Expert: Dr. Victor Dolan, DC, DACBSP - 3/1/2011

Question
QUESTION: Around November of last year (around the same time I got my flu shot) I began experiencing sharp, searing pain in my left shoulder that radiates down the upper arm to the elbow.  The pain is deep....almost too deep to be a muscle because massage doesn't seem to help....and I only get it when I raise my arm a certain way or reach for something just a certain way and it only goes away when I let my arm hang limply at my side for several minutes.  And I am unable to sleep on my left side because any pressure on the upper arm caused by laying in that position causes it to start aching.  I have not fallen, dislocated and relocated my shoulder, done anything to pull a muscle or injure it in any way.  I have been having some issues with the vertebrae in my neck (specifically C7 and 8) going out of alignment every few days which causes the muscles in my neck, shoulder and upper back to get all knotted up resulting in a migraine headache and my chiropractor has been working with me on that....but otherwise I haven't stressed any muscles out or injured them.  These are my questions. (which my chiropractor can't answer (won't answer).

1. How do you test for a pinched nerve?
2. Does this sound like a pinched nerve?
3. If yes to question #2....could it somehow be related to my issues with my neck?
4. If no to question #3...since I haven't injured myself...how could the nerve have gotten pinched?
5. If yes to #2....what can be done to fix the problem?

Oh....and I am 59 years old and I suffer from asthma and C.F.I.D.S.

ANSWER: Hello Candy,


Sorry to hear of your pain and complaints.

Let me 'cut to the chase', answer your questions first,,,, and then become verbose and maybe give to much info, even 'off target'.

You ask:  ".....1. How do you test for a pinched nerve?...."
         There are several ways to check for a pinched nerve, all available to your Doctor of Chiropractic.   One good test is called a 'Neural-Scan', see:  http://www.paindx.net/downloads/Axon_Fibromyalgia.pdf , see also: http://www.neuralscan.net/ , see video:  http://video.google.com/videoplay?docid=-1959089469279925662#
This is a sophisticated nerve test, very sensitive.  
         Another test is the traditional EMG: "....EMGs can be used to detect abnormal electrical activity of muscle that can occur in many diseases and conditions, including muscular dystrophy, inflammation of muscles, pinched nerves, peripheral nerve damage (damage to nerves in the arms and legs), amyotrophic lateral sclerosis (ALS), myasthenia gravis, disc herniation, and others..... http://www.medicinenet.com/electromyogram/article.htm .  The EMG relates to muscles, but can indirectly give information on nerves.  http://www.hss.edu/conditions_patients-guide-emg-testing.asp , http://en.wikipedia.org/wiki/Electromyography , http://www.youtube.com/watch?v=k0uSpYd_Ics
         Usually performed at the same time as a traditional EMG is the NCV:
".......A nerve conduction velocity test (NCV) is an electrical test that is used to determine the adequacy of the conduction of the nerve impulse as it courses down a nerve. This test is used to detect signs of nerve injury. ......... http://www.medicinenet.com/nerve_conduction_velocity_test/article.htm ......".  http://www.youtube.com/watch?v=fFULGl9kkTo

Another test, though perhaps not the best test for the application you desire is Medical Thermography:  http://www.ehow.com/facts_5890246_medical-thermography_.html .
         I  think  I  would  prefer  the  first  three tests  I  mention  before  this  one.

All of these above tests can be used to evaluate your 'pinched nerves'.  Your DC may order the tests, perform the tests, refer to a chiropractic neurologist for the tests.


You ask:  ".........2. Does this sound like a pinched nerve?.........."; certainly could be.  Perform the test(s) described in answer number 1 above to rule a 'pinhed nerve IN' or rule a 'pinhed nerve OUT'.


"3. If yes to question #2....could it somehow be related to my issues with my neck?", yes, and tests 1, 2, 3:  Neural Scan, EMG/NCV  would determine if they come from the neck or periphery.

