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  1. #1
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    Brief Medical History Overview

    Wasting triceps & pectoral, loss of strength

    Physical Agents In Rehabilitation
    Hello, I'm new to this forum and really need some guidance with an injury I have. My sports are bodybuilding & swimming, I've been training for about 25 years. This is a new injury for me and I just don't know what to do?

    It all started back in November, I woke up after sleeping awkwardly on my side and found that it was very difficult to extend my left arm. I had a dull throbbing pain between my deltoid and neck. The pain was quite bad and the maximum dose of ibuprofen & paracetamol with anti-inflammatories was required to manage it. After a week the pain subsided but I have been left with weakness in my left side.

    My left triceps and left pectoral muscle are about 50% of the strength of the right hand side. My bench press has been reduced from a regular 160Kg to around 100Kg. Things have improved but only very slightly. My biggest concern is muscle atrophy. My left triceps and left pectoral muscle are visibly smaller, softer and wasting. I visited a chiropractor several times who suggested that I have a prolapsed disc in my neck.

    Iíve started using a Tens EMS , electro stimulator unit on the triceps and pectoral to combat the wastage , but I donít think itís made a lot of difference. A guy in my gym had a similar experience after suffering whiplash in a car crash and lost control of his pectoral , but he regained control in about 3 months. Iím not in any pain , my problem is muscle wastage and loss of strength.

    Please can anyone advise me on what I can do to improve this injury?

    Similar Threads:
    Last edited by physiobob; 06-03-2009 at 04:35 PM.

  2. #2
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    Re: Wasting triceps & pectoral, loss of strength

    Interesting. I have a similar condition, and - as I'm a physio - I'm similarly baffled.

    My left pec and long head of tricep have both lost bulk and tone since (I'm embarassed to say) I had treatment from another physio.

    I happened to be consulting near a physio who fitted me in to help with some mid-back pain I'd been getting. The mid-back thing, I believe, was unrelated - just simple stiffness. Anyway, towards the end of the session, where he'd been providing good soft tissue and I was feeling good, he mentioned tightness in my posterior shoulder. I said I thought I was probably tight through the capsule and could probably do with some specific work there.

    He fully abducted my arm, I don't recall if there was any rotation applied, and then tractioned the joint (i.e. pulled outwards to gap the joint). He sustained that for a few 5-second bursts. I'd never come across treatment like this but thought it probably made sense and let him carry on. There was no pain at the time and it didn't concern me.

    Over the next few days at the gym I found my ability to press (standing single arm cable press - like a punch, great whole-body exercise) or to extend my elbow and shoulder (during tricep pressdowns or dumbell kickbacks, which I used to test the realtiv strength of left to right) was severely limited and my control of the movements had just gone - I was wobbling all over the place. (Slow right tricep kickback: 10kg; on the left: 1kg!!!) Freaked me out!

    The muscle mass dropped away over following weeks. Control came back over the next month or two and strength has improved somewhat. It's now about 6 months later but my pressing strength on my affected left side remains about 50% that of my right.

    My impression is that a few predisposing factors conspired against me: I tend to be stiff generally (45-year old male), have forward head posture (thanks dad and grandpa), and may have some disc bulges and degeneration through my spine as a result of a fairly physical life. So the traction was simply too much and a portion of my brachial plexus (somewhere between C6 and T1) has simply snapped.

    With time this may come back. I'm hoping.

    Your chiro's comment re prolapsed disc may be correct.

    Whatever our conditions bases, it's clearly a neural problem. In my case it's likely I'll just have to wait it out and hope the nerve regrows along its original 'track', assuming traction was the problem; same for you if the sleeping position tractioned or compressed a nerve. If our common problem is a disc bulge/protrusion/rupture, though, we may have a permanent pressure on a nerve. Surgery could be an option. I don't think the electrical stim will help.

    The lack of pain suggests our problem is with the motor nerve only.

    Is it neuropraxia I'm talking about?, when the nerve cell dies away but the myalin sheath remains intact, providing a course for the nerve to grow back along? And rate of regrowth: what is the rate? I seem to recall something like a millimeter a day...?

