Discussions By Condition: I cannot get a diagnosis.

Multiple diagnosis for arm pain

Posted In: I cannot get a diagnosis. 9 Replies
  • Posted By: Anonymous
  • November 26, 2008
  • 07:26 PM

Greetings folks at WD,

I really hope you'll take a minute to read this and respond if you can.

About 5 yrs ago I started to get *intensely painful* deep burning and sharp-electrical like shocks in my forearm. It was also acompanied by extreme tightness in my forearm and my hand would tighten up and become like a claw (similar to dystonia) and could last for weeks.

It first cropped up during a period of intense weight training where I went above and beyond my already high level of intensity.

Pain killers ( tylenol, ibuprofen and tylenol #3) did nothing for this condition, and neither did long lay-offs from physical activity.

The first sports med dr I saw misdiagnosed it as tennis elbow. I felt very uncomfortable about this diagnosis and went to a sports chiropractor who diagnosed it as a entrapped/compressed nerve. He claimed that during my extreme weight lifting sessions I created a lot of scar tissue which is inhibiting the movement or compression some nerves.

For the past 3 yrs I've been getting very frequent Active Release Technique sessions from this same chiro. It does help, but only to a certain degree. I can now function pretty well painlessly on a day-to-day basis and the electrical like pains are completely gone. Any amount of weightlifting, however, brings the incredible tightness, burning pain and the claw hand back almost immediately.

Furthermore, I cannot bend my wrist back any amount nor can I push back my ring or middle fingers without bringing about these symptoms (my other fingers are fine).

A couple of months back I went to a neurology for a nerve conductivity test (no EMG was done). His diagnosis is that there *might* be a slightly compressed ulnar nerve. He was pretty useless as he told me to not use my hand if it bothered me so much.

A few weeks back I went and saw a top-level rehab and physical medicine dr who specializes in athletes with nerve injuries. After an exhaustive physical examination and another nerve conductivity test AND an EMG test he told me I did not have a compressed or entraped nerve. He did find areas where the fascia in my arm had thickened due to my previous crazy workouts but that was not the primary cause of the problem which he said was a problem with the sensory motor program in my arm.

According this this dr, when I was going through my crazy weightlifting period i was injuring my arm. This caused my CNS to try and (partially) rewire my sensory motor program in an improper manner, causing pain and a type of hand dystonia.

I still have to undergo an MRI later this month but if that comes back ok I'll be getting botox injections which he says will help my body relearn a (hopefully better) sensory motor program.

Questions:

1) I've received three diagnoses for this pain. Which is correct?
2) From what I've read about botox injections the benefits only last a few months, yet this DR claims it will hopefully lead to a permanent improvement in my senosory motor pattern. Is this possible?

I thank you all for your time!

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9 Replies:

  • Compression/aggrevation of the ulnar nerve, or supplying nerve root, is the most likely suspect depending on the exact location of pain and involvement.Press where your "funny bone" (ulnar nerve) is and see if the symptoms appear.There could be compression/aggrevation at that site or all the way back to the neck.A MRI should show the culprit
    Anonymous 42789 Replies
    • December 1, 2008
    • 08:34 PM
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  • I do not think it is an ulnar nerve compression.If it is a mechanical compression, it should lay above the forearm.Usually, an exhaustive clinical exam with EMG can locate the height/point of the damage.I would suggest firstly an MRI of the cervical spine, with the most probable level of damage at the 6th and/or 7th nerve root. If that is normal, there might be a compression at the bracial plexus.
    tsoukase 18 Replies
    • December 1, 2008
    • 10:32 PM
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  • Itry and Tsoukse, From the bottom of my heart I thank you for you contributions. For the longest time I was sure that it was a primarily a nerve compression (either radial or ulnar). However I've since shifted my thinking after seeing this top-level physiatrist and doing some reading. My current (admitedly dummy level) thinking is that it might some type of myofascial pain syndrome. Here's a few reasons why I don't think it's primarily a compressed nerve: -- the symptoms don't quite fit into either a compressed/entrapped radial or ulnar nerve. For example, it is *fully* my ring and index finger which are affected by my condition. -- The "claw hand" I described above is generalized throughout my entire hand, and not just my small and ring fingers (which is what one would get if the ulnar nerve was involved).-- The physiatrist I saw is the head of an academic and medical dept. and he specializes in nerve injuries amongst athletes. He performed 2 exhausted physical exams and and EMG and nerve conductivity tests which show normal nerve function. That said, he has ordered an MRI to rule out other compression type syndromes. This is incredibly frustrating. Where I used to be able to conduct herculean weight lifting workouts I now can't even grip a barbbell without screaming. Any comments would be immensely appreciated!:)
    Anonymous 42789 Replies
    • December 2, 2008
    • 04:03 PM
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  • Correction: -- the symptoms don't quite fit into either a compressed/entrapped radial or ulnar nerve. For example, it is *fully* my ring and MIDDLE finger which are affected by my condition. :)
    Anonymous 42789 Replies
    • December 2, 2008
    • 04:15 PM
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  • As said, it is highly likely the compression lies at the C7 level of your spine. There are very few findings in the ENG/EMG for this. You must have the cervical spinal MRI.
    tsoukase 18 Replies
    • December 2, 2008
    • 05:13 PM
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  • As said, it is highly likely the compression lies at the C7 level of your spine. There are very few findings in the ENG/EMG for this. You must have the cervical spinal MRI. Tsoukase, Thank you once again. I'm still waiting for my MRI, which could take another month or two. (btw, I see you're from Athens ... one of my favourite cities. I visit absolutely every summer. Have a soulvaki in the Monastariki for me!)
    Anonymous 42789 Replies
    • December 2, 2008
    • 08:57 PM
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  • Wish you all good.
    tsoukase 18 Replies
    • December 2, 2008
    • 09:11 PM
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  • Aias - I am experiencing the EXACT same issues you are and have had the exact same tests. You are the only person I have ever seen with the same symptoms. My wife found your post and actually thought it was me.I would love to be able to contact you to compare notes.
    canuckbrian 1 Replies
    • December 18, 2008
    • 06:55 PM
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  • Contact via my email. affable1881@gmail.com (string all the above into one line with no spaces)
    Anonymous 42789 Replies
    • December 18, 2008
    • 09:15 PM
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