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What Causes Pain From Armpit To Elbow?
Question: Dear Doctor
I have a strong pain sensation in both my upper arms at the inside from the armpit to the elbow. I feel the painful sensation is inside the arm. At the rightern side it is stronger, it even hurts if I just pass my hand over the skin. I feel slight improvement if I lift my shoulders. Apart, I feed I cannot move my head as I used to, especially looking at the left hurts in my neck. looking upwards is also difficult and hurts. I had the same problem one year ago and went to three doctors, none of them could help me. The pain disappeared after some month but now it came back and I definitely feel that it is even stronger. A week ago I visited a neurologist with specialization in neck surgery. He send me to get an MRI of my neck and today I received the diagnosis which is: cervical spondylosis C4 to C5, C5 to C6 and C6 to C7. He said there is not much treatment and I should do more sports, especially swimming and three month (once a week) physiotherapy. He said in worst cases he recommends surgery but in my case I have not yet come to that point. I am a little confused now and would like to hear a second opinion about my chances to get rid of my arm and neck pain.
I have a strong pain sensation in both my upper arms at the inside from the armpit to the elbow. I feel the painful sensation is inside the arm. At the rightern side it is stronger, it even hurts if I just pass my hand over the skin. I feel slight improvement if I lift my shoulders. Apart, I feed I cannot move my head as I used to, especially looking at the left hurts in my neck. looking upwards is also difficult and hurts. I had the same problem one year ago and went to three doctors, none of them could help me. The pain disappeared after some month but now it came back and I definitely feel that it is even stronger. A week ago I visited a neurologist with specialization in neck surgery. He send me to get an MRI of my neck and today I received the diagnosis which is: cervical spondylosis C4 to C5, C5 to C6 and C6 to C7. He said there is not much treatment and I should do more sports, especially swimming and three month (once a week) physiotherapy. He said in worst cases he recommends surgery but in my case I have not yet come to that point. I am a little confused now and would like to hear a second opinion about my chances to get rid of my arm and neck pain.
Brief Answer:
Cervical spondylosis is a possibility.Please upload MRI.A few questions.
Detailed Answer:
Hi XXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist, here to answer your query.
If you would have presented to me as my outpatient,my clinical explanation would have been- The most common cause of the syndrome of neck pain along with shoulder and arms pain is cervical spondylosis,beyond doubt.
I would have asked a few questions in order to answer your query well-
1)Do you have tingling sensation in upper limbs?
2)If you stand straight and laterally bend your head towards the right side,in order to touch your right ear to your right shoulder,does it increase or decrease the pain on right side?-This is a clinical test for cervical spondylosis.
3)Do you have daily headache?
Please follow up with the answers to the above questions.
Here,it is worth mentioning that many persons have spondylotic changes but not necessarily,they are severe enough to cause symptoms.In some of the persons,it may be another soft tissue etiology or another bony etiology.Considering this fact,it becomes important to get a Magnetic resonance imaging(MRI) of cervical spine done to see the exact severity of spondylotic changes and the nerve compression,if any,it is causing.
Please upload MRI images so that I can look upon the severity of spondylotic changes. You have a feature to upload the images by yourself on the right side of this query page. please utilize it.
If cervical spondylosis is the cause,medicines help slightly,but regular dedicated physiotherapy can almost cure symptoms in many patients.
Hope I have answered your query for now.Waiting for your follow-up question,with the details I asked you for.
Dr.Ajay Panwar,
MD,DM(Neurology)
Cervical spondylosis is a possibility.Please upload MRI.A few questions.
Detailed Answer:
Hi XXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist, here to answer your query.
If you would have presented to me as my outpatient,my clinical explanation would have been- The most common cause of the syndrome of neck pain along with shoulder and arms pain is cervical spondylosis,beyond doubt.
I would have asked a few questions in order to answer your query well-
1)Do you have tingling sensation in upper limbs?
2)If you stand straight and laterally bend your head towards the right side,in order to touch your right ear to your right shoulder,does it increase or decrease the pain on right side?-This is a clinical test for cervical spondylosis.
3)Do you have daily headache?