    Anyone else have some thoughts? (Neuro ain't my thing, clearly)

    Regarding your best course of action: A consult with a neurologist is probably your best bet.


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    Re: Wasting triceps & pectoral, loss of strength

    Hi Wakaday,

    Certainly from what you describe there is a structure impinging the nerves supplying those muscles, most likely around C7 level (could be C5->T1). Furthermore it is quitely to be from a disc herniation. However the relatively atraumatic history you describe (as opposed to a whiplash injury for example) is not as common a cause for this type of injury, it is certainly still possible.

    From a physiotherapist perspective, there are a number of ways to manage this condition. Personally I would start with McKenzies stretches to try and encourage disc regression and reduce nerve impingement. While I could try and explain these here (they are relatively simple) they are also quite specific and to be honest you are best off to see a physio locally to get a full and proper assessment/explanation.

    Prognosis wise, if symptoms dont improve through this conservative management you would be best getting imaging (eg: Wikipedia reference-linkMRI) and maybe an orthopaedic opinion/nerve conduction testing etc but this is looking ahead.

    Best of luck

    - Greg


  4. #4
    ontheway
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    Re: Wasting triceps & pectoral, loss of strength

    I posted on here before the server crash. I am experiencing all of the same thing. I have had two Wikipedia reference-linkMRI'S with nothing conclusive. Emg just showed abnormalities. I ma supposed to meet with a neurosurgeon that keeps getting pushed back. I seem to feel like the strength is a little better, but not much. I really can not still flex the entire pec muscle to make it hard. The tricep, pec and lat are all considerably smaller. I was wondering if anyone had any updates on this. No one seems to know anything about my situation around me. I am going on 4 months from the initial onset of pain in the neck, but have not had pain in over 2 months.


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    Re: Wasting triceps & pectoral, loss of strength

    Hi folks,

    to the OP: Please stop bench pressing at the moment if you can. If you can't, try completing unilateral dumbbell pressing with the good arm only for now.

    Additionally, there is one thing that can not be emphasized Enough: Posture, posture, posture. Without examining in person your form with exercises it is difficult to tell if there is anything that could have precipitated this injury. My experience and studies suggest that the neck position in various exercises has the capacity to influence cervical spine health, especially during bench press exercise.

    The ideal would be to have a full assessment of the musculature. As one response has already stated, find out exactly which muscles and ultimately which nerve roots are affected. I would want to know specifically is it at certain levels, and or specific roots?

    The one other thing that may be missed out is the Serratus Anterior strength test. If the lateral pectoral Nerve is affected, this significant scapular stabilizing muscle may have had significant atrophy. I would want to get a full scapular examination as well. Bench movements imo are completely out of the question considering altered bio mechanics and neuro-signalling to the surrounding musculature.

    best of luck


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    Signs of improvement

    Had this condition since early December, Iíve seen an improvement over the last month. Chest pressing strength from LH to RH has improved from 55% to 27% difference, and triceps hammer style extension from 50% to 7% difference. Iím continuing to train the LH side hard and RH light in these muscle groups, and using Russian stimulator twice a week in a short & intense method. Iím hoping the muscle mass will now start to return. Iím still waiting to see a Neurologist, but that can take some time on the UK NHS. Iíll try the strength tests again next month. Iím pleased with this improvement. Iíll keep you informed.fficeffice" />>>


  7. #7
    ontheway
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    Re: Wasting triceps & pectoral, loss of strength

    Did you ever get diagnosed with anything? I have been waiting for a while to see my neurosurgeon as well. I am going today. I just started the russian stim. Done it twice in two weeks. I will probably bump up the schedule a bit. Very frustrating indeed. I am glad to see there are better results being had from you. Hopefully i will begin seeing them as well.


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    Re: Wasting triceps & pectoral, loss of strength

    no proffessional diagnosis , still waiting to see neurologist. I didn't have any obvious reason for the condition , simply woke up with it?


