Cervical disc problem/tennis elbow?

[Sonj]

Hi

I've been having problems with first my elbow, then forearm, then shoulders and other arm and my GP thinks it's all stemming from one of my Cervical discs (erm C5/6 I'm sure he said)

My problems started around a year ago with tingling in my ring finger of right hand. My Chiropracter put it down to a mild ulnar entrapment and gave me wrist stretches to do which seemed to sort it. It would come back every now and again when using my PC, but more stretching would make it go away again.

Around 3 months ago, I was climbing at a climbing wall and doing a movement that had me pushing backwards with my arm straight and palming down, holding all of my body weight onto my outstretched hand (Left) I felt pain in my wrist which prevented me from trying this move. As soon as I stopped the move, the pain went away I was never bothered with it, until trying to do side push ups I would get a stabbing pain in my hand. A couple of weeks after this I started getting pain in my elbow which I feared was Tennis Elbow (lateral epicond.) which is a very common climber's injury. The pain would be of a tight kind and comes on when I rotate my arm, when I try to pick up something with my palm facing down. When I squeeze something in my hand, it hurts at the elbow. I rested my arm straight away and began doing wrist extension and flexion stretching to no evail. Pain would be in mostly in my forearm now and up the back of my hand (hard to tell exactly where in my hand but seems to be between the bones running up to my ring finger. I was also now getting numbness and tingling in the tips of my middle and index fingers and sometimes my thumb. There is no more elbow pain or tenderness whatsoever in the tendon insertion point, the pain more seems to be in the fleshy/muscle just to the side of the lateral epicondyle (is that the brachio something or other muscle, another common problem with climbers is brachioradialus strain)
Anyway, my GP thought it wasn't Tennis Elbow but a problem with my neck, and I agreed that there was def some kind of nerve entrapment somewhere because of the tingling and numbness but I wasn't convinced of it coming from my neck.

I have full ROM in my neck and the no neck movements were causing any pain or numbness although my shoulders were VERY tender as was the area of my C5/6 when the Doc pressed into it.

He said he was happy for me to continue rock climbing so I did. I was on a weeks holiday rock climbing and the pain in my forearm prevented me from doing much, but more worrying was the weakness in my forearm. It seems much weaker than the other arm. Also, I started getting tingling and numbness in my right fingers again (ring finger again) but the middle finger also, and much worse than it was last year. I've also been getting darting type eletrical pain down my right forearm which def feels nerve like in nature and my shoulders (both) have been burning. I still have probs with my left elbow and hand (but this feels much more tendinous/muscley in origin) Also, both my triceps feel very bruised inside as if I had strenuously exercised them but I have done nothing with them. Numbness in fingers in both hands continues also. And my neck often feels sore as if it is not sitting on my head properly and feels twisted and achy, but ROM is still fully there. Now, if I twist my head so I'm looking rightwards I get severe numbness in my right fingers - all of them apart from my thumb.

Things that make the symptoms worse are sitting down for too long, being on my pc for too long, driving and doing anything strenous with my arms such as climbing. Climbing only worsens the pain in my forearm, doesn't worsen the tingling in my fingers. Only thing that worsens that is turning my neck to the right and holding the stretch.

GP is now concerned that I have numbness in both hands, weakness in my left arm and also some pins and needles in my feet. All the symptoms are intermittant and other than elbow stiffness on my left hand, the symptoms come and go. He thinks I may have a central disc bulge and I've been booked in for a Physio assessment and possible MRI.

History - I had progressive L5/S1 problems which failed to respond to treatment and resulted in Discectomy in September -07. The disc is 100% dessicated and I have dessication in the disc above. Surgery was a success and within 3 months I was back to running, biking, climbing and mountaineering.
My mother also suffers from periodical and symptomatic Cervical Spondylosis.


These problems with my neck don't feel the same as what happened with my back. The pain is no where near as severe for a start and it is non disabling. I can still work, can still exercise etc but am concerned with the numbness and muscle weakness. The symptoms in my right arm are def nerve/neck related but I'm still not convinced that the symptoms in my left arm are stemming from a different problem alltogether as it feels so much more muscular/tendinous (other than the finger numbness obviously)

Anyway, sorry that was all a bit long winded!

I'm feeling confident that seeing a Physio will sort things out but I'm very impatient and curious as to what is going on, so just after some of your thoughts rather than advice really.

1) Is it possible do you think that the problems with my left elbow/forearm are unrelated to my neck/problems with right arm?

2) What exactly is a central disc bulge? My L5/S1 rupture was lateral and compressed the nerve root, does a central disc bulge affect the spinal cord rather than nerve root? Or can it do either?

3) Is it really ok for me to still be climbing? My GP says that the damage to my disc is already done and that pain and spasm will stop/prevent me from doing anything that could cause more damage to it. And yet he said that it was probably all the constant looking upwards when climbing that gave me neck probs in the 1st place. Is it ok to continue with activities that cause pain, as long as they don't cause anymore numbness?

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[AB123]

Hi Sonj,

Without asking you all of the typical questions physio's normally ask during the initial assessment, it sounds as if you may have median nerve entrapment. A number of things may have aggravated this - you mentioned that you tend to notice an increase in symptoms while working on the computer, I'm wondering if you have had a proper ergonomic assessment in your workplace. One major culprit in this is the placement of the mouse - you tend to use supraspinatus or other shoulder muscles more if the mouse is placed too far out. You want to maintain a 90 degree angle with your elbow and shoulder, keeping your arm close to your body when typing. When you do have a physio assessment, maybe mention this possibility and they will most likely show you some nerve glides to help solve your problem. I doubt that the L5/S1 symptoms are related to your arm as these follow a different nerve pathway and will likely affect your low back or lower extremities. Hope this helps!

AB123

[Sonj]

Hi, I never said anything about the problems coming from L5/S1 (that's the segment that I had surgery on last year) My GP thought my arm problems were coming from a disc in my NECK.

Anyway, have been for Physio twice. First time she thinks my neck is fine and the pain/numbness is due to shoulder instability, causing muscle imbalance/spasm and that is irritating nerves. Second time, she has changed her mind and thinks it's coming from the Facet Joints in my neck.

Now, after doing neck stretches for the past few weeks, my neck feels brilliant! Really loose and no aches and the numbness in my fingers is much more intermittant (just a few times a week, as opposed to a few times a day) but the pain in my shoulder feels worse. It feels like it's not sitting correctly, like something is pulling it forward and there is burning all around the back of the scapular area. It feels like it would be great if someone could pull my scapula off and place it back an inch or so, then it would feel more comfy.

Regarding the elbow pain on the opposite arm. Physio thinks this is seperate to the stuff going on in neck/shoulder (which is what I suspected as it doesn't feel connected) Moving my neck in various ways does nothing to the pain in my elbow. She says it's classic Tennis Elbow and I was given stretches for that too and a brace to wear when I'm rock climbing. The brace is fantastic! Really, really helps and I feel the stretches are helping. The pain is getting better.

I'm still concerned over my shoulder/neck though.