Please follow up with the answers to the above questions.
Here,it is worth mentioning that many persons have spondylotic changes but not necessarily,they are severe enough to cause symptoms.In some of the persons,it may be another soft tissue etiology or another bony etiology.Considering this fact,it becomes important to get a Magnetic resonance imaging(MRI) of cervical spine done to see the exact severity of spondylotic changes and the nerve compression,if any,it is causing.
Please upload MRI images so that I can look upon the severity of spondylotic changes. You have a feature to upload the images by yourself on the right side of this query page. please utilize it.
If cervical spondylosis is the cause,medicines help slightly,but regular dedicated physiotherapy can almost cure symptoms in many patients.
Hope I have answered your query for now.Waiting for your follow-up question,with the details I asked you for.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Doctor, thank you for your email. here the answers:
first, I uploaded the pic of the MRI for my neck. Please see the enclosure.
1.) tingling sensation: not in my arms, I had it once in my feed but just once and for a cuple of minutes after I woke up in the morning. I do have a tingling feeling in my right ear and the right side of my head over the ear.
2.) I am not sure but it is posible the pain decreases.
3.) not daily but from time to time I suffer from severe headaches. Sometimes I feel preassure on my both eyes, especially the left eye hurts when looking upwards.
Thank you for your advise.
XXXX
first, I uploaded the pic of the MRI for my neck. Please see the enclosure.
1.) tingling sensation: not in my arms, I had it once in my feed but just once and for a cuple of minutes after I woke up in the morning. I do have a tingling feeling in my right ear and the right side of my head over the ear.
2.) I am not sure but it is posible the pain decreases.
3.) not daily but from time to time I suffer from severe headaches. Sometimes I feel preassure on my both eyes, especially the left eye hurts when looking upwards.
Thank you for your advise.
XXXX
Brief Answer:
Definite abnormalities in MRI.Please upload T2,contrast and axial films.
Detailed Answer:
Hi XXXX
Thanks for being in follow-up and answering the details I asked for.
I have gone through your MRI spine image. Yes, I must say that there are definite and significant abnormalities in cervical spine. But, I am afraid to say that the image you have uploaded is T1 weighted sagittal image. On this image, it is not able to delineate the extent and nature of the pathology. Please upload axial image, T2 weighted image and T1 contrast image. If possible,please upload the MRI CD on google drive and paste the google drive link here (that will be the best way to assess the MRI).
I am curious to see the images and advise you accordingly. I know it can be a bit of discomfort for you but please upload the CD on google drive and follow-up. The abnormalities on MRI are significant and I definitely want to guide you.
Waiting for your follow-up question.
Dr.Ajay Panwar,
MD,DM(Neurology)
Definite abnormalities in MRI.Please upload T2,contrast and axial films.
Detailed Answer:
Hi XXXX
Thanks for being in follow-up and answering the details I asked for.
I have gone through your MRI spine image. Yes, I must say that there are definite and significant abnormalities in cervical spine. But, I am afraid to say that the image you have uploaded is T1 weighted sagittal image. On this image, it is not able to delineate the extent and nature of the pathology. Please upload axial image, T2 weighted image and T1 contrast image. If possible,please upload the MRI CD on google drive and paste the google drive link here (that will be the best way to assess the MRI).
I am curious to see the images and advise you accordingly. I know it can be a bit of discomfort for you but please upload the CD on google drive and follow-up. The abnormalities on MRI are significant and I definitely want to guide you.
Waiting for your follow-up question.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Doctor,
link with my MRI - I hope everything is clear since the result is in spanish:
https://drive.google.com/folderview?id=0ByMsOKgN5z5Ifmp3NXhTZ2Y1dHN3QVB0c01Kb0RMTWFsLVdoRGh4X0lsSXdlTnBaZ1NkZDA&usp=sharing
please let me know if you could open it and if you have further questions.
regards
XXXX
link with my MRI - I hope everything is clear since the result is in spanish:
https://drive.google.com/folderview?id=0ByMsOKgN5z5Ifmp3NXhTZ2Y1dHN3QVB0c01Kb0RMTWFsLVdoRGh4X0lsSXdlTnBaZ1NkZDA&usp=sharing
please let me know if you could open it and if you have further questions.
regards
XXXX
Brief Answer:
Some problem with CD.Please upload the requested images.
