Possible causes for pain in left shoulder, arm and hand for about two weeks?
September 10, 2008 8:49 AM   Subscribe

My fiancée has been experiencing pretty severe pain in her left shoulder, arm and hand for about the last two weeks. She saw our family doctor last week and has another appointment tomorrow. We're looking for some more pointed questions to ask. Details inside.

About two weeks ago, my fiancée started getting pain and soreness in her left shoulder. Severe pain in her left hand and arm soon followed. Since then, things have been consistently painful. She has difficultly picking up all but the lightest of objects and grasping smaller items as well. Even when the pain is milder, she still describes a feelings of severe "tension" or "tightness," especially in her hand.

Things generally feel better in the morning and get very bad in the evening. Additionally, and this seems significant, if she lifts her arms above her head, things feel *much* better. Not completely fine, but close. She's trying to avoid using her hands/arms as much as possible, but obviously 100% non-use isn't really feasible.

Our family doctor checked her out last Thursday, saying it likely wasn't an RSI, tumor or MS. She said something about acute inflammation, suggested taking Advil three times per day with meals and to come back in a week. The follow-up is tomorrow and things haven't gotten much better.

We'd like to ask about some specific things, but aren't exactly sure what. If I had to guess, I'd say it was a pinched nerve in her left shoulder. Anyone dealt with something similar?

I checked the archives, but couldn't find any shoulder/arm pain questions that seemed similar. Thanks!
posted by Nelsormensch to Health & Fitness (17 answers total)
I had a ruptured disc at C4-C5 and very, very similar symptoms, though I couldn't actually raise my left arm at all. The nerve was compressed where it exited the spine, and that's what caused the pain. Not knowing what to do (I didn't know about the nerve yet) I went to an orthopedic surgeon, who had me get a shoulder MRI-- they found a very slightly torn labrum, and ascribed my problem to that and assumed I was exaggerating the pain. I persisted and got an MRI of my neck, and that was the ticket, so to speak. The pain levels were off the charts for me, hopefully they aren't for your fiancée. I eventually got an anterior discectomy and fusion, and that solved the immediate problem, though I still have a lot of neuropathic pain and numbness after the fact.

My suggestion is to mention the possibility of a cervical vertebral nerve impingement, at least ask about the possibility and perhaps you can get an MRI of the neck/shoulder to rule it out.
posted by exlotuseater at 9:04 AM on September 10, 2008

Best answer: Does she have numbness/tingling/coldness in any fingers in particular, or along any particular lines in her arm, shoulder or back? Any other symptoms at the same time?

Nerve problems can be very weird. I damaged my ulnar nerve in my left arm by typing the wrong way for many years. It expressed itself as shoulder, elbow, back and arm pain, along with reduced strength in the left hand, coldness/tingling in the pinky and ring fingers on the left, and alleviation of the problem by careful positioning.

Over time it just got better.

Similarly, I've also lost a disc or two in my spine, causing pinching-related problems that expressed themselves in all sorts of weird places along my left side/left arm. I would strongly suspect that sort of thing if raising her arms over her head (which shifts the spine significantly) feels a lot better.

If you have reason to suspect nerve problems, ask for a referral to a neurologist, preferably one with a history of treating sport-related injury. Family doctors are there to be generalists, and you sound like you have a specific problem.
posted by felix at 9:06 AM on September 10, 2008

Frozen shoulder?
posted by wyzewoman at 9:12 AM on September 10, 2008

maybe acupuncture can help?
posted by matteo at 9:38 AM on September 10, 2008

Response by poster: Does she have numbness/tingling/coldness in any fingers in particular or along any particular lines in her arm, shoulder or back?

She has described tingling in her fingers, but I think it was just isolated to the hands.

I've also lost a disc or two in my spine

This sounds weird, but how does one lose a spinal disc? Would that require some sort of injury or is it something that just happens?
posted by Nelsormensch at 9:44 AM on September 10, 2008

Your spinal column bones are separated by little spongy gelatinous discy things (this is a medical term, and I am obviously a medical professional). Over time their outsides harden and get less pliable. Eventually, they rupture (fully or partially) or slip out, or otherwise get inflamed/screwed up. In any case, suddenly the adjoining vertebrae are no longer cushioned and crash together, often pinching a nerve between them or rubbing against a nerve that had been protected by the discy thing.

