anteriorly and posteriorly.  It felt as if threads were snapping.  It wasn't painful at first, just a little sore.  I continued to work with the shoulder throughout the shift and by end of shift, I had an intense burning sensation in my axilla.  I went to the company clinic--X-rays were neg and I was given naproxen and and an ice pack.  Went  back the next day and complained of some relief, but felt tightness in my hand.  I continued treatment with NSAIDs and subsequently 6 PT sessions.  The intense, burning pain in axilla persisted and I was referred to ortho.  MRI (no dye) was done, which indicated a possible labral tear.  Was given a steroid inj in the shoulder, felt about 12 hrs of relief of the deep axillary pain.  After the 12 hours, I began feeling a very sharp, stabbing pain in the lower neck area.  Went back to the clinic and saw a different doctor who advised me to get tx for the neck.  

I had arthroscopic decompression and labral and biceps debridement on 10/29/12.  Followed by 12 sessions of PT.  Surgical pain came and went, but the deep axillary pain continues.  My elbow also feels the same burning ache, almost as if I'm being electrocuted.  Sensation travels down to my thumb and middle finger, especially coinciding with intense pain in my neck and axilla.  Certain motions of my wrist also illicit a weird sensation in the middle of my palm which travels to my thumb, index, and middle fingertips.  My whole left arm feels heavy and by end of day, I have such tight pain in my neck and scapula region.  On my worst days, I have headaches and tightness in the upper neck.  Sometimes even pressure behind my left eye.  I'm clumsy with my left hand, as well.  My upper arm spasms quite often, usually on the lateral side.  I also have severe itching in the same spot on the lower part of my scapula.  My grip strength is significantly less than my right.

This is obviously a work comp situation, so diagnosing me is taking longer than what is ideal.  I have just recently been awarded a c-spine MRI and nerve studies (which were ordered in January of 2013).  I was referred to a neurologist, but that remains to be authorized.  I'm just worried that if this is some type of nerve injury, too much time may have passed for optimal recovery.  What type of nerve injury does this seem like?  My ortho thinks it's carpal tunnel.  I'm just not quite convinced because of the origin of pain.  Although my hand does hurt (throbbing pain), it doesn't compare to the pain in the axilla and elbow.  Sorry for the lengthy post.  It's been too long to not even really have an idea of what's going.  Oh, and mammogram was also negative.  

Thanks in advance

[meechieRN]

Thank you for your input, Dr. Mathur.  I will discuss with my neurologist this coming week when I have an EMG/NCV.  How is the syndrome diagnosed?  Would I expect the nerve studies to be positive for neuropathy?

[Dr. Kokil Mathur]

Hi!
I am sorry to hear about your medical problems. What you have is probably Scalene Myofascial Pain Syndrome. When scalene muscle is the cause of pain, the pain is referred from neck to (either all or a combination of) chest, inner lining of scapula (shoulder bone), shoulder, posterior and lateral sides of the arm right up to the thumb and index finger. When this muscle shortens, this can press on brachial plexus (bundle of nerves and blood vessels in the armpit) and the subclavian artery and can compress or irritate these structures and cause symptoms such as abnormal sensation, cold extremity, spasms of pain, and lymphedema (swelling of lymph channels causing swelling of arm or leg) in the involved extremity. Treatment is by physiotherapy that involves indentifying the trigger points, and massaging them, and other exercises to relieve the muscle tension. Please discuss with your doctor. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.