Elbow pain, numbness down to ring & pinkie finger, swelling

by Devyn
(East Texas)

19 year old female, college softball pitcher. Been pitching since I was 11. No major issues until March 2018. In games, the training staff had to massage my right arm to get me through a game. Had like a severe cramp through forearm, whole arm swelling, tingling through ring & pinkie finger. The staff doctor told them to keep pitching me and I pitched another month with worsening symptoms. Then consulted personal medical doctor. Originally diagnosed as overuse injury, probably tennis elbow but did not respond to PT. Xrays & MRI of elbow were negative. Next stop was chiropractic. 6 weeks x 3 times a week treatments and adjustments and numbing shots to relax neck and shoulder did not improve symptoms. Possible scapulae involvement was mentioned. Was suggested that next step should be massage therapy on neck shoulders and right scapulae area. Minimal short term results from massage therapy. I don't know where to turn now. I am hesitant to seek a surgical answer because there is no going back from surgery. Still not sure if I have a good diagnosis and I would really like to get back to pitching, but I am physically unable to. Any advice is appreciated.

Hello Devyn
It's my job to be the Devil's Advocate, remembering that I'm not there to examine you, so what follows has only partial value.
I'm also not convinced that all your doctors have made the right diagnosis.
Three features of importance:
1. The cramp in your arm.
2. The swelling of your whole arm.
3. Tingling in the C8 dermatome, very specifically in the pinkie and ring finger.

Please do the following for me, write down your answers as you do them, and we'll take this further then. Be as specific as you can in your answers. Wishy washy replies will take us nowhere. If it tingles, pain, feels numb etc, tell me EXACTLY where.
1. Turn your head to the right, and then simultaneously look up. What happens?

2. This is a hard test, you will need to practise it, and may still not be able to give me a good answer, but if you can, we have the diagnosis. Ask your doctors if anyone did Adson's test. Find the radial pulse where it's really strong in your right wrist using your left index and middle finger. If you can't locate a strong pulse, then no point going further, move your fingers around until you can locate it. Now turn your head to the right again, look up, and then take in a deep breath, and hold it. WHAT HAPPENS TO THE RADIAL PULSE? When you again breathe normally and return your head to neutral, what happens to the pulse?

3. When there's tingling in your fingers, raise your hands above your head. Does the tingling increase or decrease?

4. As a rule, if you work with your hands above your head, as in hanging washing, changing a light bulb, are the symptoms increased or lessened?

5. In the Search this Site function in the navigation bar at Chiropractic Help, type in 'upper limb tension test'. Find a helper and do the test; as accurately as you can, tell me what the result is. Be specific.

6. Have x-rays of your neck been taken? Ask if you have a 'cervical rib'. Send me the report and better still a digital copy of the x-rays (take photos with your camera if they are on plain film), and send to brlewisatmwebdotcodotza. If none have been taken, then do that now; important.

7. Are you a smoker, and do you have a cough?

8. Do you know if any of your doctors found a change in muscle strength, or prick your fingers looking for changes in sensation? Reflexes? Ask.

There's a lot of work there, Devyn. Build up a little dossier, accurate answers to ALL the questions, and then reply here, not to the email above, rather than in bits and pieces. I have a tentative diagnosis, but everything depends on your accurate and specific replies.

Do your best, or don't bother replying. I'm not being rude; I get questions like this all the time, and folk won't take the time to go through the process, and waste both their and my time.

Thought: this might be a lot easier, if you printed this out, and went to the chiropractor who treated you, and ask them to help with these tests.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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Interesting questions from visitors

CLS writes:

Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.