Question
Hi,

I am 41 years old , male.I play softball and I injured my throwing arm. Everytime I throw the ball I feel a burning sensation in my my arm around the tricep area. Also it feels like my arm is about to fall out of my body. What is it and what should  i do?

Thank you

Answer
Dear Sylvain,

There a few possible explanations for your current symptoms.  

It is possible that you have created a tear in the tricep muscle.  If so you may be able to see an indicator of injury by looking directly at the tricep in a mirror.  Flex your tricep lightly and look for a bulge in the muscle or a small depresion in the muscle belly.  If there is a large full thickness tear you will see a bulge, if the tear is small you may see a small depression...it is possible to have a tear without the ability to see it through the skin.  The normal appearance of a healthy tricep muscle is an upside down horseshoe.  Muscle tears are ofetn accompanied by bruising and pain upon contraction.

Another possibility is a stretch/crush injury of the brachial plexus or nerve roots in the neck.  This can happen from a fall on an outstretched arm and compression of the neck, or a fall in where the arm is stretched and the neck goes the opposite direction. (Hard throwing motions can mimic these types of movements/injuries) In either case neurological inflammation, micro-tearing, and burning/tingling symptoms can arise. The specific nerve root to the tricep muscle is C7 (radial nerve), but includes fibers from C5, C6, C7, & C8. Concerning the burning sensation in the tricep area C5 & C7 are the most likely candidates due to their pain referal patterns.  

If you have a small injury (neuropraxia) this pain will most likely last up to 6 weeks, but should improve over that time as the nerve heals.  If the injury is more complex you may also have a decreased C7 reflex along with some muscular weakness in the tricep muscle.  In addition to the nerve type injury I have described, muscle strain often accompanies and will also cause local pain...usually diffuse soreness, worse with muscular work.

Now it is also possible to have some spinal cord compression involved as well, but this is not as likely.  This is usually only seen with larger trauma.

My advice is you need to have a musculoskeletal examination of the area of complaint, especially if your symptoms are progressive, or if you have any weakness.  You need to be examined by a chiropractic physician or a sports orthopedist.  They will have the best knowlege of biomechnics and musculoskeletal injury.  

Chiropractic care is helpful in these conditions if the injury is not severe (requiring surgical resolution such as a full thickness tear of a muscle).  Manipulation of the neck and upper back will frequently decompress the area of nerve involvement and reduce pain. In addition a local cortizone injection from the M.D. will help the inflammation immediately, but serial injections may cause joint disruption.  Whether choose the Chiropractor or the M.D. route, make sure to get thoroughly educated on treatment as well as your diagnosis.

Good Luck Sylvain.  In the mean time you can use over the counter pain relievers and ice to help reduce pain.  Do not place it directly on the skin, wrap ice in a thin towel, and use for up to 20 minutes at a time with an hour break in between applications.  Do not use heat, as it will increase inflammation in the tissue, and remember to ice directly after getting out of a hot bath or shower.

Respectfully,
Dr. J. Shawn Leatherman