Help diagnose my injury

Triathlon Forum
1

i’ve got a weird injury, and it’s been going on for a month. it’s so strange i’m not going to doctors yet, because i’ve got a strong feeling i’ll waste a lot of time and money and not know anything more than i know now after all the time and effort. so i thought i’d describe it to all you smart people.

i’m getting ready to run one day, and i’m stretching. not formally, sort of like a stretch you do when you yawn. when all of a sudden i feel something faint go on in alongside my spine, fairly high up, like C-6 or C-7. i think i pulled a rib out. monty says he hears a pop (we’re getting ready to run together, he’s standing 6 feet away). i don’t hear a pop, so if there was a pop it wasn’t especially loud.

i’ve got a bit of pain, but not so much i can’t run, and we go on the run. 5 minutes into the run the pain has abated enough so that i have quite a fine run, i go fast, feel comfortable, no problem. but then the next day comes…

…getting up in the morning, i’m screwed. from high neck to mid back i’m really done in. furthermore, the pain is perhaps even worse through my shoulder and even down my arm. intermittently i’ve got pain all the way down to my hand. i’ve lost about half the strength in my left arm, meanwhile. i can’t drive without pain, somewhat in the back where this “happened” but even more so in the shoulder.

a month goes by, and things slowly resolve themselves during this time, but mostly it’s the pain that’s resolved. i still have pain, but not as badly. certain arm and shoulder movements are fine, with full strength, others are not fine, and strength is only (let us say) half of what it was.

there is no loss of sensation, at least tactile sensation. there is no spot that is numb.

last night i got back in the pool for the first time since this happened. okay, i’m swimming like a dog, because i’ve been out of the pool for 7 weeks. but my left arm, which is my dominant arm (i’m left handed), the arm in which this has happened, is in really bad shape in the pool. from the catch to the point where my hand is at chest level i’ve got what feels like nothing, no strength. it’s a job just to get my arm to do the motion properly. then i pick up a bit of strength once my hand is at chest level.

i swam sort of hard, and i paid for it afterward. i feel better today, midday, 18 hours after swimming, but the pain returned last night immediately after the swim and was evident through the night. but as of now, less than a day later, it’s mostly back to the point it was at pre-yesterday’s-swim.

this is the same arm that suffered a very bad broken collarbone exactly two years ago.

that’s about it. i thought this was a displaced rib when it first happened, and this happens to me several times a year. lots of pain, but two days later i’m fine. i roll around on a tennis ball while on the floor on my back, it clicks back in.

i’ve been to no doctors, no xrays, no MRIs, no cat scans, no bone scans, no barium scans, no spinal injections, nothing therapeutic, nothing diagnostic – except – i’ve been to the chiro twice. lots of nice clicks, but no real help. if this just a rib out, it’s the mother of all ribs out.

so, a pinched nerve? permanent nerve damage? a blood clot in an artery that goes from my back to my shoulder? AIDS? ebola? hantaviris? i’m at a loss.

2

Dan, when you say ‘Stretching like you do when you yawn’, do you mean both arms up over your head and reaching for the sky?

3

Sounds like a herniated disk in the vertrebrae you described feeling the initial pain is causing a pinched nerve and you feel the symptoms on the nerve terminations. You need to have a CAT scan of the area and a doctor can recomend the necessary treatment. Further spine manipulation might not be helpful, surgery might be a possibility.

Now is this some kind of slowtwitch.com competition, do I get to win something if I get it right? :slight_smile:

Hope you get it sort out soon

Paulo

4

so, a pinched nerve? permanent nerve damage?

I’d be willing to bet it’s a bulging or ruptured disc in your back pressing on a nerve. I know the symptoms from from my own experience. If that’s what it is, the numbness isn’t likely permanent yet, but the longer the pressure stays on the nerve, the more likely it is that permanent nerve damage can/will occur.

Obviously I’m not a doctor, but I would highly suggest an MRI to make sure. Don’t mess around with nerves!

5

If I had to make a guess, herniated disk in the cervical spine.

