Shoulder/elbow/wrist pain and tingling

[JK1987]

So I have been trying to figure out the causes of some problems I've been having with my right side. It seems like it's multiple issues on my right side. My doctors (a sports med and orthopedic surgeon) have been slowly picking away at them, but it's a slow process and I was wondering if based on my symptoms, someone can make any suggestions? The symptoms have been going on for at least a year, but I've been ignoring them because they're individually manageable, and I assumed I was imagining them.

I'm a 26 year old female.
X-rays:
-an elbow x-ray (mild soft tissue swelling over the olecranon, no fracture)
- neck x-ray (mild right C5-C6 neural foraminal stenosis)
- wrist X-ray (normal).
My ortho diagnosed my wrist as being De Quervain's, for which I was given a cortisone shot two weeks ago (a little improvement).
My PT thinks my shoulder is impinged and that I have cubital tunnel in my elbow. My sports med is running tests.

I have neck pain, mostly on the sides. My neck cracks and creaks when I turn it.

Right shoulder:
- pain on the front by my armpit & the back just below my right shoulder blade
- pops and cracks when I raise arm
- have difficulty pushing in or out with my arm (opening doors, for example)
- often feels stiff, like I need to crack it
- painful to lift my arm over my head, or to lift heavy things
-- there's increased tingling in my ring and pinky fingers when I raise my arm
- pain across upper back

Elbow:
- painful on the side of my elbow closest to my torso
- popping when I bend/straighten it
- generally feels like I hit my funny bone a few minutes ago

My wrist/hand;
- on the thumb side hurts and swells
- difficulty holding a pen
- super clumsy, I drop everything
- difficult to straighten my fingers fully
- increasing tingling and numbness in all my fingers other than my middle finger.
- numbness, tingling, & pain in ring and pinkie fingers

Again, none of this is (individually) that bad. The pain in each area is around a 3-4, with occasional bursts of 5-6 in my wrist and shoulder. Together, it is making work and school difficult. I take 600-1200 mg of ibuprofen a day, and try to ice twice a day, but I frankly don't know what to ice because I'm being told to ice everything 4 times a day and that's a lot of ice packs and peas. Does anyone have any suggestions?

[jobby99]

A related discussion, THORACIC OUTLET SYNDROME was started.

[jemma116]

I have copied and pasted below a web link that explains in detail about De Quervain's that you may find informative.

http://www.medicinenet.com/de_quervains_tenosynovitis/article.htm

[jemma116]

Sorry caregiver222, but I do not agree with your comments.

Not only did I undergo the same problem and know about these issues, I hold the NEBOSH Certificate (National Examination Board in Occupational Safety and Health (UK).

[caregiver222]

One cannot state for certain without an MRI, but everything points to cervical nerve impingement. The problem is that a person begins to "self-splint" to avoid pain. Every time you do that your range-of-motion becomes a bit more restricted until you have a frozen shoulder, arm and hand and are using a walker. Your pain symptoms are :"out of the textbook". The big issue is whether or not to exercise through the limits of pain, and to use axial traction and rotate the head through the limits of pain. You want to make sure you don't do damage to a juncture that has sever arthritic deterioration. This is unlikely at your age. Basically such syndromes have nothing whatsoever to do with how you hold your hand or arm at work, although the problem may be exacerbated. Splinting is generally contraindicated.  It is a sure road to a frozen hand and shoulder and arm and level ten pain. It is difficult to find a specialist who has knowledge in this area. It is similar to a so-called "whiplash" injury. Sometimes simple professional manipulation may put everything back in place, but with stenosis you need a professional's advice before beginning exercise.  Try to think back to any time in your life when you had sudden neck flexure.

[jemma116]

You are not a specialist and by what you write you have no knowledge whatsoever of repetitive or work related injuries.

I am open to anyone's opinion, but for you to categorically dismiss the fact that this has nothing to do with work related problems is very naïve of what is already well documented with regard to work related repetitive strain injuries.

[JK1987]

Thank you! I will bring up an MRI to my doctor as well. Would you say the de Quervain's is referent pain from the neck as well? It just seems like there are so many symptoms that are all over the place, and they could be caused by 4 different, simultaneous problems, and doctors are just trying to see what's doing what. In terms of my daily life, the clumsiness is the biggest problem, but it seems like in the long term, the numbness is.

[JK1987]

Hi!

Thank you so much for your responses!

