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What could cause excruciating pain from the shoulder radiating to the fingers in an elderly lady?

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Posted on Wed, 3 Jun 2020
Question: For the past 3 months my 71 year old mother's right arm has been locked in a bent position and her wrist is almost a 90’ angle. She has excruciating pain that starts in her shoulder that goes all the way down to her fingers. The odd thing is that about 10:00am or so the wrist will straighten up on it’s own, the pain will go away and she’s able to move and talk. This will last about an hour or so and on it's own, the wrist will go back to the 90’ angle, the arm will go back into the bent position and the severe pain comes back. She’s had a cortisone injection in her C6 but that hasn’t worked and last week she’s started physical therapy. The pain is so bad that her primary care dr has put her on pain medicine, most recently a Fentanyl patch which isn’t helping with the pain. Any advice would be greatly helpful.
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Answered by Dr. Erion Spaho (2 hours later)
Brief Answer:
The cause needs to be found first.

Detailed Answer:
Hello

I have read your question and understand your concerns.

I saw the pictures that you uploaded too.

That type of painful contracture is usually seen after stroke, so, in my opinion, stroke should be evaluated and excluded first.

Another possible condition that may cause such pain and contracture is Wolkmann contracture or ischemic contracture of the hand and forearm that may be caused by blood supply impairment of the forearm in your mother's case.

So, before to be treated for the contracture is necessary to find the cause first.

A medical evaluation and tests such brain imaging, Doppler ultrasound of the affected arm are necessary for this purpose.

Discuss with your mother's Doctor about getting evaluated further.

Hope you found the answer helpful.

Let me know if I can assist you further.

Take care.

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Erion Spaho (25 hours later)
I should also add that mom was diagnosed with Parkinson's almost 20 years ago. She's on several different medications, Rytary specifically for Parkinson's, clonazepam, Zaleplon, to name a few. Could her condition be related to her disease or reaction from prolonged use of medicine? I'm just wondering because her symptoms don't seem to be permanent. They appear for about 23 hours on their own and then return a couple of hours (at the most) later.
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Answered by Dr. Erion Spaho (17 hours later)
Brief Answer:
Rytary use could also cause muscle cramps.

Detailed Answer:
Welcome back.

Rytary use may result in muscles cramps as a possible adverse effect, so, it should be taken into consideration, however, conditions mentioned before in our discussion are still possible, because, the spasms of the muscles are located only in one hand.

So, if these conditions are excluded as possible explanations of the hand and forearm muscles cramps/spasms, Rytary remains an option.

Clonazepam generally acts as a muscle relaxer.

Hope this helps.

Greetings.
Above answer was peer-reviewed by : Dr. Remy Koshy
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Answered by
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 4123 Questions

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What could cause excruciating pain from the shoulder radiating to the fingers in an elderly lady?

Brief Answer: The cause needs to be found first. Detailed Answer: Hello I have read your question and understand your concerns. I saw the pictures that you uploaded too. That type of painful contracture is usually seen after stroke, so, in my opinion, stroke should be evaluated and excluded first. Another possible condition that may cause such pain and contracture is Wolkmann contracture or ischemic contracture of the hand and forearm that may be caused by blood supply impairment of the forearm in your mother's case. So, before to be treated for the contracture is necessary to find the cause first. A medical evaluation and tests such brain imaging, Doppler ultrasound of the affected arm are necessary for this purpose. Discuss with your mother's Doctor about getting evaluated further. Hope you found the answer helpful. Let me know if I can assist you further. Take care.