Client with Biceps spasm and arm pain/weakness

[HeidiMills]

Hi
I have a client who I first saw yesterday. His right Biceps Brachii is rock solid in spasm and has been for 9 months! He has had X-rays and MRI's of the arm and nothing shoes up...other than some "inflammation" of the tendon which the Consultant just ignored.

He has see a chiropractor who manipulated his shoulder (from his recollections only) and then said she didn't want to see him anymore. Also NHS Physio who just massaged the arm and gave some stretches which make it worse.

He can't think of how it started, just was there one morning.
From my own assessment, his posture is awful, the right shoulder is drawn anteriorly considerably more than the left and his shoulders are elevated to the point of appearing to have no neck!

Neck movement is severely restricted although not painful. Same with shoulder movement. Elbow extension is limited also. No pain on palpation of the biceps or shoulder area or contraction of biceps. No pain on resisted neck or shoulder movements. Sometimes some tingling in the hand and he says often the big movements aren't painful, it'll just be something small that triggers it.

Am I wrong in thinking that this could be referred from the neck? All investigations so far have concentrated on the arm and shoulder, but showed nothing. I know pain can be referred down the arm from the neck, but can it cause bicep spasm to this extent?

Any help appreciated!

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[Dr Damien]

Dear heidimills

you might be dealing with a case of dystonia? how old is this patient? any history of stroke?

If you sure it is spasm, maybe trying some antispasmodics before mobilization may help ...or botox injections...

if treatments and investigations to the shoulder and neck are coming to not..then my first thought is a dystonic arm...

any radiological examinations for the neck? you could send him for a head/neck MRI...in the meantime, any neuro signs suggesting an upper motor neuron problem...?ie...reflexes? sensation? muscle power? stereognosis? associated reactions?does position reduce the tone in the upperlimb? what happens with passive movement? any other associated symptoms?...any family history of this problem? what happens with active movements in the limb?

cheers

[HeidiMills]

Thanks for your reply.
So far he has had no investigations for the neck, everything he has been referred for on NHS has focased on the arm and shoulder.
He has neuro symptoms into the hand so yes I think an MRI for the neck is the way forward. I just can't believe that no-one so far has even thought to do this.
Could a nerve root compression or disc prolapse etc cause this level of muscle spasm into the biceps? And are we looking at C5-7?
Thanks