Puzzling Shoulder/Tricep Problem

[burker007]

I've been dealing with a cervical radiculopathy (C7) for about 4 months now and can't seem to make much progress or really get straight forward answers. I'd appreciate any help or suggestions.

My initial problem dealt mostly with weakness and dull pain in my right tricep during activity. I had some light tingling in my hand, as well as random sensations throughout my arm. I'm 25, and a baseball pitcher, so pain/weakness/tingling in my throwing arm is a major concern. It progressed twice to where I felt normal, only to literally give out again over night. I've had 2 MRIs (wo contrast), an EMG, and Nerve Cond. study done. Both MRI's showed a very slight bulge on the right side of C7. It was so light, however, that the radiologist's report dismissed its finding as a potential problem. The nerve study came back negative and the EMG only found some slight irritation around my supinator.

Currently, I continue to have dullness and heaviness in the tricep, along with a tight right trap and scap, and occasional sensations at my inner elbow. I'm worried that my whole right shoulder/arm is going to feel like this forever, greatly affecting my career as a baseball player. My arm never feels weightless and loose like my left one and whenever I think it's getting better it takes a couple steps backwards.

I last saw my dr. 2 months ago and he said to rest it and that he doesn't have any concern that this will go away over time. My P.T. has consisted only of massage and manual traction, along with the prescription of a home traction unit. I was on oral medrol for 12 days after the initial diagnosis. I asked about the potential for an epidural (since i heard they work well with referred pain) and my doc said he would be remiss in doing that since I wasn't in a lot of pain and due to the MRI.

Could a leakage of disc fluid be causing all this? Could there be any other problem that would lead to such symptoms? Would the epidural be completely out of line? I'm dying for advice to get my arm back to normal. Thanks.

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[physiobob]

Hi there and thanks for your informative posting.

Sounds to me like the neck has been cleared so I would forget that in terms of a treatment approach for now as it's been done and you haven't progressed.

Sounds to me a lot more like a traction type issue, perhaps with some small subluxation in the shoulder joint as well during the action of pitching. This is very very common in people who throw balls at high speed e.g. baseball, cricket, javelin. It is also likely thew the 'injury' has a slow insidious onset meaning no one event caused it but rather that it was an accumulation of repetitive insults to the tissue in that area.

A key part in the identification of the issue and the rehabilitation would be to video analyze your pitching mechanics. Not just fresh but also towards the end of a long/typical stint on the mound. If the whole body is not connection from your stance leg through the hip/pelvis/lumbar spine/thoracic rotation etc etc then the arm will overwork/over-extend on the wind up. If all is not in order and if your external rotator cuff is not strong in eccentric loading then the slowing down to release of the ball will cause all sort of compensation in the glenohumeral (shoulder) joint. This can cause a traction type injury to the brachial plexus (nerves running down the arm.

Sorry if this sounds a bit complex but actually it is, especially for a baseball pitcher. You need to see a physio who works with pitchers. Perhaps look to a clinic that supports one of the big local teams and get them to check you out.

For reference: Craig Allingham is an excellent Aussie Physio who specializes in this type of rehabilitation although he is not based in the USA.

Best of luck

[burker007]

physiobob,

thanks so much for the response. although you said it sounds complex, it does make sense. I've thought it could potentially be a brachial plexius problem too. My only questions would be 1) i havent thrown a baseball in 3 months, so wouldn't rest from that cause some relief? 2) what type of rehab would be involved in correcting this problem? 3) what test (MRI, etc..) would help to confirm that the brachial plexus and not the neck is the issue? thanks again.

[Yarok]

HI

taking into consideration is no cervical/neck problem, i can agree with physiobob.
But i have seen very similar problems caused by disfunctions of scapula/shoulder girdle, especially trigger points in muscles inc infraspinatus, supraspinatus, middle and lower trapesius, rhomboideus, subscapularis muscles.

please, learn about trigger point next about muscles, then ask someone to assess it.

Obviously their existance are part of a complex - neck, scapula, back, posture, reaction on a mental/social stress.Very often locomotor malfunctions are visible in scans

all the best

[physiobob]

Might also consider entrapment bwtween the ribs and collar bone as the arm comes back as in thoracic outlet syndrome.

A specific MRI to investigate the above would assist. Rest in this instance would not alleviate the problem just the symptoms when not performing that action.

As mentioned before you need a video analysis and physical assessment to see what's going on and therefore where to start

[burker007]

thanks again for the replies.

i had an MRA done to test for thoracic outlet, that came back negative. but is that for pinching off blood flow or nerve entrapment?? my rhomboids have been really flared up the past two days. I feel like a dog chasing my tail since there are so many different things that pop up. i am heading back to the dr tomorrow to redo the EMG and have another pair of eyes check me out.

i've researched trigger points and have active release and accupuncture done on my shoulder, scap, trap. i just can't imagine having this much difficulty in my shoulder/back/arm/tricep based on some instability somewhere.

[burker007]

well upon further review it looks like i can completely rule out the radiculopathy. seems that it's more likely to be a problem with entrapment in my thoracic outlet. I've been stretching my scalenes and pecs and have felt a lot better the last 4 days. the tightness in my shoulder/rhomboids is pretty much gone. i still have some tightness in my tricep.

how can i go about completely wiping the problem out?? what kind of time table am i looking at? i've been stretching mostly using muscle energy. any other tricks that might help?

[burker007]

to further clarify some of my symptoms.

I have no loss of range of neck motion. No overpressure to my neck causes any symptoms in my arm or pain for that matter. My shoulder is a bit tight on internal rotation. the dullness in my tricep and occasional flare ups/tightness in my scap/trap/rhomboids are my main concerns at this point.

the dr.s i saw the other day mentioned the potential for neurogenic thoracic outlet, as well as a brachial plexitus.

hopefully this clears up some questions anyone had and might shed some light on potential problems. i really appreciate any help/advice.

[Sandy orton]

Hi...I got neck shoulder and tricep problem..it happened when i was doing arm wrestling..and suddenly i saw a jerk in the shoulder joint..iam very passionate about excercise..now i cant do my shoulder workout properly and recently i have got stiff neck problem which is connecting to shoulder..a small jump is taking my breath away..that is a squeezing pain...and tricep gets locked when i do workout..any one can help me out what would be the problem..i have concernd the physician he told me to take rest i did..but still it is not usefull..plz help me out with rehabilation