As you mention that you had a severe collarbone break, I remember what drove me to triathlon.

I have been a rugby player for years but stopped because of a severe problem at the joint between collarbone and scapula.

I couldn't stay without moving my shoulder more than a few minutes because of a irradiating pain and had no force in my arm, was unable to lift my elbow higher than my shoulder, unable to drive, etc.

All my back muscles were painful and sore, it lasted until I began to swim again and reinforced my shoulder ; sorry, seems not to be the best solution for you !

Your problem could be partially related to your collarbone.

I hope you'll feel better, good luck.

"My wife wants to know why you went and had a hard swim?"

i'm a triathlete. can't help myself. probably need a 12-step program.

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Dan Empfield
aka Slowman

It works just fine left-handed, but if you were to insist on standing to my right, you'd get bonked in the head with my elbow every couple of minutes.

One thing that may help everyone and one thing a good M.D. should probably do (again don't delay true care but given the weekend and holidays - you might not get in too soon - so try the following....):

Have someone go through various shoulder/elbow/wrist/hand motions and try to figure out what exactly is weak (the catch phase of swimming involves a lot of muscles and is too complex - try to isolate muscle groups or motions i.e. elbow/wrist/finger/shoulder extension and flexion, finger spread, thumb opposition.... - it should be relatively straight forward - have a friend isolate and compare muscle groups left vs. right. You are left-handed so your left should be at least as strong as your right. Write down muscle groups that are ? weak, definitely weak, and normal. Also have someone check your sensation - use like a Q-tip and compare lots of spots right vs. left - pin-prick or cold would be useful too. Check sensation entire upper extremity, around the shoulder, and back of neck/upper back.

Some rotator cuff checks: hold your arms straight out to the side (make a cross) - thumbs point downward. Hold your arms up while someone pushes them down - check sides. If you have a big rotator cuff tear thats disabling your swimming - this test should be remarkably different left vs. right (I think). Another one:

Put the back of your hand in the small of your lower back and then lift away from your body.

Good motions to check strength:

Shoulder forward flexion, extension (backwards), internal rotation and external rotation (upper arm at side- elbow touching side - forearm points straight forward - thump up - then rotate your hand in an horizontal arc outward = external rotation and inward = internal rotation. Shoulder abduction = flapping your wings. Adduction = opposite of abduction.

Elbow - extension/flexion.

Forearm supination - think motion to open doorknob and pronation = opposite.

Wrist extension and flexion.

Hand - finger and thumb extension/flexion. Finger spread. Thumb to pinky opposition (make an o.k. sign with thumb and pinky and have someone try to pull apart)

There's probably more (I don't do this sort of thing) but the nerve wiring from neck to shoulder/arm runs in the brachial plexus and the pattern of weakness should be traceable back to a specific nerve or nerve root. An anatomy book would be nice to look at for you. Usually you'd also have sensory changes along the same nerve or nerve root and it should make sense (its all simple wiring).....

Its true that shoulder injuries frequently radiate down the arm and can be associated with weakness (esp. rotator cuff) but the above should easily differentiate rotator cuff weakness from nerve weakness.....

I'll ask around re: neurologists in Antelope/San Bernadino Valleys.....

...to be the beginning of a new, regular Slowtwitch feature: Mr. Tibbs' "Does this look infected?"

Bring your photos.

Hi Dan,



I am a deep muscle therapist and I’ve been specializing in the treatment of chronic pain and sports injuries for over 15 years. I apologize for this being such a very long message, but you have a lot of various things happening all at the same time. I wanted to give you some treatments that I've taught to other people who have had similar complaints to the ones you mentioned in your message.



It sounds like the muscles that go down the back of your neck, and possibly the muscles that attach each of the vertebre to the one above and below it, may be in spasm. When the muscles contract they put pressure on the bone and will cause the vertebre to press down onto the disk, causing disk pain and impinging on the nerves as they leave the vertebre.



I wish I knew how to do HTML so I could put a picture of this onto this message, it would make the explanation a lot easier to understand, but I’ll do my best. Think of it this way, there are tiny muscles called multifidi, splenii, and rotators (it’s not necessary to remember these names, I just put them in here in case you are interested in looking them up in an anatomy book) which attach to each of the vertebre and then go down to the vertebre below. It is the normal contraction of these tiny muscles that give us the ability to make the vast range-of-motion that we have in our neck. When any of these muscles go into a spasm they pull tightly on the vertebre and will actually pull the bone out of alignment. Naturally, since the disk is between the bones, this will also put pressure onto the disks, even potentially causing the disk to bulge or herniated.



