Is it really Anterior Interosseous Nerve syndrome, or just a more rare type of Neuralgic Amyotrophy?

PTS/NA can cause symptoms that are exactly like Anterior Interosseous Nerve syndrome (AINS). I know this because I had this diagnosis originally. When my fingers suddenly could not flex to make the traditional “OK” finger gesture, it followed a month or so of arm pain and weakness. At the time, I was told I had a textbook case of AINS. But during all of my exams, no one could tell me why I had AINS.  They kept asking me about the pain in my forearm, which I did not have.  I kept telling them I had pain in my upper arm and a bit in my shoulder. At the time I had checked the known causes of AINS, and found that none of them seemed to match my case.  But, what else could it be?

 Eventually, the other shoe dropped and my diagnosis was altered to PTS/NA and I realized that nerve damage that PTS causes can be misdiagnosed as AINS. That had originally been the reason for this post. I had recently noticed some who had been diagnosed with PTS/NA reporting that they had now also been diagnosed with AINS and now have to worry about two rare diseases. And in some cases surgery had been suggested as a cure.  I had found this article which designates the names of at least some of the nerves impacted by NA.  Notice in the anatomy section the mention of the anterior interosseous nerve

http://wiki.cns.org/wiki/index.php/Neuralgic_Amyotrophy

“Description
Neuralgic amyotrophy is also called Parsonage-Turner syndrome, brachial neuritis, and brachial plexitis. In response to bodily stress (e.g., surgery, flu, unusually excessive exercise, post-vaccination), the brachial plexus, branches of the brachial plexus, or other upper (rarely lower) extremity nerves may develop idiopathic inflammation. The exact cause is unknown. This inflammation is quite painful, which limits use of the arm. As the pain slowly resolves over a few days or weeks, the patient now notices paralysis and a variable degree of numbness in the shoulder and arm. The amount of paralysis varies, with unusually severe cases having complete arm paralysis. Weakness and numbness slowly resolves over time. This may take many months, or even 1-3 years. Although most people improve, the arm may not return to normal and remain partially paralyzed. Brachial plexitis may involve nerves controlling almost any muscle; however, nerves to the shoulder, scapula, and forearm are more commonly affected.

Anatomy
The following nerves may be affected (unilateral or bilateral): brachial plexus, long thoracic nerve, anterior interosseous nerve, posterior interosseous nerve, suprascapular nerve, lumbosacral plexus, and others).”

I hate to see anyone go through surgery that would possibly not be needed or even be an answer for the problem being experienced if there were a viable alternative that may help, namely just to wait it out.  If you have a case as AINS, and do not have the typical causes in your history, it may be caused by PTS/NA.

Well, then I just found this suggesting that maybe doctors have realized that inflammation of the nerves can cause AINS in a similar way as PTS.  See the link here:

http://en.wikipedia.org/wiki/Anterior_interosseous_syndrome

“Most cases of AIN syndrome are due to a transient neuritis, although compression of the AIN can happen. Trauma to the median nerve have also been reported as a cause of AIN syndrome.
Although there is still controversy among upper extremity surgeons, AIN syndrome is now regarded as a neuritis (inflammation of the nerve) in most cases; this is similar to parsonage-turner syndrome. Although the exact etiology is unknown, there is evidence that it is caused by an immune mediated response.
Studies are limited, and no randomized controlled trials have been performed regarding the treatment of AIN syndrome. While the natural history of AIN syndrome is not fully understood, studies following patients who have been treated without surgery show that symptoms can resolve starting as late as one year after onset. Other retrospective studies have shown that there is no difference in outcome in surgically versus nonsurgically treated patients. Surgical decompression is rarely indicated in AIN syndrome. Indications for considering surgery include a known space-occupying lesion that is compressing the nerve (a mass) and persistent symptoms beyond 1 year of conservative treatment.”

Notice it says in most cases it says that surgery would not be indicated for most AINS cases now a days, and outcome for surgery rarely improves the outcome of just waiting.  Unless they can be relatively sure there is something to decompress, you may be better off just waiting.

My left arm- I feel like I have already seen this movie

All along, I have thought NA/HNA- what is it anyway? Was just impacting my right arm, and most sites agree it impacts mainly the right arm and shoulders. But I always knew my left shoulder was just not as bad. Well, it seems to be changing of late. I had mentioned the ache I had a while back. That went away. But in its place I have been feeling tenderness in the biceps tendon.

This is a weed whacker issue also since I used it just the other day again. During use, and for a couple hours later it was OK. Then the tendon started to become inflamed and my arm was shaking during any use. And I now was having trouble lifting my arm at all. It started to feel all too familiar. And this was not so much how my arm and shoulder felt preceding my winging right scapula, but it was a similar sensation as I had preceding my thumb and index finger problems. And the ache I had also involved my thumb. This makes me wonder. And it makes me feel like I have to be more careful or I will end up with two hands that are not much good.

