What Muscle is this?

Underground S&C Underground
1

OK, so I've explained this to my physical therapist and to a chiropractor, but they have no answers for me (I'm seeing a neurologist tomorrow).

What muscle/nerve/tendon is responsible for this...

Imagine holding your arm bent in front of you, with your elbow at your stomach, palm up. Now simply lift your arm up and in front of you, all the way up in a straight line till it's over your head.

My arm is essentially paralyzed once I get the elbow to just below shoulder height. At that point regardless of how hard I try or concentrate, nothing happens.

I can lift my arm over my head as long as I turn the elbow out, or turn the palm down.

This is very frustrating , and I don't recall any specific time that the injury could have happened, nor is there any pain (I was suspecting a torn rotator, except for the lack of pain).

This has had a great overall weakening effect on most movements with that arm, except for pulling. I can still do pullups and chins etc.

It's been 3 weeks and I'm beginging to get worried, as there has been zero improvement.

Can the S&C forum diagnose this faster than my disinterested doctors? I'm betting yes.

2

Check with JR in the health medical. I had a similar problem that didnt limit my motion, but instead caused excruciating pain at the same level as yours and i'm pretty sure it had something to do with a rotator cuff, but i have no realy idea.

Good luck.

-doug-

3

Thanks V, I wasn't even aware there was a Health & Medical forum! I'll paste a copy over there too.

From what I read about rotator cuffs, they don't really get better without surgery. Did yours heal completely, and how long did it take?

4

Moke, you describe a very odd situation. I can see why your helath care practioners are perplexed....mainly because there is no specific muscular anatomical answer. The two muscles that aid in straight forward shoulder flexion are the anterior deltoid and the long head of the biceps muscle. It makes no sense that you cannot do the motion with the palm up but you can do it with the palm turned down. It is that aspect that is not making sense. It would make sense being able to reach over head with the elbow out to the side but not in front, but the palm up/down thing is odd.

My best guess (and it is a guess) is that it is something neurological and not totally muscular.

Sorry I couldn't help more.

Best in Health and Training, J. R.

5

JRSFITNESS1,

Well I am seeing a neurologist tomorrow, but I'm sure any answers from him (if any) will be weeks away at best. I've already had 2 MRI's in the last year...I'm not sure if I'm over my radiation limit.

So far you have set me on a better path than I've been on so far.

Something else I forgot to mention which may be a clue is, I am also totally paralyzed when trying to do lateral rotations (see the very bottom movement at http://www.exrx.net/Articulations/Shoulder.html#anchor102874 for anyone who wants to see it clearly).

I cant even hold a 3 pound plate in my hand and do this movement. About all I can manage is the weight of my arm. It's freaky and scary! The only pain I have been having is the strains of muscles trying to compensate, and the spine between my shoulder-blades is going wacky because of the muscular imbalance.

Thanks again for the help!

6

Difficulty with the lateral rotation movement could be indicative of a rotator cuff problem. But the muscles involved in that motion are on the opposite side of the shoulder than those that would be causing your other problems.

PS, an MRI does not use any radiation. It uses magnetic waves to produce an image.

Best in Health and Training, J. R.

7

JRS- I havn't taken athletic injuries yet so I'm sorry if this is a stupid question but the symptoms like some kind of variation on frozen-shoulder.

8

Ya know, that's what I had always thought. I mean MRI has Magnetic right in the name, but somewhere along the line, someone had told me that you get a pretty big dose of radiation from an MRI.

In that case, I'll just steer the doc to an MRI appointment today, and then we can use it from there whethter it's a nerve or tendon issue.

But after looking up the bicep long head tendon and where it inserts to the shoulder, I'm more convinced that it has something to do with all this. I even realise there is actually a pinching pain/feeling there when trying to move my arm out in fron of me, or raise my arm out to the side.

Given what you just said, I'm fearing that it may be more than a single problem, and there may be a couple of damaged spots.

What's frozen shoulder?

Thanks all.

9

JR,

When i turned the palm down in the past, it allowed the use of some other muscles to bypass whatever was hurting. Thumb up (or palm up i suppose) would cause almost unbearable pain and invariably failure of action at the same level Moke describes, but if i turned the palm/thumb down i could use other parts of the delt to finish the motion. Holding my had at the top incurred no pain.

Moke,

JR says it might not be the rotator. I guess i experienced some pain with internal rotation, but i dont know. Still sounds like a similar problem, and still seemed deeper to me the the delt itself (I NEVER experience pain during any other bicep related motion so i would assume delt), which is why i thought it was a rotator problem.

