help help nerve damage

[eboebo]

Hi all
I am sorry this is a bit long winded but I don’t know wear to turn to in getting the answers I need to sort my self out so any advice I will be most great full
Medical history

I am a 43 year old male.
In 2002 I had thoracotomy operation on my left hand side to stop bleeding following a stabbing incident.
After this operation I was fine with no pain and no nerve damage I was also back in work after a few weeks as a window cleaner.

On the 5.11.04 I had a fall and twisted my back and hurt my left side of my chest on a kerb which became bruised and very painful .

On the 12.11.04 went to A/E still in very bad pain to my back and left chest wall not relieved with analgesia sent home.

On the 15.11.04 went back to A/E pain very bad this time noticed small lump over thoracotomy scare which has became larger in size from a 5 pence to a 10 pence and the pain is excruciating had a cat scan identified a lipoma which needs surgical treatment.

On the 13.04.04 operation excision of lipoma incision was made over the old thoracotomy scar the lipomata was dissected and excised. Haemostasis was achieved and closure was carried out in layers.

On the 7.7.05 still in pain and movement to my left side now aggravates the pain I am still in now have numbness on the front of my chest the doctor has said he did not cut any nerves and did not split the intercostal space so he could not explain the kind of pain I am in from a surgical point of view. Told to take ibuprofen for pain.

22.9.05 back at cardiothoracic clinic still the same nothing further they can do sent to pain clinic.

10.11.05 the pain clinic have said this is nerve damage and I have to take the following for pain pregablin caps 300mg twice a day amitriptyline tabs 50mg twice a day and keep a pach on for 12 hours a day which is lidocaine 5% the medication dose help but I can not return back to work.
The medication has gone up over the years but I still can not understand how my nerves can be damaged so much just by a fall I just don’t understand what has happened is this thoracic nerves damage like I have been told.
Is their any other doctors I can go to for help or do I have to just live with it without a life any help please.

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[physio.smith]

Have you ever seen a physio or anyother musculoskeletal based therapist?

[eboebo]

hi physio.smith
thanks for your reply i have seen a physio in the past but movement to my left side caused more severe pain and was told that they could not help.
thanks again for your reply

[Canuck Physio]

hi physio.smith
thanks for your reply i have seen a physio in the past but movement to my left side caused more severe pain and was told that they could not help.
thanks again for your reply

Hello,

Sorry to hear about your situation, but I believe that it is very much possible to solve your dilemma.

It is possible that the physio's may be cautious because of previous lipoma, however, they may not know that lipoma which can develop in any part of the body, particularly beneath the skin, seldom give any trouble beyond that connected with their size and position.

I think you should get this confirmed from a dr before anyone considers providing advice here.

It may be necessary to try some more 'esoteric' modalities of physiotherapy to ease your problems (ex. acupuncture).

Additionally it would be helpful to know whether or not you mobilised the left side over the period of surgery. The thoracic cage like any area of the body is just as prone to stiffness, adhesions, scar tissue build up, and soft tissue changes.

For example: are you able to fully expand your lungs from your abdomen?

Being able to achieve this alone may contribute to 'better' thoracic movement and contribute to localized improvements in soft tissue repair.

Just some things to consider,

Regards

[milo]

it sounds like there may be some rib joint dysfunction. these joints can often refer pain into the sides and front of the chest. though this pain is often descibed as being quiet sharp and brought on by twisting, deep breathing.

A good physio should be able to perform a thourough spinal examination and determine whether your problem is musculoskeletal.

let us know how you get on.

[eboebo]

hi milo and canuck physio
thanks for your reply s
first of all i can fully expand my lungs from my abdomen but this dose produce pain under my arm on my left side as dose any movement.
how do i get to see a physio for a spinal examination do i have to go back to my doctors to get sent to one?.
i have seen a doctor a few weeks ago and he has sent a report to me in it he says he thinks due to the fall it pressed on hmy injured thoracic nerve through the lipomatous area and because that nerve was tetherd caused a tear which made the pain worse.
he says the main trigger point for the pain is at a critical point.it is at the lateral axillary line,the point where sensory nerves surface before spreading medially and laterally above the appropriate intercostal space.
also at the operation excision of the lipomata tore sensory branches to his lateral and anterior chest wall.in addition it produced an additional tear in the tethered index thoracic nerve in the intercostal space.the lipoma acted as a passive buffer to transmit pressure to the injured indexthoracic nerve in the fall of 5.11.05
the thoracic nerve was tetherd and further tearing produced a substantial increase in chest wall pain and it will last for his remaining life.
the sensory loss was in the T3?2 to T5 area. of course it is an organic distribution thear is numbness in this area which can be demonstrated clearly.
it is completely consistent with branches of these nerves being in relationship to the lipomatous area with an indefinite margin which was dissected out/torn out.
the tissue obtained for the specimen was the result of dissecting out/tearing out an indefinite lipomatous area.
the pathology in the lipomatous area removed dose not suggest any other pathology other than injury to the index thoracic nerve as the main cause of the thoracic pain he has.
i dont have a clue what all this means can you explain this in eniglish many thanks
ian.

[milo]

sound like the Dr has given you quiet a definitive diagnosis.

from my understanding a lipoma usually lies quiet superically under the skin, so excision of the lipoma should not affect any nerves.
on your 1st post you said that no nerves were cut.
on your last post you said the dr tore the nerve on excision of the lipoma.

How big was the lipoma?? you must have been very lucky, or should i say unlucky to fall directly on to the lipoma. (no disrespect to your doctor)

if taking a deep breath causes pain, then it may still be musculoskeletal. i would be inclined to get it checked by a physio. not too sure how its works where you are ian, but in Australia you can go straight to a physio without a doctors referral.

sorry to sound narky. would love to be able to assess your spine.

[eboebo]

hi milo

thanks for the reply, the size of the lipoma was 7.5 cm x 5 cm. 8/4/3cm deep
regarding cut nerves i read this in a report from a doctor who has examined me for a solicitors report.
as far as i know when the lipoma was removed the surgeon said he did not cut any nerves in removing of the lipoma yet the doctor who wrote the report said nerves have been cut.
the doctor who i see for pain has said that the nerves wear damaged in the fall so at the moment i am still no nearer getting this sorted out.is there anyway i can find out if nerves are cut or just damaged .
many thank ian

[milo]

this is beginning to sound like a compensation claim.

i've heard of nerve conduction tests, but performed on people with suspected carpal tunnel syndrome. and usually on compensable clients as an obective diagnosis. private clients are usually quite happy for a physio to make this diagnosis with out an invasive test, which i've heard is rather painful.

[hari priya]

if there is nerve damage the symptoms you experience will be weakness or wasting,loss or diminished sensation,loss of reflexes,some atrophic changes in the skin like excessive or loss of sweating.pain due to nerve damage is seen in early stage when there is inflammation.if there is mild nerve damage,we call neuropraxia,it will start its own healing with in 21days.if there is long duration suppose 4 months passed from the time of injury there is nothing to do to the nerve.mores,the pain could be experienced when there is compression on the nerve.the type of pain couldbe like burning,shooting radiating pain along the nerve and not as localise deep ache.