Sports Medicine/arm pain for 2 years

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cervical spine mri
cervical spine mri  
Dear Dr. Arthur,

I am struggling with weird pain and I hope you can help me!
I have had bad arm pain for almost two years now. It started when doing chin-ups during training. I felt a light sharp pain in my biceps near the bone. I went to 2 doctors, but it didn't get any better, even with rest. It got worse with each training, leaving my arms in pulling-like pain after exercises like pull-ups, uneven bars ( I am a gymnast) and especially rope climbs! I also feel it when throwing a ball, like in handball or in shot-put. Then it feels as if my ulnar and medial nerve is pulled out of my upper arm! But it never reaches my fingers, and it is not a sharp pain and I also don't have tingling, numbness, swelling or redness.

This is one thing, which is actually not too bad.

The other thing is the above my elbow.
It sometimes hurts above my medial epicondyle somewhere in the connective tissue.
If you look at this picture, it is at the "medial brachial cut".
https://www.google.at/search?q=medial+brachial+cut&newwindow=1&espv=210&es_sm=93&source=lnms&tbm=isch&sa=X&ei=JSs1U66RCufX7Ab26IE4&ved=0CAgQ_AUoAQ&biw=1280&bih=892#facrc=_&imgdii=_&imgrc=MPgYFneeyU-XPM%253A%3BM9FvnxZqTPEH1M%3Bhttp%253A%252F%252Fupload.wikimedia.org%252Fwikipedia%252Fcommons%252Fthumb%252Ff%252Ffa%252FGray812and814.svg%252F512px-Gray812and814.svg.png%3Bhttp%253A%252F%252Fen.wikipedia.org%252Fwiki%252FMedial_cutaneous_nerve_of_arm%3B512%3B508

This is even worse than the pulling pain in the whole arm. It flares up for some seconds whenever it wants to, especially after a workout, and is a very unpleasant burning and pushing pain! I can aggravate it when I put my hands on my hand and push against my head as hard as possible. Then it hurts! Itís in both arms, but more in the right one.

I have been to 5 specialists so far. I got diagnosed with bicep tendonitis twice, tricep tendonitis once, Vit D deficiency once, and I got no diagnose at all once.

I am really desperate.
I recently had an appointement with another specialist. He said it might be the cervical spine and a disc herination at C6 or C7!

I had an x-ray and an MRI. It shows that there is no herination, they are also thick enough and everything is fine, but my cervical spine is too straight. At C6 and C7 it shows some light "bumps" between my vertebraes, and the doctor said this is causing the problem. I will attach a picture of the MRI!

Do you think this is possible?
So do you think this may cause the problem? And if so, will physiotherapy help or should I visit a Chiropratic?

Thank you!

Lina

Answer
Hello Lina!

This will be the second letter I have sent you, and I apologize for whatever happened to my first letter.  Your history, and discourse of your injury was very good.  What I am seeing with the system of injury is the fact that chin-ups are incredibly hard on the Teres Major, and  somewhat on the Teres Minor muscless.
But the Teres are strong enough to hold the body up, but they can't do it alone.  What I believe is there is a stretch, and perhaps a tear,  of the upper Brachial Plexus, along with a rotator Cuff tear/ impingement.  Both of these soft tissues........Brachial Plexus and Rotator Cuff.....could be responsible for the neuropathy felt in the right arm.  Tracing the nerves from both of these entities will take you from the origin of the Brachium and the Cuff.

To validate this premise, you stated the left arm was also involved with the some pain as on the right side, but not with the same intensity. The same movements of the left arm as of the right arm are basically the same.  In other words, there is probably no motion on the right the left doesn't feel also.  As in the case of pushing against your head with your right hand causes intense pain........pushing into the impingement, or causing more of a crushing syndrome of the nerves in the cuff.........and when pushing against your head with the left hand causes pain, but not the intensity of the right.

In my imagination, I feel you were chinning with both arms, but as you suddenly felt the sharp pain, you released your left hand seconds before the right hand  released the bar.  Therefore, the left shoulder/arm/hand was less impacted than the right.  Granted, we are dealing with micro-seconds, but as I have seen, it will make a difference if there is a bilateral injury, where one side will take increased injury than the other.

As far as your graphics are concerned, they are excellent  as a simplistic road map of the pattern of the nerves.  The body is made so in the case of neurological  impact, when the nerves are irritated, they fire at different stages depending on the insult.  So, when you feel pain around the medial condyle, the nerve has fired off at the point rather than the origin of the nerve.  

The Specialists have reported several different diagnosis, ie:  (1).    There are different criteria with spinal herniation, and I am not convinced  any herniation has occurred;  (2). Vitamin D deficiency....no comment;  (3). Biceps, Triceps tendinitis...... No tendonitis would cause such wide-spread  neuropathy. My fear is that the physicians have initiated steroid shots.......you never mentioned it, so I am assuming you have denied the use of these injections!  Never allow their use in  skeletal and/or neuropathy usage.

Now, it will not do any good to go to a Physical Therapist, nor to a Chiropractor.  What you need at this point is a very GOOD shoulder specialist surgeon who is familiar with Minimal Invasive Surgery to tie up the tears in the associated soft tissue.  After the surgery is completed, the physician will release you to the Physical Therapist for rehabilitation.  A thought to use the Medical School at the University to find the best surgeon would be a good start.  The 5 physicians you have already seen don't need to be seen again.  Please try the University next, and if that does not work, ask them for a referral to an outside Specialist.

Thank you for your letter, and I hope you will send me a note as to what you have found, and what will be done for you.  I am concerned, and I need you to see the very best available. Take good care of yourself, and I will look forward to your reply.

Best wishes,

Dr. Patricia Arthur  

Sports Medicine

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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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