I never had surgery, never even got it checked out. I just avoided that motion for several years. No bench and no OH pressing (pulling worked just fine).

I got sick of it, though, eventually, and started working on it when it felt ok (after a good rest, i could raise it w/out weights without much pain). I would do this until it either started to hurt a bit, or until i could feel a good shoulder pump (sometimes took 100 reps of hand weighted front raises or even lateral just to get the blood to the area to promote healing). It started to get a little better in time, until i could bench and OH with light weights.

The real improvement came when i started BJJ. I dont know what it was about BJJ, but as long as i didnt do the under leg pass, my shoulder felt great. In fact, it felt better all the time and now it is about 95%. I say 95% because i have to favor it a bit; i can't push it as hard as maybe i once could, but no motion brings me pain any more.

good luck!

-doug-

10

"When i turned the palm down in the past, it allowed the use of some other muscles to bypass whatever was hurting. Thumb up (or palm up i suppose) would cause almost unbearable pain and invariably failure of action at the same level Moke describes, but if i turned the palm/thumb down i could use other parts of the delt to finish the motion. Holding my had at the top incurred no pain." Here's the deal...turning the palm up or down is an function of some muscles in the forearm below the elbow. And this motion moves the radius bone around the ulna bone and has nothing to do with shoulder motions. And none of those muscles cross over the elbow much less all the way up to the shoulder joint. So, turning the palm up should not make any difference as far as shoulder motion goes. There are no muscles that could become active to, "bypass" anything. However, if you are actually flaring the elbow out and not just rotating the palm then this puts the head of the upper arm bone (Humerus) into a different position and can cause a narrowing of the space between the clavicle and the acromium process to make the arm motion occur at the shoulder joint. This closing of the space where a tendon slides can lead to fraying of the tendon (one of the rotator cuff tendons). Then it is common for the long head of the biceps to try to kick in to aid in shoulder motions. Since it's now doing a job which it was not designed for it becomes inflammed from being overworked and you develop tendonitis. Also, the farther out the elbow is and the more you are moving the arm to the side instead of straight in front the less the biceps long head will be involved.

In regards to frozen shoulder (adhesive capsulitis)...there is a tissue surrounding the shoulder called the joint capsule. It provides some stability, limits some motions and holds fluid inside the joint that provides lubrication to the joint itself. Sometimes following an injury, surgery, or sometimes for no reason at all this tissue develops adhesions and the shoulder begins to get tight and painful and active motion becomes limited.

The main reasons I didn't suspect this is because you are only limited in a VERY specific motion and frozen shoulder almost always causes problems in multiple planes and motions. Also, Moke stated he has minimal pain at rest and frozen shoulder is typically a VERY painful condition. Finally, he said he can do chins and this would be a virtual impossibility with frozen shoulder.

Best in Health and Training, J. R.

11

Ok, let me clarify that i was trying to connect his palm rotation to the flaring of the elbow without actually mentioning the flaring of the elbow. Stupid? yes. I do, however, know that none of the forearm muscles cross the shoulder joint, and i was trying to illustrate (very poorly) the very case you described.

I could laterally raise my arm with almost no pain (if it was already hurting, even lateral raising would hurt, although to a lesser extent), and could bring it back with no pain. I could also engage in any pulling motion completely pain free no matter how bad the pain was raising my arm, and i also experienced no pain whatsoever at rest.

Moke,

I also just remembered that i started to work a lot of light push pressing into the routine. The momentum carried the weight beyond the painful portion, so i could get better blood flow to the area (because i could use more weight, and cause a greater response) without actually causing as much pain.

-doug-

12

Thanks for the clarification. Good to make sure we're all on the same page.

J. R.

13

OK here's the deal. The neurologist, who never seemed very competent yet very disinterested in the past, came through today.

After doing a handful of strength and movement tests with my arm and shoulder, he said my infraspinatus is gone (his words). He says it's likely a complicated mix of things because of the weaknesses at different angles, but that's one he knows for sure.

He said there is a nerve that feeds it that comes at an angle from the shoulder-blade area that is likely being blocked off somewhere. He mentioned some other affected areas, but to honest, I can't accurately remember them all (I have a hard enough time remembering easy names).

He mentioned a possible problem at the brachial plexus or at the neck, and noted atrophy in the back, delt and even in the corner of my pec.

He's ordered an EMG and an MRI (which I should get the papers for within the next ten days). He also set up an appointment with a guy he seems to hold in high regard who does physical rehabilitation, but he didn't want the physical therapist (who he has working on my lower back) to handle this. What is the difference between PT, and a PR? But that's for after the MRI obviously.