I had herniations between C4-C5 and C5-C6 about ten years ago. It was the strangest thing… Other than a little stiffness, almost no pain. But I lost almost half of the strength in the left side of my upper body. In addition, I couldn’t relate the injury to any specific trauma. I was lifting weights quite a bit at the time (so that’s what I’m attributing it to) but I couldn’t associate it to anything unusual that I did.

A doctor actually wanted to do a fusion, but the thought of somebody working on the back of my neck by going in through the front of my neck didn’t sound like something I wanted to try if I could avoid it. I went the physical therapy route instead and was pretty much back to normal in 4 to 6 months. Other than stiffness when I overdo it when lifting a lot and occasional numbness in my fingertips, no problems since.

6

“do you mean both arms up over your head and reaching for the sky?”

that’s what i mean, but i don’t recollect that this is what i did. what i mean is, it was a stretch in the course of normal daily activity, not part of a formalized stretching routine. i don’t remember with any precision the movement i was making.

7

This exact thing happened to me. I couldn’t figure out what was causing the problems. Eventually, my upper back, shoulder and neck pain developed into pain plus spasms. I was unable to run. Heck, I was unable to sit down or get out of a car. My condition became progressively more painful and worse. Eventually, I was forced to buy one of those four legged walkers we see some of our gallant senior citizens use. I thought it was the beginnings of MS, or something, even worse. I refused to go to the doctor to discover the truth.

Then, one day, as I hobbled out to the mailbox, I saw my neighbor’s child holding something in his hand. He was about 12 or 13. I had seen him before in my garage looking at my new $8900 Trek Time Trial bike. I thought then, he had the mischevious look of a young kid who wanted to steal it. At any rate, back out at the mailbox, as I reached in to retrieve my mail, he said “Sir, if you give me that bike, the pain stops.”

I said “what the hell are you talking about kid?” And as I looked at him, he slowly opened up his hand, and it was a doll of me, with the clothes I wear, face, everything. Unbelievable. In the back of the doll, were pins and needles stuck deep into my shoulder and back and neck. He began to remove them and place them in and out of back, the alternating pains and releases in my body made me a firm believer and convert into the validity of voodism, right there.

Cutting the story short, that Trek Time Trial bike is his bike now.

His family moved a few years ago, might want to look around the neighborhood.

Just kidding. Heck, it’s probably a pinched nerve.

8

“In the back of the doll, were pins and needles stuck deep into my shoulder and back and neck.”

this can’t possibly be the cause of my problem, because everyone loves me and wishes me success and the good fortune.

9

Dan,

I’ve seen a lot of the sort of thing that you are describing in my 22 yrs of clinical practice as a chiropractor. In fact you sound similiar to my last patient that just walked out the door a few minutes ago. Most of the time this sort of thing is successfully treated by chiropractic/spinal manipulation and related therapies but occassionally really bad cases have to be refered out to the orthopeadic or neurolgist specialist.

It could be a number of things but sure sounds like an irritation of the nerve at C6 or C7 level. If a rib went “out” it most likely would be the first or second. You need a clinical assesment of motor strength, sensory discrimination, reflexes, etc. If you were a new patient of mine, I’d almost certainly send you for x-rays, particularly since this is a recurring problem.

You only seen the chiro twice, which isn’t very many times for this sort of a problem. You should convey to him/her whether or not the treatments are helping but also be prepared to go for more visits.

Don’t try to be a “bull of the woods” or a tough guy and ignore this. Obviously its not going away by itself and you should have it properly examined and evaluted.

Wish I lived a bit closer.

10

I agree that this sounds like a disk thing, though it may not necessarily be ruptured or herniated. It may simply be compressed. I had a compressed disk between L5 and S1 about a year ago. I can’t say exactly what caused it, or when it started, but it gradually progressed to pain in the right hip flexor and down the front of the thigh, and numbness in the top of the thigh. After 2-3 weeks of chiro treatment, ART, stretching, and icing, the pain was gone, and after another 4-5 weeks of the same the numbness was gone. I’d definitely get an x-ray (at a minimum) and probably some sort of higher resolution scan (I’m not a doctor, so I can’t say whether CAT, MRI, PET, colonoscopy, EKG or whatever would be best). Mine was found with a simple x-ray.