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    Re: Wasting triceps & pectoral, loss of strength

    I too woke up one night to a limb that was asleep more than usual as it took longer that normal to regain circulation, dont know if it was due to the amount of time asleep or what I just knew something was different, I sleep on my right side mostly with my arm extended and pillow between my head and shoulder, the next night i had severe twitching or spasms in my right upper back for almost an hour an then it stopped, I didnt recognize anything being wrong until a week or so later I tried to catch myself on the floor pushup style and my right arm didnt support and my face crashed to the floor, I'm 5 10 210 and usually bench press 275 8-10 times on my last bench set...at that time I started investigating and noticed severe pectoral sagging or atrophy and atrophy of my long head on the tricep this was after the hurricane in september and I didnt see a dr. until december, since then I have had x-rays of c spine and Wikipedia reference-linkMRIs of the shoulder and c-spine two EMG's. the first one the nuero said I definately had a pinched nerve somewhere, prob from the bulge in 4-5 protrusion 6-7 and bulge in 7-t1 or 8 that was seen in the MRI.... My neurosurgeon seems to believe its a brachial plexus injury of some sort, a strech or tear, he says that my disc injuries are minimal (3mm) since there is no pain and that there is no impingement on the nerves from the discs...he didnt like the results from the first EMG and sent me to another nuero for a more in depth test, she said the same thing that there was some sort of nerve damage but that they had started to heal and said it would just take time, I have been loading up on b vitamins as recommended....... I cannot get a definative answer form anyone and that is aggravating, he(my neurosurgeon) also suggested in returning to the weightroom ASAP to slowly rehab the muscles, Since I cannot barbell press from the imbalance of strength I have started back with flyes(lightweight 25-30-35 lbs) and machine press and also isolated pressdowns and extentions for my tricep...I notice that when I flex the muscles that they cramp up easily and after they uncramp they twitch/spaz for a short while(30 seconds) ......working out is my hobby and this has been quite a depressing time for me and finding answers have not been easy, from the searching I've done on the internet this seems to be more common than I thought, but all my dr.s seem to be at a loss...I dont understand


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    Re: Wasting triceps & pectoral, loss of strength

    Just wanted to say that my right lat has also been atropfied as well it just isnt quite as noticable as the tricep and pec but when i flex it it will cramp also...this is soo frustrating cuz I dont recall the injury


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    Re: Wasting triceps & pectoral, loss of strength

    Holispaul I know just how you feel, it's quite depressing, i once was a competitive bodybuilder, I've spent the last 18 months on a slow steady diet and my old physique was returning , then this injury! my guess is it's nerve damage from sleeping in an awkard position and it will go away as next month or next year? I don't think there a going to be a course of treatment. I'm still going to see the specialist. If it helps this is how I training Triceps & Chest:

    Chest

    Peck dec , 3 x warm up , 2 x set failure , almost stack or until LH starts to fail 1st

    smith m/c bench - 2-3 x set building up to about 100Kg (used to do 160-180Kg), max weight before RH takes over

    upright seated press m/c - press LH only 2-3 set to failure

    Triceps

    Cable push down - normal weights , warm up 2-3 sets to failure
    Seated triceps hammer m/c - LH side only 2-3 sets to failure
    Seated tricep barbel extension behind head 2-3 sets, bit lighter than used to.

    Russian Stimulator - 2 x week after chest recovered, 10mins , 100Hz, 10sec on/off, as much amplitude as I can take , almost max intensity.

    Not really sure how to use Russian thing, my other idea was use it every day , low intensity , low frequencey , say 10Hz, for several hours. I haven't tried that theory. Read some reseach about muscle astrophy reduced in rats when they used the low intensity-high duration route , rather than the high intensity/short duration route I'm currently doing.

    I train all over body parts & cardio like normal.

    Hope that helps


  12. #12
    ontheway
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    Re: Wasting triceps & pectoral, loss of strength

    well saw the neurosurgeon today and he looked at the Wikipedia reference-linkmris and emg and can find nothing. he wants me to see a neurologist now.
    The weird thing going on here is that we all sound extremely similar in size and lifting capabilities.
    I am curious if it is coming from the discs and the laying down mri's are not catching it.
    I feel like i am getting some tingling going down my opposite side now as well. I think it is from how i am sleeping. I need to figure this out before the other side goes too!


