Injuries and RehabTell us where it hurts! Do a quick search before asking about your shoulder injury to make sure your question hasn't already been answered (about 50 times), and read the sticky post first.
1. When did the pain begin? The WEAKNESS began about 6 weeks ago, I noticed that I was having difficulty holding a coffee cup. In the next day I experienced a variety of minor flu type symptoms and extreme fatigue if I did anything strenuous. Also tingly feeling in upper and lower jaw, sometimes teeth, lower arm. It started bi-lateral, and as ended up almost solely on the left side (and I am left handed)
2. What were you doing at the time? Or did the pain come on gradually over time? The first morning I noticed it, I remembered some minor weakness the previous two days.
3. Where, anatomically, is the pain? Now the tingly lower left arm, weakness is in the fingers, especially force to the side, like turning a key, using an aerosol.
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting? No pain, tingly and weakness
5. Is the pain constant, or intermittent, or only on certain motions? weakness is constant
6. What motions make your pain worse? The neurologist said no pullups or chinups, or more specifically not to go much beyond 90 degrees, ie, stop before the top. Yesterday I did deadlifts and my left hand fatigued,
7. What, if anything, makes your pain better? nothing helps the weakness
8. Does your pain radiate to any other part of your body? no
9. What things could you do before, that you cannot do now because of your injury? chinups, pullups, I can do dead lifts, pushups, the fatigue is gone now, and I am sprinting several laps (see workouts)
10. What is your main concern regarding the pain and its consequences? Am I injuring my arm/finger nerves doing weight lifting. What sort of exercises should I be doing? What is the recommended treatment. Neurologist does not see any connection between the flu like symptoms I experienced and the finger tingling/weakness. Odd coincidence.
11. Have you ever injured that part of your body before? If so, how? No
12. Is your pain getting worse over time? And if so, how much worse over what time period? Weakness is better in right hand, but left hand is not getting better.
I have had a brain MRI, neurology exam (no instruments), in Sept. am scheduled for an electrode exam of left arm/ulnar nerve.
Neurologist seemed to think it was an injury. I have some doubts. Originally I was suspecting viral spinal meningytis, or possibly statin reaction. I've quit statins.
I have had the standard every three months bank of tests internists do for diabetics. Any particular test, I keep copies at home?
Rob - you are saying ulnar, your test will be for ulnar but you list a symptom like turning a key or using an aerosol. Maybe it makes sense to Julie but I thought ulnar nerve symptoms would be more manifest in pinky & ring fingers and to me turning a key is more a thumb/first finger activity. Did I misunderstand?
The other thing that struck me to ask about - how are you sitting at a desk? Has your chair changed or the desk or the layout? A few years ago, I had problems with my left arm and finally narrowed it down to some light but constant pressing on the nerve at the elbow when I was typing and that elbow was on the desk. Just my anatomy combined with the angle for the forearm and keyboard. I put a mousepad under the elbow and symptoms were relieved (but they were never so bad as yours) - just thought I'd mention it if injury is suspected, it might not have been a single event.
I would be interested in markers for inflammation which they probably don't routinely test you for.
I don't know Rob ... sounds funny to me ...
Ulnar nerve would be more power grip (like gripping a hammer), while holding a teacup, turning a key, and an aerosol would be more median. Also, a peripheral nerve injury wouldn't cause tingling in your face and teeth.
So I am concerned about a more central problem ...
What did the brain MRI show?
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Julie - your thoughts on this probably parallel mine. The second day all this happened I was not able to get hold of my doctor, and checked with d in law. Because it was at that time still bilateral she suspected something spinal. The MRI was head only, although it still goes down to what I would call neck. Outside of a fatty deposit it all was normal. They gave me a copy of the CD, and the neuro went over it pretty carefully, as well as having read the radiologist report.
When I read up on spinal viral meningytis it said older folks may have untypical symptoms. Statin side effects are pretty much the same set. Both can have flu like manifestations. And that was about how I felt, diarrhea, slight temperature, feeling 'off', fatigue, cramps in lower leg after exercise (new to me). Also I had a heck of a time with my blood sugars. I had before this started got to an average of 90, and it went up to about 96, and that was using quite a bit more insulin.
Thoracic outlet syndrome or lower C-spine issues might cause this sort of a picture.
Has a cardiac origin been ruled out?
MCI:I have a copy of the CD, radiologist and neuro saw nothing out of the ordinary.
Thoracic outlet: Sounds suspicious, while it started off bilateral, it seems confined to left arm/hand(tingly)and mostly fingers now
cardiac: I ended up with a stress test and the radioactive injection, followed by a 3-D scan a month or so earlier, and resting heart scan the next day. It all came out clear. Although that is all the Internist told me. I do not have a copy of it. The technician stopped the test when I got to 152 pulse, and commented I was performing like a 51 year old. (I am 68). I have checked my pulse as high as 200 at the end of 14 sprints - and feel tired, but not exhausted. Pulse also drops really rapidly.
It sounds as though the most ominous possible causes have been ruled out.
Do you have a copy of the MRI report by any chance?
Thoracic outlet can be bilateral. The difficulty turning a key is a pretty classic symptom of TOS, IIRC, but isn't unique to TOS. Anyhow, I'm sure your Neuro will be investigating that as well as potential C-spine causes.
Rob, that's good ... it sounds that you and your docs are being thorough. Have you mentioned to the internist or cardiologist that you suspect a statin problem?
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res MRI: signal intensity, mass, edema, contrast, cerebral himi. brainstem, cerebellum, ventricies, basilar cisterns, extra-exial are all normal. Impression: no acute or subacute abnormalities. A 2.8 by 1.5 ovoid lesion isointense with fat onsistent with a lipoma is seen witbhin the right semispinalis capitiis muscle. Neuro could not detect it palpating. But it was obvious in the MRI. My neck is pretty muscular.
I looked up IIRC on google, and obviously didn't find what you are referring to. Give me some clues on googling.
My statins were doubled about 3 months ago, with concern for triglycerides, which are now down, ie, 67. I am becoming a lot more agnostic regarding statins.
Much appreciate all the information. I am aware that the most likely outcome will be a problem of undetermined cause. I am comfortable with uncertainty.
ps - res statin side effects. I understand that physicians are reluctant to recognise statin side effects. I am really up in the air now regarding them.
Well, in treating any type of peripheral nerve injury, you want to work selective progressive strengthening, but avoid complete fatigue. Actually, you might ask the neuro to refer you to a hand therapist after all the tests and if the weakness isn't returning on it's own. But until then, ball squeezes, putty pinching, and finger drills (touching the tip of each finger to the pad of your thumb) can help. I would probably avoid deadlifts for now because if your grip is compromised, you could end up compensating elsewhere and creating another problem down the road. JMHO. (Just My Humble Opinion)
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ulnar nerve - esp in fingers
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