Suggest treatment for carpal tunnel syndrome

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Posted on Wed, 13 May 2015 in Cancer
Question: Can a firm/rubbery, immobile mass (actually I have two of them) on the right infraspintatus sit on a nerve and cause front shoulder, radius, wrist, and hand pain? And if so, what could that mass be?
doctor
Answered by Dr. Grzegorz Stanko 1 hour later
Brief Answer:
No, that is not possible.

Detailed Answer:
Hello!

Thank you for the query.

No, this is impossible. In general, firm and rubbery masses palpated under the skin are benign soft tissues lesions. On the back, such lesion is usually sebaceus cyst or lipoma. It is very hard for such lesion to compress any nerve. This lesions are too superficial.
Nerves are hidden deep in the tissues as our body needs to protect them. So you have skin, fatty tissues and few layers of muscles above any nerves on the back.

Your symptoms are caused either by nerve compression in the spine or by nerve compression in the wrist.
Spine nerve compression usually gives back pain, neck pain, headache along with arm, shoulder and hand pain. All fingers can be affected.

In case of nerve compression in the wrist, you can have carpal tunnel syndrome. The pain starts in first 3 fingers, radiates upward to shoulder. It gets more intense during night so you may be awaken by the pain. Tingling and hand weakness can appear as well.

To find out the source of your pain, you should consult neurologist. Spine MRI and EMG test should be considered.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 28 minutes later
Thank you for your quick response.. I'm concerned because there are two masses, side my side. One is visible to the naked eye.. I can't tell if one of them is on my deltoid or not. It moves with my deltoid but feels right on the edge. I had thyroid cancer last July and a thyroidectomy the same month and I was cancer free. In December I noticed swollen lymph nodes in the groin, I had a lymph node biopsied but unfortunately he didn't grab the one that is about 3cm long. He grabbed one around 1cm and it showed reactive hyperplasia. Since then I've lost 30 pounds (I'm underweight now with a bmi of 16.9), I'm having pain under left collar bone but it's not my heart, severe fatigued, joint pain all over my body (it hits different places at different times) but the joint pain on the front of the right shoulder is persistent, and I'm having muscle weakness.. I also had a small mass on the parotid gland and lymph nodes that felt enlarged that came up 3 months ago but CT didn't show anything. However I don't trust CT after missing my 1.6cm thyroid tumor. I had my TSH checked 7 weeks ago and it was 97 so that's not a reason for weight loss.. And I got it back on track as of 2 weeks ago if that helps with anything. Are the masses still nothing to worry about after my symptoms and history.
doctor
Answered by Dr. Grzegorz Stanko 12 minutes later
Brief Answer:
The masses should be checked.

Detailed Answer:
What type of thyroid cancer it was and what stage?

Weight loss is very alarming symptom. It may indicate some cancer recurrence indeed. Joints pain in some cases is an reaction of immune system to a cancer so this might be an alarming sign as well.
CT can give some information about possible cancer spread, but if yours cancer was pappilary or follicular than we have radioactive iodine scan. It can identify small cancer areas. The other test which can do that is PET scan.
Enlarged groin lymph nodes and in other location should be tested correctly. Same thing with the lumps you are able to palpate. At least soft tissues ultrasound of this areas should be done and if an image will be suspicious, biopsy should be done.
So considering that you have had thyroid cancer, any new lumps or lymph nodes enlargement should be carefully checked. From the other hand, most of thyroid cancers has extremely good prognosis. But it has to be checked.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 58 minutes later
It was papillary thyroid carcinoma. I had a palpable 1.6cm tumor on the isthmus and then two more that were .5cm in size located one in each lobe. They did a central neck dissection and tested one lymph node which was clear. I had no treatments after surgery. I wasn't necessarily concerned of thyroid cancer spreading to the shoulder; however, I was scared of another disease in the making. My masses are so alarming to me because when I first felt them, almost 2 weeks ago, the largest one felt firm and was visible to the naked eye but XXXXXXX so I was not concerned. It's also very round and smooth if that helps. However all the severe joint pain started this week so I felt it again yesterday, it has not increased in size but it is now very very fixed to the muscle. It's not moving unless the muscle moves. The other mass, which is very small but also fixed and is on the edge of the deltoid has slightly increased in size and it has very odd texture to it. It almost feels like 2 BB's stuck together if that makes any sense. My husband describes the texture and shape as a very tiny peanut. It's probably around .5cm in size. My final questions.. Are the textures and shapes I'm describing a good sign, or is it alarming? What could be all the reasons, good and bad, for them to pop up all of a sudden like this?... I've never heard of two masses being so close together, my husband says they're an inch apart.. Is it common for lipomas to have the characteristics I described and become very fixed in the muscle over the course of two weeks? I see a Rheumatolgist in 8 days for all this joint pain because I thought maybe it was unrelated to the shoulder masses.. I will still plan to meet with him just in case but is there another specialist I should get in with for these masses? Or just wait to let the rheumatologist evaluate it? Thank you so much for all your help. Researching online hasn't been helping me any. I'm glad I turned to this site. You've been very prompt and detailed and I greatly appreciate it.
doctor
Answered by Dr. Grzegorz Stanko 12 minutes later
Brief Answer:
Description fits to benign masses.

Detailed Answer:
Well, before answering this question I want you to know some thing. Please note that the skin on the back is very hard and thick. When you cut the skin on the back, sometimes you need to cut the same are two or three times before you reach the fatty tissue.
This makes any masses on the back hard to evaluate. You may palpate some mass as a large and immobile, but surprisingly after cutting the skin you get small and XXXXXXX lump.
The point is that as long as you are not experienced in physical examination it will be very hard for you to determine if its XXXXXXX or not and how large it is.

From your description this masses are benign. Round and smooth lumps are usually created by benign cells. Cancer grows chaotically so it has no time to create smooth surface. Cancer grows constantly so it gets larger with every week. And finally cancer rarely develops so superficially.

It is common that lipomas or sebaceus cysts are multiply. Actually very common. And can be close together.

I suggest you to have soft tissues ultrasound of this areas before visiting rheumatologist. Otherwise he/she wont be able to determine what is the lump build of. And ultrasound will tell if it has fatty structure, cyst structure or if its suspicious.

I also suggest you to have some basic tests for most common cancers. I do not know how old you are, but if you are close or over 50, colonoscopy would be a good idea. Breast mammography and transvaginal ultrasound is a good idea as well. Blood work (CBC) to see WBC levels is also advisable.

Hope this will help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 43 minutes later
I did not know that about the skin. That is reassuring. I'm 5ft 8 and after losing all my weight I am down to 110 pounds so obviously I can see and feel every bone in my body. I also have very very little muscle mass especially in my back.. So I assumed that the lump I felt, would be very close in actual size. I'm only 25 years old but I keep up with my yearly exams considering my past medical history. I'm almost due for an annual and I may have that dr look further into my lymph nodes in the groin that have also increased in size. I'll also see about getting an ultrasound this week on shoulder lumps and possibly a CBC. Thank you!
doctor
Answered by Dr. Grzegorz Stanko 9 hours later
Brief Answer:
You are welcome.

Detailed Answer:
If you are really thin person you may feel the actual size of the lump. But size does not indicare anything. So it will be good to have it checked with an ultrasound.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5768 Questions

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