I want to thank you guys for your help, as I went in there with better clarity and preparedness than I would have had otherwise, and I believe this helped in the overall diagnosis so far.

JRSFITNESS1, it looks like you hit the nail on the head figuring it to be neurological. Oh yeah, the whole palm up/down thing was a mystery to him too, but I guess it's more like you guys were discussing above...When I turn the palm down, it allows me to flair my elbow out and THEN I can raise my arm. Every single mundane thing I do with my right arm now, has to be with my elbow sticking way out lol!

I feel and look totally retarded. I can't even naturally lift/pull my grocery bags onto the car seats without rolling my elbow out and kinda yanking them up. It's very weird for me , because pulling was my most naturally strongest position and movement. My tendons and muscles seem very well situated for that. So now I'm like mr. uncoordination.

If it is purley neurological, what are the odds of needing surgery vs rehab (in general)?

I will keep this thread updated as I know more, for curiosity sake, and for anyone who has or ever gets a similar condition.

Thanks again guys!

14

vermonter,

Man, you rested it for several years?! I wish I had your patience. I haven't stopped lifting or doing BJJ (very tough now because I can barely post with that hand) and if I don't get this figured out in the next month, I'm going to explode or die, lol!

On a humorous/mental side, It's very weird to be walking around with your strong side arm pretty much out of commission. I feel physically vulnerable...You know those crabs that have one big pincher, and the one little one? I feel exactly like that crab who's gotten his big pincher snapped off by an eel or something, and he's just scrambling around with just the one small pincher.

15

Moke, I'm not sure of the difference between an Physical Therapist and a Physical Rehabilitationist (I think I just made that word up). Anyway, good to hear that the problem is at least getting narrowed down and somewhat diagnosed.

As far as the need for surgery vs. therapy I could only speculate and that would be pointless since you're getting high level diagnostic imaging tests soon. Just wait for those results and take it from there.

Please let us know more when you do.

Best in Health and Training, J. R.

16

I rested it for several years because i thought it would never heal ;) I still worked out in all the ways i could, and avoided the ways i couldnt. This was back when the forum here was a bunch of bench press haters anyway, so i fit right in.

Then i got sick of working around it and worked on it until it got better. That still took about a year worth of my own rehab to get to where it is now.

-doug-

17

MRI tomorrow (11/10/04)...

18

Well I got the MRI, but my doctor just went on vacation for a month...how's that bullshit? He's aware of my concern about permanent damage and wanting to start surgery/therapy/whatever as soon as possible. I'm pissed.

I WAS able to strike up an extended conversation with the MRI technician (who normally are not allowed to discuss their findings and opinions with patients), and he told me that in his opinion there is nothing wrong at the spine, and that's what he would be writing in his report to the doctor.

He agrees it could be in the brachial plexus or something else entirely. But to image the brachial plexus would have to be another appointment anyway, because it's a whole different set-up, technically.

So I guess I wait for a month?

19

Damn.

Is it getting any better on its own?

-doug-

20

Moke -

In your first post, you said it's been about 3 weeks.  Did this start very suddenly or has it been a gradual weakening since you first noticed a change?

What is your injury history like?  (Don't limit yourself to just the most recent few weeks.)

What kind of work do you do?

What kind of training do you do? (martials arts & otherwise)

Have you noticed any changes in the strength or coordination of your left leg/hip recently?

It's highly unlikely that your problem will require surgery.  It sounds like something that can be corrected with therapy and movement.  While your doc is away, find a Kinesiologist, as this is the sort of problem they specialize in: a strength imbalance.  Bring your MRIs and other results to them for a second opinion and see what treatment options they suggest. 

My experience has been that people specializing in Applied Kinesiology generally have a better grasp of non-invasive treatment methods than do regular docs.

You can also start working on regaining the arm's ROM (range of motion) by actively moving the joint as best you can, or by having others move the limb while you passively allow it to be manipulated through a normal ROM. 

I've personally had success with Scott Sonnon's "Warrior Wellness" and some massage.  The key is to regain your normal ROM before worrying about rebuilding your strength.  My bet is that your strength will return rapidly once your ROM normalizes. 

Right now, turning your elbow out shifts the load-bearing duties onto muscles that are still working fine.  It's a stop-gap measure that can result in fantastic physical adaptations if left long enough. (think Tre Telligman here)  Since those adaptations may lead to other problems, I'd get with the Kinesiologists and start working on it before your regular doc gets back from vacation.

Good luck!