The other shoulder

Off and on recently I have had things going on with what had been my un-impacted left shoulder. I say un-impacted even though my left scapula does show sign of slight winging. What has been happening is that I feel a dull ache from my scapula that feels like it is traveling down my arm to my left thumb. During these times, my arm is about useless even though the pain is not what I would call bad in any way. At least it is not bad compared to what I know it could be.

So, I am not sure what it means, if anything. I have had no pain recently in the left side of my neck. But, I do continue to have left sided headaches periodically, as I have had since this all started in 2006. I know my doctors would just say it is due to overuse. But, what should I do about that?

From pushups to tingles. . .

Well, if you are following this in any way, I had worked my pushup count back up to 20 very slowly, sort of taking my neurologist’s suggestion to exercise but do not overdo it. It still kills me that they think I am weak from not trying to exercise. Anyway, I had gotten to 20 about the time I had seen him last time- whey he told me I should be trying to exercise. A day or so later, I tried and could only do 15. I think those who have been here may already know where I am going. A few days later I tried, and could do 8 or so. Today, I could barely do 5. There you have my attempt at exercising slowly to build up my muscle mass. Yep. Right.

So, the tingles of last week are gone too. They only lasted that one day, and however active that was it turned out to be just a fluke in the overall scheme of things. Or at least, if it did mean anything, what it meant has not become clear yet. I have no improvement of movement or strength. And, I have no decrease of movement.

It goes on. If I can get my last couple of months of insurance straightened out by tomorrow, I have another appointment with my regular doctor to discuss the findings of the Neurologist. The end of next month, this insurance goes away, and I will have to figure out a new way to pay.

My right hand. . . Now what?

It has been a while since I have written anything that actually was about NA, the subject of the blog. As it turns out, I have been preoccupied by other matters.

Remember that my right hand had been the site of my original attack of NA? Today, when I woke up, I began to notice that my right thumb and index fingers were tingling a bit. This increased through the day, and has been going on for around eight hours now. It increases when I stretch my arm out away from me. This is from the lower part of my hand, radiating out through all but the little finger. It has now been just under ten years since my first incident with my thumb and index fingers of my right hand. And my hand has been pretty much a quiet and a non issue for at least 5-6 years.

What does this mean? Hey, even though I got lucky with the diagnosis for my shoulder, I have no clue about this. Doctors I have seen pretty much implied that any tingling like this would happen only early on in the injury, and then it would eventually stop. And, they did not seem to be suggesting that the tingling was a good thing. What do I know? Not much. All I know is that the last time I felt this much activity in my hand was right before I became able to move my index finger again. And one more thing; I have routinely stretched my right arm out in the way I am now doing that cases the tingling to increase, and there was nothing. Tomorrow, maybe there will be nothing again. But for now, I know something is going on that has not happened for a long time.

Keep those joints moving!!!

Hello Blog People- You know who you are.

It has been a while since I have written anything substantial. A week or so ago I woke up in the middle of the night and wrote an entry in my head as I lay there trying to fall back asleep. It still has not been written, but it would deal with the importance of KEEPING YOUR IMPACTED JOINTS MOVING.

(DISCLAIMER- I am not a Doctor or a Physical Therapist- Do any exercise program not prescribed by them at your own risk-)

Movement is essential to regaining any of your strength. What good would it be to get back strength if you could not move the joint? Start passive movement of the joint as soon as you can do so without pain. Your Physical Therapist can give you exercises to help. But remember that PTs are just there to remind you of what you should already know about your body. If you do not use it, you will lose it. In order to use it, it has to be able to move. Strength will follow.

A good and easy passive arm motion exercise is to just bend at the waste, and let the impacted arm hang lose towards the floor. Gently swing it using movement of your upper body. Swing it back and forth, or in a circular motion. Maybe go one way for a few turns, and stop and reverse. Do not use your arm muscles in any way to do this. That is the passive part.

Another passive exercise you may be able to do yourself if your good arm is good enough to lift your impacted arm through its range of motion. Or, you can enlist the aid of someone you trust. I say that tongue in cheek a bit, but trust is important in dealing with allowing someone to lift your arm for you and move it through range of motion you may not have. You have to be aware of when and if it is uncomfortable for you, and they have to be aware that you may not react in time to stop them before you reach that point. It is best to do this after being shown by a Physical Therapist, but if you do not live with one, you may have to improvise.

You can also do arm movement on your back on a bed. At that time, your scapula is fairly well supported, and may actually be in its normal position. When I tried to do range of motion on my back in this way, I was pleased to discover I could do a lot more movement than I thought I could do. But still be careful.

