Question
Lately I have had increased pain in my bicep (underneath by armpit) whenever I lay on my stomach or raise my arm above my head. (Right arm) When this happens my thumb and forefinger get tingly. In the past I have had my thumb and forefinger go numb when mountain biking and kayaking. I adjust my hold on the handlebars or paddle and it relieves the pain. To sleep I need to either sleep on my left side, and hold my right arm straight. I can also lay on my back and there is no pain. I thought it might be a first rib injury... but not sure now. Oh... I haven't been able to throw anything using my right arm either. If I do it gives me sharp pains in my shoulder. I played racquetball for most of my life. "A" league. While in the Navy I played all the time for at least an hour, sometimes two. Just wondering if that may have something to do with it. I'm hoping that excercises will fix this.

Answer
Hi Jim,


Sorry for the delay on this.   You must have just caught me before I set my "vacation/away" parameter on AllExperts (I volunteer to treat the Jamaican track/field team at Penn Relays and was without a computer...just arrived home now...).   Okay, so it seems you get finger paresthesias (numb/tingle) that is positional.   Also, you have been active with a one-sided sport (I, too, played racquetball, for 20 years, club-A in the latter stages).    From what you described, it sounds like you have one of three conditions: 1) cervical radiculitis, 2) thoracic outlet syndrome, 3) shoulder impingement syndrome.    Most likely you have #1.  A bulging disc in your neck will cause this, as will degenerative changes in the joints of your neck such as bone spur formation and other items that come with osteoarthritic degenerative changes to the joints.   The nerves from you neck have to pass around and through these joints and anything in the way that can rub or irritate the nerve wiill cause symptoms in the location where the nerve goes: the arm, hand, fingers, and some of the nerves go to the chest/pect and axilla.     You may also have a shoulder problem, impingement of the tendons in the shoulder, and this is common in racquet sport and throwing athletes, and in folks that have injured or repetitively strained the shoulder joint.   It usually will not cause paresthesias, though, just pain with shoulder/arm movements, especially when reaching up or overhead.   #2 is a possibility.  Thoracic outlet syndrome, or TOS, is where the space in front of your neck, just behind the collar bone, is tight and it compromises the nerves that exit your neck and go down the arm.  This zone makes a tent-like opening for the array of nerves, called the brachial plexus, and if the "tent" opening is too tight, the nerves get irritated.  If you bend your head to the left, left ear towards left shoulder, and reach behind you at the same time (like reaching behind your seat when you are driving your car), you will stretch the brachial plexus and tighten the thoracic outlet.   If this provokes finger tingling and arm pain, then you might have TOS.   If you sit straight, turn your head to the right, and then bend your head backwards (e.g. put your right ear in your right rear pants pocket), and if this causes arm/hand/finger pain, then you likely have diagnosis #1.    A good chiropractic check up will help determine which of these three items you have.  You can find well qualified DC's on these lists:  www.westhartfordgroup.com and www.acbsp.com.    

'Hope this was helpful.


Dr. G'
www.drgillman.com