11

Next Issue:

good orthopaedic MD in santa clarita, valencia, saugus, simi valley, burbank, etc., or even better (but much less likely) in palmdale/lancaster WITH access to a first-rate imaging center.

12

Slowman,

I sent my wife, who is a physical therapist, your write-up. Here’s her take:

Well, my guess would be tendon tear (shoulder or neck area) because of a “pop” sound. Disc problems usually don’t give a popping sound. The symptoms down the arm are common for nerve entrapment from a bulging disc, but a tendon tear in the shoulder causes similar problems.

13

Agree that some of this may be related to the shoulder, too–tied in with the collarbone break you had. Maybe some scar tissue in the rotator cuff/scapular area as a result of the injury. I had “frozen shoulder” a couple of years ago. I had only about 75 percent internal/external rotation in one arm, about 85% in the other. Lots of pain and weakness associated with certain shoulder movements. After PT to (mostly) clear that up, my neck started hurting and I had numbness down my left arm. I had a muscle spasm in the left trapezius causing misalignment of two already arthritic vertebrae in my neck. More PT, and it is better, but not 100%. The X-rays will show if you have arthritis in the vertebrae–noticeably thinner spaces between bones due to shrinkage of the discs.

14

yeah I would get it checked out through mri as it’s the best tool for specialists to use…I think it sounds like nerve is being pinched either through a disk or as someone else said maybe some scar tissue. My fiancee has been forced to retire from the pro circuit due to disk problems but hers was in her lumbar region…she had surgery to remove a bunch of scar tissue and trim her disk as well as drill a hole in the vertebrae to allow the bulging to be “sucked” back in…it last for 6 months of hard training and then the disk above that point went on her…very similar as she loses all power in her lower legs (due to this being her lumbar region…different obviously than your thoracic area). Mri combined with die to highlight the areas of problem.

15

It’s been over nine years since I suffered through a very similar (painful and debilitating) neck injury. Mine seemingly came out of nowhere, although at the time I was windsurfing a lot and we’d carry our rigs over our heads down to the water. The wierd thing is your arm or back will hurt but it is just the nerve being compressed where it exits the neck vertebra. I tried pain killers, chiropractors, massage and it was getting worse by the month. I wound up getting an MRI and was diagnosed with a bulging disc and pinched nerve at C6-C7. I started physical therapy and this helped a bit but what really did it for me was a neck traction device. The best one had you lie on your back and and you could regulate the amount of traction: by gently lengthening your spine…ahhh, instant relief. Once you know you can minimize the pain things start to get better fast. Soon the anxiety fades and you will be yourself again. I still have some slight numbness in my left index finger and get paranoid if I get a stiff neck but usually some chin tucks and a few Nuprin do the trick. Good Luck!

16

Dan,

I was talking to my wife about this post and she had an idea that you might want to look into. She told me that as a physical therapist, she has treated quite a few patients with thoracic outlet syndrome (TOS). This is a condition that produces pain and paresthesias (changes in sensation) in the neck, shoulder, arm or hand. The cause is not certain, but it can be due to compression of nerves and blood vessels that run through the neck and chest area. Some people have an extra rib or very tight muscles that contribute to the problem. It can be confirmed by special tests or by reproducing your symptoms with certain movements. Treatment emphasizes postural correction, anterior stretching, and posterior strengthening.

Hope this helps.

Pete

18

All unofficial advice - never take medical advice on the internet - always seek care/advice from a medical professional after a full exam…blah, blah, blah…

I’ll pipe in on this one:

True weakness not related to pain really points to nerve involvement - most likely a “pinched nerve” from a herniated disc in the lower cervical/upper thoracic region. The only common “spontaneous” shoulder tendon injury (mainly people >50) would be rotator cuff and usually pain >> weakness and your pattern of weakness with the early pull phase of swimming doesn’t match the rotator cuff. So if you have definite weakness not related to pain - I’d worry about it.