Regular readers know that I have used push-ups as a gage of my strength being there, or not. This is not something you should just start out doing on your own, or at least, not full push-ups. My PT suggested to me that I start with scapular push-ups. For these, you get in the standard position, but instead of lowering yourself to the floor, you attempt to just flex and release muscles of your scapula. It is not easy to describe. Here is a You-Tube video (http://www.youtube.com/watch?v=z4G0lSwL2os). It would be better if the guy was shirtless to see if he had the right technique, but it looks OK to me.

Along with those, there are various stretches to try. Stand in a doorway and put your arm up at a 45 degree angle as if you were motioning for someone to stop. With your arm against the door jamb, push through the door enough to slowly stretch your upper arm.

Then there is wall walking. I tell you, the internet has everything. I was going to try to explain this, but here is a link that does it with pictures. http://nih.kramesonline.com/HealthSheets/3,S,89905 Like it says; do not try this unless you have been cleared by a professional. I was cleared fairly early. In fact, I think it may have been too early. It was at least before they knew I had the scapular winging. But, the range of motion and strength I have to lift my arm over my head are because I did this exercise from the beginning.

What if your arm is OK and you have a problem elsewhere? Well, for me, my hand was also impacted a few years earlier. All they told me was that I should keep my tendons flexible. Be creative. Your hand is a lot easier to do passive exercise on. People may look at you funny, but you really have to make it such a habit to keep your fingers moving that you do it without thinking about it. Do a bit of passive, and then try to actually move the fingers that will not move yet. I mixed this a bit, and physically moved the finger with my left hand as I tried to move finger of my right hand on its own. It would also help to have some sort of electric muscle stimulation treatments. At least, it helped me. I was lucky that a Physical Therapist who was interested in my case loaned me a muscle stimulation unit that was surplus for his practice. I used this at least a couple of times a week as my right hand returned to function.

Well, that is not quite how I wrote it in my head, but it will do. Good Luck getting movement back!!!

The clinical spectrum of neuralgic amyotrophy in 246 cases

I think I may have cited web pages that refer to this study in the past, but this link I have added goes to the main study results where before I may have only been able to find the abstract to the study. Click here for the complete listing-

This study was quite extensive as are the results in the web page, and is worth looking into if you are a NA/HNA sufferer. I will leave a link to the pages out to the right in my links section.

Sometimes functions that had been lost return- almost

When I first had any problem related to PTS or AN, whatever you want to call it, it was my right hand that was impacted. At the time, everyone thought this was a simple case of Anterior Interosseous Nerve Syndrome. The only problem was that I had not had any of the common triggers of this syndrome. I thought my doctors had the diagnosis nailed down. After all, they were hand experts. Of course, now looking back, it bothers me that none of the experts ever listened to me when I told them that it all started in my upper arm. I tried to give them clues even then, and even though I did not really know what clue I was trying to give.

Out of the blue, I have this very rare problem that seems to have rendered my right hand almost useless. I say almost, because it was still OK for things that did not require any finesse. I could not pick up a pen, and even if I could pick one up, I could not write at first. It took me a bit of experimentation to find a way to hold a pen, and then a bit of practice to relearn the wrong way to write- simply by moving my entire hand instead of holding the pen, and making use of the finger tips to control making the letters flow.

From earlier posts, I have mentioned that I was constantly keeping my hands and fingers of my right hand in motion. Part of this included trying to hold things with my thumb and index finger. Early on, I was not successful holding anything. I could barely hold my thumb and index finger together tightly enough to do any movement. Over time, this changed and I could get them to hold together and even bring them from the flattened finger pinch back into a more standard O. At that point I started to try that exercise with a pencil between my fingers. My doctors all thought I would never regain use of my hand without surgery, so I had a lot of incentive to prove them wrong.

I eventually had some return of my index finger movement. Shortly after that, I started to hold the pen or pencils between my index finger and thumb, and with my left hand, I would grab the pencil and move the tip while I tried to keep hold it with my almost useless finger tips. Over time, I could hold on with more strength. On occasion I would try to hold the pencil or pen down against paper. Usually, this action caused one thing to happen. That would be the pen or pencil flipping away from me. Eventually, I could hold the pen in contact with the paper, and I would try the next step; to move the pen against paper. And of course, that would flip the pen out of my hand. After a while doing this, and also trying to hold the pen as my left hand pushed and pulled it, I finally could move the pen against paper again. Then it was like trying to learn to write again.

The initial attempts look just like that. I could not even read what I was trying to write. But, now all these years later I can use a pen pencil right handed, for short use anyway. I could never write anything like this document by hand. Even writing out a check at a store I can lose my grip and drop the pen. But, generally I have enough strength to write short things- writing checks or short notes are OK. Much more, and I try to do it on computers and print it out.