HELP PLEASE! RSI injury, minor peripheral NERVE injury?

I was told to re-post the thread here


My name is james , i'm 22 year's of age, and i have been receiving treatment from the NHS for 8 month's with no answers and no treatment plan. I injured both forearm's early september time of last year "2009" from weight lifting, the injury is very much affecting my life.

My story.

I've been weight lifting for the past 3 and half year's, had a minor injury through weightlifting, I damaged both rotator cuff's through lifting weight's which was treated, and now is healed.
10 month's ago I started to isolate the forearms alot more through weight lifting, and
noticed a a sudden tingling/burning sensation throughout both forearm's, with dull sharp triger point's throughout both forearm's, I also noticed both elbow's seemed to flare up and was tender to touch, but that settled down after a month. Both forearm's feel very weak, typing seems to bring on the symptoms right away, both forearm feel's tight, as if the the muscle is being squeezed, also front of hand*knuckle side* and wrists, skin feel's tight. symptoms overall feel's like a hand grasping both forearm's, chinese burn sensation? I have completely stopped training, and have stopped all activities which falre up my arm's.

I've already had physio treatment for the first two month's of the injury, then i was sent to see a plastic surgeon who deal's with nerve compression release, I was given two sterriod injection's which didn't work ect.. i've currently had nerve conduction studies done which showed no nerve compression, but as you know minor peripheral nerve injury's tend to fall of the radar. I never saw the same consultant,which added to the confusion of the situation. the last consultant i saw was convinced the next step was to see a rheumatology consultant, because "the NCS showed no nerve damage or compression, therefore it's not a nerve related injury"

I think i have a minor peripheral nerve injury's, RSI, Or non specific arm pain.. but no one seem's to no what it is, and i'm being passed round like a football......

I have no idea what to do, or what action to take. i don't know what type of treatment i should be looking for. this is affecting my work life, and every aspect of my day to day life

apologies for this poorly constructed email, it really hurt's when i type :(
is there any info, or advice you can give me? any good uk NHS based clinics or clinical trials for this?

I have listed my referral's

My nhs My referral

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Any input would be fab¬!¬


taaaaaaaa

hi james. sorry to hear you're having so much trouble.

its quite a complicated picture you paint and to be honest trying to diagnose and treat you over the internet would probably be futile... however.

the fact that both forearms are affected would lead me to assess you further up the kinetic chain. i would be looking closely at your cervical spine (neck), thoracic spine (your back around your ribs), shoulder, scapular stability.

i just had time for a quick scan of your post but it would seem like you may have some nerve related pain indeed. you can have a situation where for some reason the nerves that supply your hands and arms can become very sensitised, to the point where normal actvities are felt as painful as the nerves threshold for pain is lowered. you could get the burning sensation you describe. you do not necessarily have to have "compression or nerve damage" for this to happen so NCS dont necessarily rule this out.

you probably need to have your C5-T1 spine assessed in detail, you also need to have your shoulder and scapular posture asssessed and muscles length checked to see is there anywhere that your peripheral nerves could be coming under a bit of pressure.

i would hazard a guess that you are fairly well developed in terms of pecs/chest and that you have rounded shoulders and probably weak back and scapular stabiliser muscles relative to the pecs. you probably have a bit of a poking chin too? neck and posture/muscle imbalance is where i would be looking as the source of your problem.

neural provocation tests are a way of assessing if these peripheral nerves are sensitised. basically you tension (stretch!) the nerves out in a particular way, looking to see if it recreates your pain. most decent physiotherapists would be able to do this but i couldnt promise! if it was found that this is an issue there are exercises called sliders and gliders that may help you. again these need to be shown by someone wth experience in this area.

If you came to see me with this information, I would widen the scope of your assessment to include the cervical spine, thoracic spine and shoulder function. I may even leave your elbows alone for a little while (partly a decision to avoid too much focus on pain as this increases any neural sensitivity). I may try mobilising the cervical spine, loosening up the cervical muscles, doing a lot of work on shoulder stability and working on the muscle balances around the shoulder girdle.

If your physio hasn't done the neural provocations tests that Roycar suggested then I would suggest that you find a physio that will do these (someone who has done the NOI courses for example) That being said they will probably all be positive from what you have described. But I would plan treatment by observing if there is any change in the neural provocation tests with a treatment to your neck.

In the meantime you should avoid any activities that aggravate the pain. if there are any positions that relieve the pain such as leaving your hand on your head for 5 minutes then you should do this whenever you can.

You shouldn't really be posting other's referral letters with their details on them on the forum. The detail of the letter is fine however I would block out the details of the referring parties as that perhaps is not appropriate.