Now I will jump to Question 5:
"......5. If yes to #2....what can be done to fix the problem?........" .  If your condition relates to your spine, to a 'pinched nerve' at your spine..... Chiropractic usually works wonders with this condition.  What can be done?  A good Doctor of Chiropractic with appropriate chiropractic adjustment techniques and your compliance with a regimen of treatment should successfully treat this problem.


Now I will skip  BACK  to  question #4:
"..........4. If no to question #3...since I haven't injured myself...how could the nerve have gotten pinched?........".  Now  I  will  CHANGE  a  word  in  your  question....
........ instead of 'pinched', let us talk about a damaged nerve.  How else could your nerve have been damaged?
         Well,,,, you say your problems started with the Flu Vaccine Injection.  Although injections are usually pretty safe, EVERY procedure has RISKS and benefits.
         Perhaps your injection 'nicked' / damaged / irritated a nerve or a muscle.  This is rare, but it can happen.  See:
         http://wiki.cns.org/wiki/index.php/Injury,_Injection  ..... "....Peripheral nerves may be injured by medications or vaccine injections. The injury may be from mechanical trauma caused by the needle itself, or also by the substance injected. If the injection is within the nerve, then the pressure created by the volume of fluid injected can cause damage. Depending on how irritating the medication is to the nerve, it may also cause chemical nerve damage, both acutely, or in a delayed fashion. As with all traumatic nerve injuries, subsequent scarring may also lead to additional nerve dysfunction......"
         Injections into the 'shoulder area':  ".... If a deltoid injection is placed too posteriorly, it may damage the axillary nerve, or selectively affected its anterior or posterior divisions, as they pass around the neck of the humerus underneath the deltoid muscle. Occasionally, the radial nerve itself may be damaged by the injection also. This can occur if it is placed to too caudal (near the spiral groove), or posterior where the radial nerve passes into the posterior compartment of the upper arm......"


You also give as part of your health history description:  "....Oh....and I am 59 years old and I suffer from asthma and C.F.I.D.S........", so you have a complicated health picture, and ANY health approach you take will TAKE TIME since your body's health is not what it could be to begin with.

Some background information that may be helpful to you ( I do tend to give my Staten Island Chiropractic patients TOO MUCH  information):




“Pinched  Nerve”   

( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )
“pinched nerve” – is only ½ a diagnosis,  WHAT is causing the ‘pinch’? Your Doctor of Chiropractic will examine and evaluate you to make sure you are not showing signs of neurological damage or disease, tumors, cancers,  severe pathology, perhaps a Herniated Disc, or a Vertebral Subluxation Complex.

Sometimes  we  can  wake  up  with  a  ‘pinched nerve’,  or  a  muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a ‘pinched nerve’.  Very often -  the true    c a u s e   of  the pinched nerve, painor numbness  in the:    neck and/ or  shoulder  and/ or  arm  and/ or  hand;   pain in the back and/ or   buttock/ hip/ leg/ knee/ foot -  is a misalignment,  a  ‘kink’ in the neck or back - more properly termed a Vertebral Subluxation.

         Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)

The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.



This is a serious condition identified by its five parts:

      Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
      Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
      Myopathology:
         Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
      Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
      Pathophysiology:
         The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.



The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
         Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.    For good health-
Treat   the   Cause,  not just the Symptoms.

“Pinched  Nerve”   ( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )
“pinched nerve” – is only ½ a diagnosis,  WHAT is causing the ‘pinch’? – That “pinch” has to be taken care of FIRST!

