Wasting triceps & pectoral, loss of strength

[ontheway]

I did have the numbness/tingling in my fingers. That has been gone for a little while now.

[SPPAWA]

I did have the numbness/tingling in my fingers. That has been gone for a little while now.

Can you remember which fingers specifically? More the thumb and first finger? Or more the middle finger and ring finger pinky finger? Was the sensation more to the palm or on the back of the hand? Also was your neck pain aggravated by certain motions, was there one side you found youself leaning towards to minimize discomfort?

I did a bit of homework because anytime idiopathic is used it can be a bit of a wastebasket diagnosis. Anyways, whatI took away was that usually this condition this begins with an acute episode of shoulder pain. You described the problem to have initiated with severe neck pain. This gets me a little worried, as it is possible that an MRI taken supine of your neck may have missed a possible C7 disc lesion. That C7 root is shared by the distribution of your weakness and has me a little doubtful given my understanding that idiopathic neuritis would likely affect more than one root level. There may be some form of chemical radiculitis from the inside of the disc irritating the root. What were the results of the EMG and did they do a reading from the paraspinal muscles at C7 which share that innervation as well. That area of the spine is common to degeneration as well and given you history as a bodybuilder I would suspect you have had heavy loading placed on the neck. What is the bony integrity of the area like?

As for your chiro making your pain better this could be a good or a bad sign, depending on how he/she is monitoring how you responded to their treatment. A neck maniuplation followed by a loss of reflex and power as well as a decrease in pain would cause one assume that they have further damaged the nerve, despite you feeling less pain.

Just to clarify you have no weakness in the biceps, brachioradialis, finger extensors or flexors?

W

[ontheway]

The numbness started more in the pinky and ring finger then moved to the index finger and thumb. I did not have any strength loss in the bicep. The fingers were still strong as well. When i say neck pain, i may be a bit off. It was in the neck/trap/shoulder blade. I can not pinpoint one spot. I do know that when i was getting xrays that i needed to hold my head completely straight and back and that was painful. I would have to stoop my head to keep the pain down.
The emg showed abnormalities in the pec and lat the most. She said the tricep really was not bad, but i have definite weakness there. I really do not know the specifics of the report. As far as the other questions, i really do not have answers to them. I do know that i am getting some strength back, but not to where i would like.
Are there things you think i should ask? Which doctor should i go to and ask them as well. I have seen numerous types. I do appreciate your concern and time. Thanks.

[SPPAWA]

I guess the best thing is that you feel you are improving. As for what questions you should ask and who you should see, I would be pushing for a 2nd opinion from another neurologist. I'd also be keen to see if they did an EMG on the paraspinal musculature at the C/T junction. A root lesion there will give atrophy here as well, it should be a routine part of an EMG exam when trying to eliminate a root lesion; however, it can be forgotten. A few more questions though:
1. When your neck painful you had to hold it forward, as in looking down improved your pain levels? This will open the IVF and give the nerve root more room to move and relieve some of the discomfort associated with it if there was some encroachment on it.
2. Also, were there positions you could put your arm in that improved the arm and shoulder pain (ie. holding your arm over your head)? I ask because these are findings common to a mechanical lesion in the neck involving a nerve root.
3. When you post when squatting at the gym did that aggravate your neck pain by chance or give you discomfort in the shoulder? This would increase the intrathecal pressure and aggravate a sketchy disc.
4. How long has this been going on for now?
5. When you say you can't get your whole pec to flex is it more the sternal fibres or the clavicular fibres?

As I said previously I'm surpirsed that an infectious or an autoimmune type condition like they propose only managed to affect one nerve root, although possible, I'd just want to be confident that nothing mechanical and more plausible wasn't missed. It's more likely to have an uncommon presentation of a common condition than to have an common presentation of an uncommon condition.... Diagnostic words to live by.
At any rate it's an interesting case and it would be great to view your films and read those EMG reports. Would be amazing if they could get posted somehow! Thanks for sharing, I hope you find this helpful.
W

[erinjames]

Hi guys! I personally dont know much about body building but i saw Parsonage Turner syndrome mentioned and thought i'd put in my pennys worth! Im a physio student and on my recent outpatient placement i saw a lady who had been on holiday 2 months earlier and since that time she had felt pain around the posterolateral aspect of the shoulder. On examination she had only about 30 degrees of active shoulder flexion and abduction, she could not acheive hand behind back or hand behind head movements actively. Passively she had full range of movement ruling out frozen shoulder (which was my impression from the referral as she was also a diabetic).Tests for RC injury were negative. She also had very marked wasting of her shoulder musculature, particularly infraspinatus, supraspinatus, and deltoid. The only method of injury that we could identify was that when on holiday she had slept in a bed with a big dip in the middle and she felt she may have slept awkwardly. After doing some resaearch and consulting the medical staff we made the diagnosis of neuropraxia or Parsonage Turner syndrome. The good news for this lady is that with some simple strengthening exercises she had regained almost full active ROM within 6 weeks of initial assessment (so roughly 3 1/2 months post injury). The difference from your story is that she experienced very minimal neurological symptoms no tingling, numbness etc. I know this isn't much help to anyone but just wanted to let you know of my experience of Parsonage Turner syndrome as Ive heard its quite rare and as a student its nice to be able to post something other than a question on here! Hope that you all find a conclusion and that your problems resolve!