I find the rib theory somewhat lacking - your top rib is T1 (unless you have an extra cervical rib) and I’ve never heard of ribs popping out of place posteriorly. I’ve seen people who pop their ribs out in front (the rib separates from the sternum and pops in and out with push-ups/surfing…very reproducible and very annoying from what I hear) but never in the back (personal experience only). I’m not sure what the rib/tennis ball cure thing is - I’d guess more likely a muscle spasm than rib related…I doubt its related to whats going on now.

Prior clavicle fracture - likely unrelated.

Thoracic Outlet syndrome - more of a vascular problem - I don’t think it fits your pattern.

What I’d worry about: if you have something pressing on a nerve causing weakness it can lead to irreversible weakness (bad if you want to swim fast).

Most cervical disc herniations are treated conservatively (i.e. no surgery) for quite a while but depends on MRI/nerve findings…some need surgery but remember that surgery is a big deal and surgeons/neurosurgeons like to and get paid to do surgery (unless they are Kaiser/capitated…)

Bottom line: You need to see a professional and get evaluated. Plain regular x-rays are relatively cheap but only show bones - I doubt would be particularly useful but they likely will be done (its relatively unusual to go straight to MRI). CT wouldn’t add much at all. MRI is the study of choice to look at the spinal cord, discs, and nerve roots. If you see a neurologist, they can do a good exam - work you up and refer you to a surgeon if needed. I like neurologists because they don’t do surgery so they generally have no finanicial benefit to suggesting/recommending surgery though they might just refer you to a neurosurgeon anyway…neurologists focus on nerve-problems (duh) and any specialist can be narrowly focused (i.e they assume its a neurological problem cuz they are a neurologist.) Though with a neurologist you’d get the best detailed nerve exam. Sports medicine are generally orthopedists and would be another good choice. General orthopedist would be pretty good, too. A good primary care M.D. would be another choice. Neurosurgeon.

At least go see someone - we’re talking about significant arm weakness that is affecting your swimming - plus your dominant arm! An office visit wouldn’t be that much - an MRI would be a bit more - but still you should be able to get a pretty good evaluation for less than a new Yaqui would run me…

I don’t know any neurosurgeon triathletes. I know an orthopedist (very nice guy and fairly fast…) in San Diego who does triathlons/IM’s and he may know someone to refer you to. Let me know if you want me to contact him…

19

“I don’t know any neurosurgeon triathletes. I know an orthopedist”

excellent stuff. one thing, tho. i’m not sure it’s not rotator cuff specific. yes, i get pain all the way down my arm, to the top of my hand. but the big loss of strength is right after the catch, during that part of my pull when i’m building a pulling surface, keeping my elbow high. is that rotator cuff?

anyway, yes, orthopaedist, neurologist, PT, that’s the question. i guess i’m thinking neurologist because my biggest concern is with my loss of power.

anybody know a neurologist in san fernando valley, or antelope valley?

20

I’m chiming in with the herniated disc crew. If it was a ligament rupture it would not cause Radicular (nerve root) signs such as numbness and weakness. also the mechanism of injury is not very consistent with a ligament injury. Sometimes when there is a disc injury part of the disc herniates down through the end plate(the most superior part of the vertebrae below the disc herniation) and this can cause the “pop”.

Based on your loss of strength alone you should be evaluated and probably imaged with a MRI or at least a CT.

Hope you get better soon and that it doesnt affect your typing because then I will have to go to bed befor midnight without my nightly dose of slowman

21

Slowman:

Despite the disc crowd having some valid points, it is common for patients to get arm weakness and radiating pain from almost any shoulder problem - proposed mechanism is secondary tightness in the scalene muscles putting pressure on the nerves. Before the fancy / schmancy tests, you just need someone who can do a competent physical exam.

I’m an orthopaedic surgeon, but I’m up on Vancouver Island, so I’m afraid I don’t do you much good.

Good luck with it.

Deke