Shoulder pain and tingling hands after rugby tackle

by Gareth
(Devon, UK)

Increased tingling when raising the arm suggets a problem in the inter scalene triangle.

Increased tingling when raising the arm suggets a problem in the inter scalene triangle.

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Hello,

I'm currently trying to get an appointment to see my GP but as ever struggling to get in. I play a lot of Rugby (full contact) and while playing a few weeks ago my head got pushed forward and depressed onto my chest, this caused some pain and tingling at the time but I carried on playing; rested for the week and played the following week. While playing the following week I made a tackle with my arm outstretched and my head on the wrong side which sent an instant push of pain and sensation down my arm, I came off the field and have been suffering with shoulder pain since.

The pain in my left shoulder has reduced to a constant ache but increases in intensity when I look up, I can't really turn my head fully to the left and there is some pain turning my head either side, as well as this it feels like it's is grating when I do this. I have pins and needles in the whole of my left hand intermittently and constant pins and needles in the right thumb and index finger which increases in intensity if I lift my hand above my head. There is also some ache and discomfort at the bottom of my shoulder blades, but this may be due to adoption of an awkward posture to alleviate shoulder pain.

I will hopefully see my GP ASAP, but would be interested if I should push/ask specific questions to ensure I get a good consultation.

Thanks in advance.





Hello Gareth,
Thank you for taking the trouble to write an in depth history.

Firstly, when there are symptoms in both arms, you have to take it seriously. No more rugby for the present until your doctor agrees to it.

It's likely that you have both a shoulder injury, and a neck injury, but they may be one and the same. Certainly your cervical spine is involved. The fact that the pain in your left shoulder increases when you look up is very significant.

Normally, if you lift your arm above your head it brings relief to the tingling; the so-called shoulder abduction relief sign. The fact that it increases the tingling in your right hand suggests that the first rib and the thoracic outlet need to be carefully evaluated. The crunch examination is called Adson's test; does the pulse in your wrist stop when you turn your head to the right, look up and take in a deep breath?

Again, the rhomboid muscles between the shoulderblades are supplied with innervation via the dorsal scapular nerve which comes from the lower neck; it's very common that you have both arm, neck and an ache in the midback.

I fear your rugby days are over, Gareth. Go and find another sport that suits your temperament. I gave up squash for different reasons, moped for six months, and then found that gliding was far more interesting. You'll have a similar journey, I suspect.

At the very least a set of x-rays including obliques is indicated for your neck; an MRI would be better still, but expensive.

I would recommend a conusultation with either a neurologist, or a chiropractor with a strong neurological background. Fics trained chiropractors are well qualified to examine you and make recommendations. A call to the BCA would find a local DC.

Good luck, let us know how you get on.

Dr Barrie Lewis





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May 13, 2016
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starstarstarstarstar 		Further info following MRI
by: Gareth

Dear Barrie,

First thank you for your previous comments there was some useful info, especially around how to take this forward.

So following my initial consultation with my GP I was refereed to get a CT scan, however, this never happened due to the wait time 3-4 weeks and an increase in my symptoms I went to accident and emergency (under the advice of my GP). While in A+E I had X-rays to confirm that there was no break and was then refereed for an MRI.

I have had the results back from the MRI and have now been refereed to a spinal specialist. The results form the MRI were as follows:
No recent fracture
No obvious damage to spinal cord
Disc contusion C2/3
Disc contusion C3/4
Cervical osteophytes C2/3
Cervical osteophytes C3/4
Stenosis C3/4 Left side mild
Stenosis C4/5 Right side mild
Stenosis C5/6 Right side moderate

My big issue with this is that apart from being given tablets to reduce the pins and needles, which I have opted not to take as they only mask the issue and not treat it and are not worth the side effects associated. I haven't really been given any information on what I should and shouldn't do and whether the rugby career and weight lifting are no longer an option. I;m obviously awaiting the referral to a spinal specialist but feel a bit lost at sea.

Any thoughts
Cheers
Gareth





Hello Gareth,
Actually, the delay did you some benefit; an MRI far more useful.

I'm not sure if you wrote a precis, but that report is very superficial; it's that lower cervical stuff, and C4/5/6 that is likely causing your pain in the arms. Good that there are no signs of disc injury down there, but frankly I'd like to see that scan read by someone with more experience.

Spinal stenosis is unusual in your age group; I take it you're not 79 and still playing rugby! There's no mention of what is causing the stenosis; what does the x-ray report say about the foramena and paravertebral (or paracentral? joints? Is there loss of lordosis, a kyphosis and narrowed disc space?

If they push you to have surgery I'd consider seeing a local chiro who is experienced in cervical spine injuries.

I hope all goes well; meantime, hang up your boots. There are other exciting sports out there that are less traumatic.

Dr Barrie Lewis

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