It has been my experience that when a person sleeps with either too many pillows (so the head is raised up toward the ceiling for hours at a time) or sleeps on his side and uses too few pillows (causing the head to be bent toward the mattress for hours) that these muscles go into an isometric contraction and pull on the vertebre. This is frequently the case when a person comes to see me with severe headaches, the tiny muscles are in spasm and are causing pressure to be placed on the spinal cord as the bones are shifting.



There are larger muscles called semispinalis capitis and cervicis, and even larger muscles called splenius capitis and cervicis, that will do the same thing, and for the same reason. Finally, there are the major muscles (levator scapulae and upper trapezius) that also originate on the cervical vertebre and can cause the vertebre to be pulled out of alignment. Spasms in any of these muscles will cause pain in your head, neck, upper back, arms and hands, and can also potentially cause numbness to your arms and hands.



Also, the loss of strength down your arm can be coming from another neck muscle called scalenes. The anterior scalenes originate on the front side of C2-7 and insert onto the first and second rib. When there are spasms in the fibers they cause pain, numbness and tingling in your shoulder, arm and hand, and also into the area of your upper back that you mentioned is hurting you. This happens because the brachial nerves pass through the scalene muscle fibers and if the muscle is in spasm it traps the nerve fibers. This is commonly called Thoracic Outlet Syndrome.



Finally, a spasm in a muscle of your shoulder blade, called infraspinatus, will also give pain and tingling to the shoulder, arm and top of the hand. All of these referred pain points have been scientifically proven and documented, and the points of spasm are commonly called “trigger points”. Also, when a nerve is impinged, or a muscle is held in a contracted state, you will often feel a loss of power. The reason is because the muscle isn't able to pull from its longest length, decreasing it's pulling power.



Fortunately, these muscles can all be self-treated easily, and with just a little direction you will know exactly where to press because you’ll often feel a bump and it will hurt. One word of advice, the pressure must ALWAYS “hurt so good” or you are pressing too hard.



I’ll begin with the infraspinatus because it is the easiest to teach without pictures. This muscle is the shape of a fan and is right on top of your scapula (shoulder blade). The wide part of the scapula is the origination of the muscle, and the insertion point is at the posterior tip of your humerus (upper arm bone). A spasm here will feel like a rope going across from the wide angle directly to the insertion point. All you need to do is to lie on your back on the floor and place a tennis ball so you are resting your shoulder blade directly onto the ball. Move about a bit and if you feel a painful “rope” you are on the spasm. Just lie on it for 60 seconds, moving the ball slightly so it will go in the direction of the muscle (don’t go across the muscle, go with the fibers). Adjust your weight on the ball so you reach that “hurts so good” level, adding more weight as your pain tolerance allows.



For your posterior neck muscles, since you are feeling the discomfort especially on your left side, bring your right arm across in front of you and use your fingertips to press directly into the left side of your neck, just to the outside of your vertebre. Press in deeply and slide down the back of your neck. If you feel a painful bump, that is the spasm. Just leave your finger on the bump, increasing the pressure every 15 seconds for one or two minutes. Then move your finger down a bit to continue searching for spasms. Do this slowly to your entire posterior neck, going as far down your back as you can reach. After it feels like you have found, and released, all the spasms, then put your four fingers right to the outside of your vertebre, hold them in place and slowly bring your chin down toward your chest. Don’t let your hand move with your neck, keep it in place so you are stretching the muscles. Then do the other side of your neck because there are also spasms likely to be found on the right side.



Using your left hand you can do this same treatment to the left front of your neck, pressing in toward the front of your vertebre. (Do the right side when you are finished treating the left side) There is some caution to be taken here because the carotid artery is passing in this area. Be very careful to not be pressing where you feel a pulse. Feel for the pulse before you press down, and if you feel a pulse just move your fingertips until it is gone. Do this all the way down to behind/underneath your collarbone. You’ll likely find several points that will cause shooting “needle-like” pain down your arm and under your shoulder blade. These are the spasms that are trapping the brachial plexus (bundle of nerves in the Thoracic Outlet). GENTLY press on these spasms and hold them for 15 seconds before gently increasing the pressure. Continue doing this until you don’t feel any discomfort regardless of how hard you are pressing.



