Floppy arm comes back to life!

Here’s a rather unusual case I had recently. A man came to me having fallen on his front & sliding along the turf during a hockey game, leaving him with profound weakness in his right arm.  Now our clinic Eftpos machine is kept on a shelf above waist height & it was so bad he could hardly raise his arm high enough to swipe the machine!  He could only do it by hitching his shoulder up.

What was so unusual was the fact that he had very little pain.  In fact he only had some in his lower right neck some 2 days after the fall, when he woke with neck pain, but none in the arm.  Interestingly, he’d had a similar episode some years ago which gave him grief for over 3 weeks.  So it seems that there was probably a weakened structure there waiting to re surface.  

 

So what happened?

Well, we’re both stoked as he’s recovered almost all his lost power and has no pain at all.  And even though he started showing signs of improvement after a couple of treatments, I still referred him to a specialist for an MRI because at that point I was concerned at the amount of weakness and, of course, I didn’t know then that he was going to recover so well.  Hope for the best but plan for the worst!

The MRI confirmed my suspicions, showing disc bulges in the area I expected them to be to produce weakness in the affected muscles. But what this man’s recovery tells me (& others might disagree), is that his nerve irritation was probably less from the actual disc bulge than from inflammation from the damaged disc and surrounding the nerve. And that’s not so unusual.  Studies have shown that lots of people have disc bulges but no pain.  The same has been found for rotator cuff tears in the shoulder.  This suggests that some of these things are in fact quite ‘normal’ in people and not a reason to automatically get worried.

Back to the point.  Inflammatory fluid contain chemicals which can irritate nerves, but the actual pressure of the liquid probably squeezes against it too.  This could explain why my patient’s symptoms eased a bit during the day because the inflammation would be flushed out of the area more by movement, whereas during the night it just collects as we lie still. Anyway, 7 visits and he was good to go.  

And the take home point is…?

Put the Eftpos machine on a lower shelf!

Posted in Adults