Gisella,          I am a 43 year old male who been experiencing nerve pain. I notice the pain several minute after waking. It seems to originate on the rear deltoid, but there is pain in the under the brachioradialis and the dorsal side of the hand. There is no numbness in the extremity. I notice the pain worsens with shoulder pronation, shoulder depression, wrist extension, and forearm pronation. Cool air on the back of the forearm intensifies the pain. The pain will lessen usually diminish on its on. I usually sleep in a fetal position with my affected hand between my knees. What nerve would would cause this?

Dear Rick,
Firstly, my sincere apologies for my late reply.  I hope that you have had some relief since you sent this message.  I will try to help out as best I can with this, but ultimately, you may wish to address your concern with a physiotherapist (or even a sports medicine physician).  Hopefully, you'll be able to find one on AllExperts.  They probably have a better working knowledge of muscles and nerves, and would be in a better position to offer advice on how to manage your condition.  I'll give it a shot in the meantime.

I am no neurology expert, but it is possible that the nerve implicated here is the radial nerve.  But this knowledge doesn't really offer a solution to your problem.  I may have more questions than answers at this stage.  How long have you experienced the pain?  If it's fairly recent, do you recall an injury that may have provoked it?  Yes, the pain may be nerve-related.  The fact that cool air intensifies the pain might suggest that it is neuropathic.  But I wouldn't eliminate the possibility of it being muscular in origin at this stage.  These sites of pain are often implicated in heavy lifting.  Do you visit the gym or lift weights by any chance?  If this is relevant to you, I would suggest revisiting your lifting technique when working your upper body.  Avoid these exercises for a week or so to minimize repeated injury, and see if this offers relief.  Remember that exercise of this nature can result in either muscular or nerve pain.

Neuropathic pain presents differently to muscular pain.  Muscular pain is not usually obvious until the limb is moved.  Nerve pain is a little more sporadic and unpredictable in nature...even at rest.  The cause is often different also.  Nerve pain can often occur from an action that, in itself, does not produce pain, but when prolonged or repeated can result in nerve inflammation; such as maintaining an awkward position during sleep.  I'm not sure whether your sleeping position is entirely to blame, however.  If it's a position you've been comfortable sleeping in your entire life, then maybe it is not the culprit.  Having said this, trialing another, more 'inert', position may offer you some relief and aid in recovery.  Try sleeping on back (if you can).  

Have you tried anything to relieve the pain?  A good test to determine whether the pain is muscular or nerve-related is to try a NSAID (non-steroidal anti-inflammatory drug), such as ibuprofen.  I'm unsure of your concurrent medical history, allergies, or medications, so it is best to run this information by your pharmacist before using a NSAID.  NSAIDS should be used with caution in patients with gastrointestinal disorders, asthma, high blood pressure and renal impairment.  Generally, nerve pain does not respond well to NSAID.  So, the response you get from these agents may help in determining the nature of the pain/injury.  Topical application of NSAIDs may also offer relief, as can massage.  Opioids may be considered for more resistant or severe cases of muscular.

You mention that cold air triggers the pain.  But have you tried cold/heat packs?  Recent injuries are always best treated with ice.  More chronic injuries require heat.  Nerve pain often responds well to an alternating application of heat and cold.  But be sure not to use anything that is scorchingly hot or uncomfortably cold.  Other methods for controlling nerve pain include acupuncture and electrical nerve stimulation, such as TENS.  Prescription medications are available for more chronic cases.  Antidepressants and anticonvulsants are typically used for such cases, not for their antidepressant or antiepileptic activity per se, but for their unique neuronal action.

Rick, I hope this helps some.  Try to rest your arm if you can and give some of these measures a try.  Try the simple ones first, then add in a NSAID (if safe for you) and take it from there. Please feel free to send me a follow-up email if you require further information, and don't hesitate to reach out to a physiotherapist.  All the very best.  


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Gisella Campanelli


I am able to answer questions relating to pharmaceuticals, therapeutic regimes and primary health care. This includes offering advice on drug indications, dosages, and disease state management. I can also identify side effects, drug interactions and contra-indications, and offer recommendations on ways to mitigate these. I can diagnose minor illnesses and suggest appropriate over-the-counter remedies and/or preventive healthcare tips. I can recognize cardinal symptoms which would otherwise require referral to a medical practitioner.


I am a registered pharmacist in Australia, and I have practiced in a hospital pharmacy for over thirteen years. My clinical specializations lie within the areas of psychiatry and general medicine (including gastroenterology, respiratory, endocrinology, neurology, infectious diseases, gerontology, dermatology). I self-managed the training program for pharmacy interns in preparation for their final registration exams, and I have worked for the Pharmacy Board of Australia as an examiner and exam writer.

I hold a Bachelor of Pharmacy from the Victorian College of Pharmacy, Monash University, and I am board-registered to practice within Australia. I also hold a Master's degree in an unrelated field (art conservation).

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