Detailed Answer:
Hi XXXX
Thanks for being in follow-up.
The CD files you have uploaded are in a few KB's.MRI CD should be in MB's atleast. I tried opening with MICRODICOM VIEWER which is my default dicomviewer. Some error opening file. Please upload T2, contrast and axial images here as you posted T1 image earlier. You can also send the larger files at YYYY@YYYY and address it to my name: Dr Ajay Panwar.
Waiting for your follow-up question.
Dr. Ajay Panwar,
MD, DM(Neurology)
Some problem with CD.Please upload the requested images.
Detailed Answer:
Hi XXXX
Thanks for being in follow-up.
The CD files you have uploaded are in a few KB's.MRI CD should be in MB's atleast. I tried opening with MICRODICOM VIEWER which is my default dicomviewer. Some error opening file. Please upload T2, contrast and axial images here as you posted T1 image earlier. You can also send the larger files at YYYY@YYYY and address it to my name: Dr Ajay Panwar.
Waiting for your follow-up question.
Dr. Ajay Panwar,
MD, DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Doctor,
I send the full information to " YYYY@YYYY " through the webpage "wetransfer" and I also send it to the same email with a link to my dropbox. In both cases you will find a file where you make a right click and say "extract here" - it is 35mb big.
I hope this works out.
Thank you very much for your very kind help.
Regards
Tim
I send the full information to " YYYY@YYYY " through the webpage "wetransfer" and I also send it to the same email with a link to my dropbox. In both cases you will find a file where you make a right click and say "extract here" - it is 35mb big.
I hope this works out.
Thank you very much for your very kind help.
Regards
Tim
Brief Answer:
Seen the MRI.C3-C4,C4-C5 and C5-C6 disc bulges.
Detailed Answer:
Hi,
Thanks for being in follow-up.
Thanks for providing the MRI CD. Its absolutely fantastic in image quality. Posterior longitudinal ligament opposite C3-C4,C4-C5 and C5-C6 appears to be separated from the corresponding vertebral bodies, probably due to the corresponding disc bulges(not much clear, but appears like that). But in axial sections, neural foraminal narrowing doesn't appear to be significantly narrowed, severe enough to cause the symptoms you are having.
For one last step, please upload the scanned image of the radiologist's opinion as MRI report, so that I can give you a conclusive answer and plan out a treatment strategy for you.
Waiting for your follow-up question.
Dr. Ajay Panwar,
MD, DM(Neurology)
Seen the MRI.C3-C4,C4-C5 and C5-C6 disc bulges.
Detailed Answer:
Hi,
Thanks for being in follow-up.
Thanks for providing the MRI CD. Its absolutely fantastic in image quality. Posterior longitudinal ligament opposite C3-C4,C4-C5 and C5-C6 appears to be separated from the corresponding vertebral bodies, probably due to the corresponding disc bulges(not much clear, but appears like that). But in axial sections, neural foraminal narrowing doesn't appear to be significantly narrowed, severe enough to cause the symptoms you are having.
For one last step, please upload the scanned image of the radiologist's opinion as MRI report, so that I can give you a conclusive answer and plan out a treatment strategy for you.
Waiting for your follow-up question.
Dr. Ajay Panwar,
MD, DM(Neurology)
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Dear Doctor,
the report is in Spanish but I did my best to translate it. thank you very much for the follow up.
regards
XXXX
Translation:
A Magnetic resonance was realized with the equipment Siemens 1.5 Tesla.
The resonance was realized with sequences in sagittal cuts in T1, T2, T2 with fat suppression, sequences with cuts in T2 and sequences with axial cuts in T1 and T2.
In the present study we observe a conservative cervical lordosis without scoliosis. The vertebral bodies conserve their form, altitude and intensity with normal sign in the different sequences. There are no tumors in the bone structure.