As the “pinch” – the MECHANICAL component of the problem, the CAUSE of the problem is being taken care of  through Chiropractic treatment,   perhaps additional help would speed your return to health:

Nerve Health Support:
-----B complex containing thiamine, folic acid, B-12 and niacin is highly suggested for nerve support.  High dose
B-vitamins should only be taken at the advice of a licensed healthcare professional.
-----B-6 is lower in patients with neuropathy.  Vitamin B-6 reduces the glycosylation that can cause nerve damage.  Amounts greater than 200mg/day can cause neuropathy symptoms.
-----Calcium and magnesium are important for nerve conduction and as muscle relaxants.
-----A multi-vitamin/mineral supplement is suggested for comprehensive support.
-----Essential fatty acids are necessary for nerve health.  Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).
-----Proteolytic enzymes may be beneficial in neuritis for the inflammation.
-----Lecithin aids in nerve support.
-----Natural herbal remedies including passion flower, valerian, chamomile, scullcap and white willow bark may be helpful.
-----Eat a healthy diet.  Avoid foods that stimulate the nervous system such as caffeine, chocolate, refined sugars, soda pop and cigarettes.
-----Drink plenty of filtered water.
-----Chiropractic care is imperative to remove nerve irritation.
Joint Support:
-----Glucosamine sulfate helps strengthen joint integrity.  Glucosamine is effective in relieving joint pain associated with osteoarthritis.  Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties.  These disease-modifying effects are not seen with simple analgesics and are of particular benefit.
-----MSM is known for its pain-relieving properties in such conditions as fibromyalgia, osteoarthritis, bursitis, tendonitis, back pain and muscle soreness.  Not many clinical trials have been done using MSM, but clinical observations support the theory that MSM is beneficial in pain managment.
-----White willow is an antiinflammatory and analgesic agent.  White willow was used as far back as the Middle Ages to reduce pain and fevers.  The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects.  Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.
-----Boswellia and turmeric (curcumin) are potent antiinflammatory herbs.  Curcumin may have similar action to aspirin.
-----


Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians;  Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN);  FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine;  Selected to provide care to US OLYMPIANS at the US Olympic Training Center, Colorado Springs , Selected to provide Chiropractic to the  NYPD  Police Department  Football Team


I  hope  that  information  is  helpful.  If  you  need  further  information,  please  do  not  hesitate  to  REcontact  me  here  at  AllExperts.com:   http://www.allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm
    or you can visit me/ talk to me at www.DrVictorDolan.net .

You may also find this information interesting:

BE  CAREFUL  OF  PAIN  MEDICATIONS:
PAIN          
Pain  is a  ‘red light on the dashboard’.   
RED  LIGHT  =   Trouble !!

Pain  is  your  body  telling  you  that  something  is  wrong.   
Think  you  should  listen??

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  

Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?   

Pain,  do you cover up the pain by taking a painkiller?  Take a painkiller, mask the pain, and allow a problem to progress in your body?


Pain  Killing  medication???  =    16,000  deaths   ( probably  under-reported )
         DEATH ! ? ! ?    better   watch  out  on  those  medications!!!  

         NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to  include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468   Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001)  Motrin, Advil = NSAIDS

      The  American Heart Association issued a scientific statement  recommending medical doctors change the way they prescribe OTC pain relievers from a first choice  to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

      NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ).   Many times people take NSAIDS  for  the pain of Arthritis,  not realizing these drugs may make the underlying condition worse.   These medications  cover  up  the  pain,  and  cause  the  problem  to   worsen.

http://rinf.com/alt-news/business-news/prescription-drugs-kill-300-percent-more-
= An analysis of 168,900 autopsies conducted in Florida in 2007 found that three times as many people were killed by legal drugs as by cocaine, heroin and all methamphetamines put together.    BE  CAREFUL  WITH  THAT  MEDICATION !!!
It was reported in 2000, that 700,000 U.S. citizens die as a result from medical causes (iatrogenics). Of course, other records and statistics had the number above the one million mark. Whether 700,000 or one million people, that's a lot of innocent people dying from visiting a hospital and trusting a medical doctor.= http://www.dherbs.com/articles/iatrogenics-99.html

Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.
The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.


http://articles.mercola.com/sites/articles/archive/2010/05/01/regular-flu-vaccin

http://articles.mercola.com/sites/articles/archive/2010/02/09/6-principles-you-s

http://chetday.com/janecfids.html

http://chetday.com/immunizationarticles.htm



Finally, if your Doctor (of any type) 'cannot/ does not want'
to answer your questions..... I may think about another Doctor.