Violent motion in sport, especially when you're older, can make this happen. Or, just getting old, apparently.

Anyway, sometimes it's severe enough that you need surgery, but most of the time in my experience the doctor just shrugs and says to deal with it, and over time the problem lessens/goes away.
posted by felix at 9:53 AM on September 10, 2008

It sounds like a disc problem to me too. I have/had the same symptoms. It can happen on its own without a specific injury or incident.
posted by JohnnyGunn at 10:08 AM on September 10, 2008

I had problems with my leg and lower back being really painful earlier this year. Went to the doc, she whipped out a little card of spinal nerves and their locations, told me to point to where it hurt, I pointed, she said "That's your L5 disc, take [prescription dosage] of [NSAID] every 12 hours. Come back in six weeks if it's not any better-- we'd try physical therapy next, then steroid injections, and *only then* would we even begin to consider surgery."

I gobbled scrip doses of said NSAID for six freaking weeks. The pain finally went away right when I was looking to book that next appointment, although I still have a little bit of neuropathic pain (my doc offered me Lyrica for that, but I am wary of going on sudden adventures with my neurochemistry over "my big toe feels kind of weird").

One week might not be enough time for the inflammation to subside. YMMV.
posted by fairytale of los angeles at 10:43 AM on September 10, 2008

Ruptered, bulging, herniated discs do not directly cause pain. It is proven.

The pain is caused by stress and worry that the disc is causing the pain.

Understanding (gaining the knowledge) that non-trauma-induced pain is psychosomatic will eventually eradicate the pain.

Google "TMS Sarno".

The spine is the most resilient part of your body.
posted by Zambrano at 10:53 AM on September 10, 2008

I forgot:

So-called "compressed nerves" in your spine do not directly cause pain either.
posted by Zambrano at 10:55 AM on September 10, 2008

Zambrano is right, in that the discs themselves do not cause the pain. The discs pressing on the nerves cause the pain.
posted by exlotuseater at 11:01 AM on September 10, 2008 [1 favorite]

Best answer: So-called pseudoscience helps no one.
posted by exlotuseater at 11:02 AM on September 10, 2008 [3 favorites]

Best answer: Well, apart from cervical disc rupture, which is rare in young folks, it could be Parsonage-Turner syndrome, also called brachial neuritis. Sounds a lot like it, actually. But I can't tell from here. She needs to be examined by a neurologist.
posted by ikkyu2 at 11:20 AM on September 10, 2008

Best answer: Zambrano is right, of course, that discs and nerves do not cause pain - pain occurs in the brain. When I see that kind of philosophical foolery waved in the face of someone who is suffering, though, it saddens me.
posted by ikkyu2 at 11:26 AM on September 10, 2008 [2 favorites]

Best answer: I think that more than anything, you need to go in there with a strategy. Were it me, the strategy would be something like "I understand this most likely acute inflammation, but since it isn't better after a week, can you tell me when and how we'd rule out things like frozen shoulder, trapped nerve, disc issues or Parsonage-Turner?"

Doctors are people too and although you are entitled to competent care at a minimum, asking questions like this can prod your doctor to make a re-assessment to answer your question. Also, the answers may give you a benchmark for future visits, like "We'd send you for an X in Y weeks if there's no improvement to rule out Z."
posted by DarlingBri at 11:33 AM on September 10, 2008

Response by poster: Excellent, thanks everyone. We'll discuss nerve issues with the GP today and see about getting a referral to a neurologist or a similar strategy.
posted by Nelsormensch at 11:50 AM on September 10, 2008

Before surgery etc. I suggest she has a look a Trigger Point Therapy. For example a trigger point in the scalene muscles (responsible, a.o. for lifting the first 2 ribs) can pull the rib to the shoulder, thus pinching the nerve. This is of course only one of many scenarios.
posted by Eltulipan at 7:04 AM on September 21, 2008

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