It would be beneficial for you to treat your entire back, next to the spine, which can also be done with a tennis ball, and I have a very specific back stretch that has helped lots of people in the past, but is complicated to describe. I’ll be happy to tell it to you if you let me know that you are interested. I have an active forum that discusses self-treatment of pain. The forum has helped so many athletes in the past, feel free to join our forum and to ask for the back stretch. I’d like to share it with the athletes who are regulars on our forum, and I’ve decided I’m going to ask our webmaster to put the pictures of this stretch onto the website so it will be easier for people to follow. The URL is: www.julstro.com, first read the section that is titled "Muscles and Pain" (it's pretty interesting) then go to the link for the forum.



BTW, the problem you had while swimming, exactly what is the movement you are having a problem making? As I read your message it sounds like you are having more of a problem at the beginning of your pressing down into the resistance of the water, am I correct? This could be caused by spasms in the rhomboid muscles which bring your arm down. It would make sense because you are feeling pain into your upper back and the rhomboids originate at C7 and T1-5, therefore pulling on those vertebre as well as preventing your arm from having full power in the downward stroke.



I’ve worked with so many athletes through the years that I’ve learned that we almost always find the spasms that are causing the problems, it just takes some “detective” work. But, once we find the points, the treatments are easy to do.



I’ll be happy to work with you. Keep in touch via the forum or you can send me an email to: Julie@julstro.com.



Wishing you well,

Julie Donnelly

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Don't let pain cause a DNF! YOU are your own Best Therapist! Visit http://www.FlexibleAthlete.com and http://www.Julstro.com to learn logical solutions to repetitive strain injuries and how to stretch safely.

Hi Slowman. If you don't mind going down to LA, my father is a neurologist down there. He isn't a specialist in sports but is an excellently trained neurologist who worked at Kaiser for 30 years. If you are interested, you can email me and I can give you all the details. (I'll talk to him too and prep him) Now that he doesn't work at Kaiser anymore, he has a small private practice. You can email me at (email edited for slightly more anonimity).

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berndog
How did we all get sucked into this crazy sport anyway?!!

Hello Dan,

What happened to you sounds just like me. Maybe you can help. This past June, I crashed and broke my left clavicle. Mid clavicle break, comminuted. Healed pretty quick. At 3 1/2 weeks, was calcified together. At 7 1/2 weeks did the Full Vineman (not very fast; 12:52:29 but I did it). This past Tuesday was at 13 weeks since I broke it .

Well, the past two weeks I was out of town so was only able to run, which I did almost every day. About a week ago, my left hand started to go numb, along with like you, about 50% of my grip and strength. Stopped running of course. Yesterday went back to the ortho and he took another xray. The collarbone is solid, but of course has a big bump. Apparently, a callous or something is pressing down on the brachial plexus. He gave me a subscription for steriods and I am to make an appointment with a neurologist to have an EMG done. It has improved somewhat in the last two days but I am worried. I need both arms for work and also want to be able to continue in triathlon. The doctor mentioned that he might have to do surgery if it never clears up, which means he would have to re-break the bone. Of course that option is an absolute last resort.

Is this what happened to you? And if so, what did you do for treatment.

Thanks,

Conrad



`

I think, if you can lift a shot of Tequila and repeat again and again, you'll be OK. Otherwise, you're screwed.

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Proud member of FISHTWITCH: doing a bit more than fish exercise now.

No advice, just sympathy - that sucks, whatever it is, and I hope you get it taken care of.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Ummm, you guys realize you're replying to a nearly 2-year old post by Dan? Now, Conrad's post is a different story...

I immediately thought bulged disk as well. I had one four years ago. You need to have some medical attention. a bulged disk is a weakened disk and you don't want things to get worse.

Dan,

Not an ortho or a neuro but a chiro in Monrovia, would be happy to do a full exam of the area including strength and sensory tests and take any x-rays if indicated by exam. Could also refer out to a local MRI center if indicated which from your history is a good possibility.

So far it does sound as though it is probably a disk. TOS may be a possibility but is less likely with your symptoms and mechanism of injury.

PM me if interested

Michael Donia, D.C., QME

You guys are cracking me up today. See my post above.

<shaking head>

While, sometimes, diagnosis can be made with some assuredness, on history alone, in this case I will not venture a guess without a physical exam and, most probably, indicated imagery. I would want to know, at the minimum, if all of your vertebrae were moving normally and where you are tender. Most docs are incapable of doing this exam (the individual vertebral motion part, even I can't do it but I had people on my staff who could). More likely to get it from a physical therapists (depending upon their training).

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Frank,
An original Ironman and the Inventor of PowerCranks

classic case of strain during the moment of ejaculation. definitely.