  13. #13
    ontheway
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    Re: Wasting triceps & pectoral, loss of strength

    Alright everyone grab a seat this is going to be a long, but informative one.

    Saw a neurologist yesterday morning. Went in and got in a gown for examination. He did not look at any of my atrophy for a while. Did all of his reflex tests, motor skill tests, strength tests, and then proceeded to ask me some questions. I gave him the run down of my whole experience.
    About 5 months ago woke up with terrible pain in my neck and trapezius to where i could not hold my head straight. After going to chiropractor for 2-3 weeks the pain went away, but numbness and tingling was present in the fingertips. While battling to get the numbness away notice strenght seemed to decrease overnight in the pec, tricep, lat, and little bit in the shoulder. Got to the point where i could barely do 5 push ups from benching 315. Told him about Wikipedia reference-linkmri's for herniated discs and brachial plexus injuries, blood-work, neurosurgeon visit, emg and nothing could tell me what was wrong. He finally checked my atrophy and asked me a couple times if i had been sick before this happened.
    I just had a daughter 4 months before this came on and remember distinctly not being sick because i would try staying away from her so that was a no. he said ok, told me to get dressed and he would be right back to talk. He comes back in and throws a name of PARSONAGE-TURNER SYNDROME or IDIOPATHIC BRACHIAL NEURITIS. This is my diagnosis by names. I made sure i got them so you guys can make sure you ask about them.
    Basically what happens is the immune system ramps up to fight a bacteria or virus from being sick or a cut or something and ends up attacking the brachial plexus nerves as well. This is most common in men in good health, above 20. Basically it starts with pain (like my neck) as the pain subsides numbness and tingling may become present then the weakening of muscles affected by the nerves starts and atrophy sets in rapidly.
    You guys can pull more information up, but this described me perfectly. Basically they do not know why it happens or what really causes it. Good news is that it normally happens and you do recover. It does take time because as we all know nerves heal slowly.
    I was still stumped how it affected me, but whatever at least i had some kind of answer and direction, and better that i should be recovering. When i asked for him to write the names down so i could bring the info back for you guys he got the book out and read me the passage.
    As he was reading i had to stop him at one point when he was discussing the possible reasons. He stated the illness aspect which i ruled out but he then said something that floored me. Vaccinations and immunizations can be a trigger for this. Remember i said i just had a daughter 4 months prior. Well as cold and flu season were coming, my wife and i thought it would be a good idea to get flu shots to avoid passing something to out daughter. This was right before this happened. I had never had a flu shot in my life until this and was on my affected side. I told him this and he said he should have asked me about that, but there is a decent chance that it may have triggered all of this. He said he is not guaranteeing that is what caused it but a good chance. As far as i am concerned that was it. He said there is a chance he is wrong about the diagnosis, but he is pretty certain. He told me to come back in a couple months to follow up. So he said keep working out to work on the muscle and measure the sizes, 1 rep max, and just keep track of everything. It will take time. I am hitting the gym, doing russian stim and striving for improvement.
    I am really floored by the fact that i get a flu shot trying to do some good and get kicked with possible a 18 month problem. It really scares me for my daughter getting all of her vaccinations. If something like this or god for bid anything worse happened to her i would lose my mind.

    Anyway this may not be what is going on with you guys, but something to check on, especially if someone is pushing surgery on you. Good luck guys.


  14. #14
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    Re: Wasting triceps & pectoral, loss of strength

    do you have any sensation disturbances in the arm or hands?


  15. #15
    ontheway
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    Re: Wasting triceps & pectoral, loss of strength

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


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    Re: Wasting triceps & pectoral, loss of strength

    Quote Originally Posted by ontheway View Post
    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 Wikipedia reference-linkMRI 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


  17. #17
    ontheway
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    Re: Wasting triceps & pectoral, loss of strength

    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.


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    Re: Wasting triceps & pectoral, loss of strength

    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


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    Re: Wasting triceps & pectoral, loss of strength

    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 Wikipedia reference-linkfrozen 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!