There are slight degenerative changes in the vertebral disks as of per derogation of the sign in the sequences T2 in the intersomatic cervical disks, posterior swelling of the disks C3 to C4, C4 to C5, C5 to C6 which deform slightly a bag without compressing nerve roots nor medulla spine.
There is no stenosis in the canal or in the forminal stenosis.
Articulations interfacetaria and yellow ligaments without evidence of alteration.
Cervical medulla spine presents diameters and intensity with normal sign in different sequences.
As an incidental remark we observe perineutral cysts intra foraminal in the level of C7-T1 of 2mm diameter bilateral.
the report is in Spanish but I did my best to translate it. thank you very much for the follow up.
regards
XXXX
Translation:
A Magnetic resonance was realized with the equipment Siemens 1.5 Tesla.
The resonance was realized with sequences in sagittal cuts in T1, T2, T2 with fat suppression, sequences with cuts in T2 and sequences with axial cuts in T1 and T2.
In the present study we observe a conservative cervical lordosis without scoliosis. The vertebral bodies conserve their form, altitude and intensity with normal sign in the different sequences. There are no tumors in the bone structure.
There are slight degenerative changes in the vertebral disks as of per derogation of the sign in the sequences T2 in the intersomatic cervical disks, posterior swelling of the disks C3 to C4, C4 to C5, C5 to C6 which deform slightly a bag without compressing nerve roots nor medulla spine.
There is no stenosis in the canal or in the forminal stenosis.
Articulations interfacetaria and yellow ligaments without evidence of alteration.
Cervical medulla spine presents diameters and intensity with normal sign in different sequences.
As an incidental remark we observe perineutral cysts intra foraminal in the level of C7-T1 of 2mm diameter bilateral.
Brief Answer:
Cervical spondylosis is unlikely to cause the symptoms.
Detailed Answer:
Hi XXXX
Thanks for being in follow-up and putting great efforts in converting spanish to english.
As I said,MRI report also says that spondylotic changes are not significant to cause foraminal or canal stenosis.Thus,there is no reason for significant nerve root compression.So,cervical spondylosis is probably not the cause of your symptoms.
Some of the diseases which can result in similar syndrome and need to be ruled out are-
1)Tension headache variant-In this neck muscles and shoulder muscles may remain tensed and result in pain which can worsen even on touch.
2)Fibromyalgia
3)Thoracic outlet syndrome-Digital cervical X-Ray and chest X-ray may be done to detect it.
4)Connective tissue disorders-Please get done ESR(Erythrocyte sedimentation rate),CRP(C-reactive protein),ANA(anti nuclear antibody),RA(rheumatoid arthritis factor).
Management plan-
1)Dedicated regular physiotherapy.
2)Tab.amitriptyline 10 mg once a day at bedtime.
3)Tab.methylcobalamin 1500 mcg a day.
4)calcium and vitamin D supplementation.
Neurological examination by a clinical neurologist and not a neurosurgeon.
Hope I have answered your query for now.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Cervical spondylosis is unlikely to cause the symptoms.
Detailed Answer:
Hi XXXX
Thanks for being in follow-up and putting great efforts in converting spanish to english.
As I said,MRI report also says that spondylotic changes are not significant to cause foraminal or canal stenosis.Thus,there is no reason for significant nerve root compression.So,cervical spondylosis is probably not the cause of your symptoms.
Some of the diseases which can result in similar syndrome and need to be ruled out are-
1)Tension headache variant-In this neck muscles and shoulder muscles may remain tensed and result in pain which can worsen even on touch.
2)Fibromyalgia
3)Thoracic outlet syndrome-Digital cervical X-Ray and chest X-ray may be done to detect it.
4)Connective tissue disorders-Please get done ESR(Erythrocyte sedimentation rate),CRP(C-reactive protein),ANA(anti nuclear antibody),RA(rheumatoid arthritis factor).
Management plan-
1)Dedicated regular physiotherapy.
2)Tab.amitriptyline 10 mg once a day at bedtime.
3)Tab.methylcobalamin 1500 mcg a day.
4)calcium and vitamin D supplementation.
Neurological examination by a clinical neurologist and not a neurosurgeon.
Hope I have answered your query for now.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Prasad
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