THANK YOU for your question.
This is your Staten Island Chiropractic friend signing off and wishing you- Good Health Naturally!

Dr. Victor Dolan, DC



---------- FOLLOW-UP ----------

QUESTION: If the nerve was nicked when I got my flu shot (and that is entirely possible because the pharmacist at Walgreens gave me the shot much higher than most shots are given on the upper arm) will it heal itself in time?

Answer
left shoulder pain, pinched nerve, pain, Staten Island Pinched Nerve, nerves heal, nerve support, staten island chiropractor, www.drvictordolan.net




Hello Candy,

Thank you for the follow-up question.

IF,
If the nerve was 'nicked', damaged, when you got your flu shot will it heal in time??......
For this question- a nerve damaged by an injection- I do not feel 'Expert' in answering,,,,,,
I  would  think, , , yes, it should heal in time;  BUT- I recommend you ask a Nurse who gives many injections (and knows the RISKS/ Benefits of the procedure) or a Medical Doctor- i.e.; perhaps an orthopedist, physiatrist, or pain management MD who give lots of shots.....
         Have they 'nicked' a nerve?, When it happens, how long to heal?

I am sorry to 'duck out' on you, but I think it best you ask a different expert on this site- AllExperts.com, or your own family MD or NP (nurse practitioner) who gives shots!

IF
If this is what happened--- and you do remember the shot being a little higher, a little different from the norm,,, so perhaps it did happen,

If you 'nicked a nerve' with the injection- to help maximaize potential healing- take the nerve support supplements posted previously:

Nerve Health Support:
-----B complex containing thiamine, folic acid, B-12 and niacin is highly suggested for nerve support.  High dose
B-vitamins should only be taken at the advice of a licensed healthcare professional.
-----B-6 is lower in patients with neuropathy.  Vitamin B-6 reduces the glycosylation that can cause nerve damage.  Amounts greater than 200mg/day can cause neuropathy symptoms.
-----Calcium and magnesium are important for nerve conduction and as muscle relaxants.
-----A multi-vitamin/mineral supplement is suggested for comprehensive support.
-----Essential fatty acids are necessary for nerve health.  Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).
-----Proteolytic enzymes may be beneficial in neuritis for the inflammation.
-----Lecithin aids in nerve support.
-----Natural herbal remedies including passion flower, valerian, chamomile, scullcap and white willow bark may be helpful.
-----Eat a healthy diet.  Avoid foods that stimulate the nervous system such as caffeine, chocolate, refined sugars, soda pop and cigarettes.
-----Drink plenty of filtered water.
-----Chiropractic care is imperative to remove nerve irritation.
Joint Support:
-----Glucosamine sulfate helps strengthen joint integrity.  Glucosamine is effective in relieving joint pain associated with osteoarthritis.  Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties.  These disease-modifying effects are not seen with simple analgesics and are of particular benefit.
-----MSM is known for its pain-relieving properties in such conditions as fibromyalgia, osteoarthritis, bursitis, tendonitis, back pain and muscle soreness.  Not many clinical trials have been done using MSM, but clinical observations support the theory that MSM is beneficial in pain managment.
-----White willow is an antiinflammatory and analgesic agent.  White willow was used as far back as the Middle Ages to reduce pain and fevers.  The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects.  Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.
-----Boswellia and turmeric (curcumin) are potent antiinflammatory herbs.  Curcumin may have similar action to aspirin.
-----

But,
Please,
I would feel most comfortable if you asked the MDs, RNs, NPs, PAs,-- the  'shot-givers' this question (I do not give shots).

Thanks,
Good Luck in returning to health,
Your Staten Island Chiropractor friend,

Dr. Victor Dolan, DC
www.DrVictorDolan.net