Expert: Dr. J. Shawn Leatherman - 12/13/2006

Question
Hello... 50 year old male, very active... w/ lots of floor exercises ( pushups, pullups, and core exercises as well as dumbbell workouts. I am no longer able to do my pullups... my pushups are very weak and almost non existant anymore since i've had my pain.  I do not know how it happened or have any idea of when this problem started.   I have just had surgery to help with pinched nerve in the C5 C6 C7 areas.   My problem is now this.. it has not yet helped my exercise problem but has helped the numbness in the rear of my right shoulder flowing down my R arm to my R hand (tingling).   My Right pec has deflated... i have pain under the Right arm and pain in the Right Tricep area.   I am thinking it may be a tear in the Long head of the Tricep, but not sure of the attachment to the fron pec area.   Can you give me any insight.  thank you....

Jay. Gobrecht

Answer
Dear Jay,

I am not sure of the exact location of pain to which you are referring.  Is this chest pain (pecs)and tricep pain?  Plus how long have you had pain?  What type of surgery did you have...decompression, fusion, foraminotomy?

Concerning the information you have related, the decreases in your symptoms do follow what would be expected concerning the C5, C6, and C7 levels, with the exception of the tricep area.  For an illustration of these areas, please click on the following links:  

http://www.apparelyzed.com/myo-dermatomes.html
http://www.apparelyzed.com/dermatome.html

Concerning the pec pain as well as the pain under the arm (armpit), neurologically this distribution is supplied by the T1-T2 nerve roots.  If there is a problem with those nerve roots it could easily affect the performance of the pec muscle as well as the size...this is called atrophy.  Although the tricep and pec work together in push movements, they are anatomically distinct in their attachments.  

The injuries could be related if you consider the proximity of the nerve roots that supply those muscles. Surgery could compromise the function of the nerve supply, but I would lean more towards separate injury unless both problems began at the same time.

Concerning a tear of the tricep head...you should have felt an initial sharp pain in the tricep while under load, or just after the load was released.  An audible pop is often heard and felt when this occurs.  If a tear is present, this will likely heal on its own with only light muscular work.  You should be careful though to limit the weighted extension of the affected arm, as I know that push-ups are already problematic.

I would suggest that you return to your treating doctor or surgeon and ask about further examination of the area of complaint, as well as physical therapy.  The only true way to determine the extent of the problem is will a physical examination and possible imaging if warranted.

If you have any further information or questions feel free to write back.

Respectfully,
Dr. J. Shawn Leatherman