I do work in a coat check 3 days (15 hours) a week, which involves repeatedly hanging coats & bags, and lifting heaving things. But 4 days a week (25 hours) I'm an usher and basically just stand still, which does lead to a lot if back discomfort. I'm also a student, so that involves a lot of writing and computer use.

I have been trying to modify a lot of my work motions, but especially with my shoulders, I'm having a difficult time finding comfortable positions. I definitely do not want to make things worse. I 'll ask my PT about what I can do differently.

I will definitely ask my doctor about the nerve conduction test, thank you! The splints option was something  my doctor mentioned for after we tried the cortisone shots, so I will definitely bring it up again. It just seems to be a very slow process to find out what I should be doing.

Thank you so much for your help!

[caregiver222]

You have nerve impingement at the level of C-5/C-6. The only question is the etiology. If there is general arthritic deterioration ,exercise won't help. You absolutely positively need an MRI, preferably a "T3" MRI. The MRI machines are rated in Tesla units. The older machines are 1/2 T, the later ones 1T or 1 1/2 T. The 3T machines provide the best image. The problem has nothing whatsoever to do with the way you are supporting your wrists or wearing splints around your hand. In general, treatment involves provision of what is called axial traction, pulling the head upwards along the general vertical axis of the spine, for several minutes at a time, several times a day, combined with a transdermal lidocaine patch over the Cervical area. Use for no  more than 12 hours a day. You have a problem relating to what is called a pain dermatome. This has absolutely positively nothing to do with you using a computer and splinting your hand is inappropriate and meaningless. How you use your keyboard is meaningless.  The problem is nerve impingement at the cervical level. Period. There is no damage to the wrist. Resting the wrist is pointless. You have a narrowed opening through which the nerves are passing. When nerves are impinged at that level phantom pain develops in the wrist and hand. Sometimes a cervical collar is prescribed, but this is contraindicated because it causes loss of muscle tone. A cortisone injection will help, but only for a day or two. A differential diagnosis must be made to determine if range-of-motion exercises will further damage the nerve, or relieve the pressure. This can only be determined by the MRI. Depending on this evaluation range-of-motion exercises may be prescribed rotating the head through the limits or pain, as well as forceful manipulation of the head by a therapist. Sometimes there are calcined deposits that may be broken in this way. You have symptoms of a textbook subluxion injury, caused by a sudden forceful movement of the head a very-long-time ago. Opiates do not relieve pain because you have what is called glial cell stimulation. One problem with your disorder is that you will begin to "self-splint" to avoid pain. The range of motion of your hand, wrist and arm will diminish until they are frozen in position. Yuch. This may bring on level-ten pain. Treatment is often contrary to common sense. Common sense tells a person that movement through pain will cause further damage. This isn't necessarily so. Sometimes fasting helps a bit because high glucose levels cause nerve impingement cause of osmolysis. Keep well hydrated. You need to find a physician who is familiar with this injury and knows what he/she is doing. X-rays are inappropriate for differential diagnosis. There is hope at the end of the tunnel. I suspect the problem is correctable through proper physical therapy.

[jemma116]

You should also not be lifting anything that is heavy above your shoulders.
You should not be doing any pushing or pulling.

I get the impression that all your problems are work related.  If that is the case, you will have to look at the way you are doing things and how things can be modified so as not to make your condition much worse that you will end up not being able to do anything.

[jemma116]

Pins and needle sensations in the pinky finger are usually an indication that there is in impingement on nerves in the neck area.  Your tests show that you have problems in the neck and that is also the reason why you get the creaks and crack sounds when your turn your neck.

The other sensations in your fingers and wrist would indicate a carpal tunnel problem.

What type of work do you do?  Your symptoms are indicative that you do a lot of repetitive movements whether this is due to the type of work you do or from sitting and writing for a long time without breaks.

The symptoms classed altogether remind me of RSI (repetitive strain injury) sometimes referred to as Upper Limb Disorder.

You should stop doing what you are doing and support the wrist or wrists that are causing you the problem.  Nerve conduction tests would confirm whether you have a carpal tunnel problem.  If this comes back negative, it is likely that you have overused the soft tissues and tendons in your hands and wrists.  Ask your doctor about support splints to wear around your hand and wrist to help with recovery.  If you do not do anything about this and continue to use your hands, the condition will get much worse.

If you do use a computer for any length of time, you will need to look at the way you use your keyboard and also your posture as you sit at the desk.  It is important to take breaks.  At the stage you are at at the moment, you do need to rest and support the wrists and hands.