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    Re: Wasting triceps & pectoral, loss of strength

    This is my first time posting, i seem to have the same problem that many of you have mentioned: my Left - Pectoral muscle as well as the left Triceps.

    Today i went to the Physiotherapist, to my knowledge i thought it was a waste of money as she was touching my shoulder and neck totally not paying attention to the serious problem of the left pectoral as it clearly became much smaller then the right.

    Her Diagnosis: Wikipedia reference-linkRotator Cuff ( that's right ) Pinched nerve ( as many of you mentionned ).

    i am quite flexible and double jointed at the shoulders but my left shoulder makes a small click as my arm is rotated towards the top and it's believed that due to BAD POSTURE from either; sleepy badly, playing computer, stopping activities that use to b done. I'm glad to hear that others have seemed to recover some strenght.

    6" 200 lbs previous bench 280 lbs
    current bench a shameful 120 lbs (with difficulties)

    i aswell have seem a major drop in left Triceps and i believe the nerve damage is linked.

    Physio therapy suggested is working the rotator cuff
    using adjustable cables start with a small weight at elbow height and pull from the exterior to the interior and place a towel between the elbow and torso make sure the movement should not move in the elbow but just to focus on the rotator cuff. I'll post back in a few days with results of workout and keep thread alive.

    Also when in normal stance your shoulders should not be facing forward but more like pulled back which she explained is more natural and more room for the nerves if you find yourself having shoulders that are more infront that could b the start of your problem reply back thx.

    There is hope


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    Re: Wasting triceps & pectoral, loss of strength

    I've made some more progress this month. Tricep extension strength is about equal and chest press is about 18% difference. That's a major improvement from January when both triceps & chest were around 50% difference. I still don't know what caused this? The Wikipedia reference-linkrotator cuff pinched nerve is another possibility. I'm still waiting to see a neurologist , now mid May. I'm hoping to be almost recovered by then. My bench is up to 120Kg, big improvement on 60Kg back in December. I'm hoping this will be almost repaired and muscle mass recovered in say 3 months. Keep you posted.


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    Re: Wasting triceps & pectoral, loss of strength

    Has anyone had the problem worsen after the initial loss of strength/wasting?

    about 6 months ago I lost strength in my left arm and had majour instability in the shoulder, i eventualy started seeing some improvements and started to become more active however about a month ago I was leaning on the arm and had a few awkward nights sleeping resulting in some pain within the shoulder and in the trap. On waking up my hand had gone numb and more strength especialy in my grip was lost.

    Now the strangest part is that shortly after some physical work using my good right arm it felt a touch weak and the tip of my thumb went numb the night after I woke up up with a buring pain in the shoulder/trap again (but on the right) and now the whole thumb is numb aswell as the top of the forearm, and worse I cant even lift my arm above my head or hold it out infront of me.... and all in the space of 3 days or so.

    Anyone had anything similar????


  23. #23
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    Re: Wasting triceps & pectoral, loss of strength

    At times of immobility, muscle wasting in Ursids is also suppressed by a proteolytic inhibitor that is released in circulation. ... in working against a much shorter lever arm than other muscles. ..... List of muscles of lower limbs ...


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    Re: Wasting triceps & pectoral, loss of strength

    Recently visited a Prof. of neurology. He diagnosed the condition neurologic amyotrophy. Basically a viral attack on the thoratic nerve. Symptoms are high pain in shoulder area 1-4 weeks, followed by some degree of paralysis and muscle wastage. Good news most people make full recovery. Did some research 80% recover in 2 years, 90% in 3 years, Iím hoping to beat that although last month has not seen any improvement. Thereís no effective treatment, just time. Itís more common than people think. Thereís no point doing MRi , thereís nothing to see. Itís often triggered after an immunization, or post operative stress or child birth , although I donít fit into any of these categories. Do some research on the condition, I think this may be the issue with some of you.fficeffice" />>>


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    Re: Wasting triceps & pectoral, loss of strength

    Aircast Airselect Short Boot
    THank you for the update. It is great to hear that you have some information about what is going on.



 
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