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Bicep and Armpit Pain
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By Nate Ball
Administrator
From Taipei, TW
Jul 18, 2013
Some route at Smith Rock

This is a very specific and complex issue that I have been dealing with for over a year now. After searching the internet, talking to several doctors, and trying several different types of treatment, I am still no closer to understanding what is happening and how to get over it.

In May 2012, I had been climbing hard for several days. After starting on a fairly hard climb in the morning, without warming up or stretching, I got down from the climb and noticed that my left bicep had a deep throbbing pain that extended from upper forearm (tennis elbow), along the inside of my arm between the bicep and tricep, into my armpit, and then up into my deltoid. The pulling motion of belaying aggravated it. After a couple hours of rest and stretching, it was gone, and I continued to climb for several days, although cautiously, with only minor pain. The pain came back on days that I would climb really hard, but would go away just as quickly, and not appear at all if I was climbing easier stuff between long periods of rest.

In September, after returning to Taiwan, my arm would almost instantly start hurting whenever I climbed hard. If I took a few months off, it would take a day or two of climbing to start hurting again, but inevitably it would start hurting. Climbing in a gym would always hurt instantly. I tried forearm stretches for tennis elbow and rotator cuff exercises for my shoulder. I saw several doctors, none of whom took my condition seriously or thought it was much of a problem.

In February, I finally found a doctor who actually took it seriously. He took several X-Rays, which were totally negative of any bone problem. Then he did an ultrasound and diagnosed calcified tendinitis in my left forearm and shoulder. I then began a series of "extracorporeal shockwave therapy" treatments to break up the deposits. Whenever I climbed after this treatment began, I had no pain. But I never climbed for several days straight, although I was able to climb in a gym without pain.

In April, after two days of climbing, I was playing baseball and when I swung the bat my left shoulder subluxated. It does this in a strange way - it comes out the bottom of the socket, where I feel the pain in my armpit. It didn't hurt at all afterwards. But as soon as I jumped on a short, bouldery 5.11, it began to hurt again.

We continued the treatments for a few more sessions. Shortly thereafter I fell off my motorcycle and tore a tendon in my rotator cuff. Obviously, I stopped climbing. I rested, iced, and eventually began rotator cuff exercises and stretches again. Within a month, my strength was back to normal, although I do feel a little impingement pain if I reach for something high (like that far-off jug). I took another month off because I was busy.

In July, just a week ago, I spent three days climbing hard. By the third day, I was starting to get the old pain again. This did not seem to be in any way related to the rotator cuff tear. The pain was very minor, so after a day off I decided to climb at the gym. I did a little warm-up, stretched out well, then continued to climb. By the end of a long session, the pain had come and gone, but never stuck around. The next day, I went out to the crag again, did one physical climb, and the pain started to come back. We rapped, ropes got stuck, and I had to prussik back up to get them. After this, my arm was in agony.

This puts me at the present. The same pain, the same location. It only happens after several days of climbing hard. I am not a particularly flexible person, and I definitely have very tight lats and scapula, which feel very good but sore to massage. It also feels good but sore to dig deep into my bicep and armpit to massage the tight cords (tendons?) that feel like they are at the root of the problem. When I do this, it almost feels like I am hitting a nerve, as I can feel a sensation running all the way to my fingertips.

What is causing the pain?
What can I do make it go away?
Should I stretch more often?
Should I get massages more often?
Should I start a back exercise routine?
Should I stop the shockwave therapy?

It has been a year of injury, and I'm just ready to figure out what I can do to heal myself.

Thanks for reading this epic long post.


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By Nate Ball
Administrator
From Taipei, TW
Jul 18, 2013
Some route at Smith Rock

Don't mind the purple bruising. That's just from my masseuse. I'm trying everything.

Area of pain
Area of pain


Depicting the area of pain on the inside of my arm: in the armpit, where the bicep joins the lat; the small band of muscle (Coracobrachialis?) between the bicep and tricep, all the way to the elbow.


Area of pain 2
Area of pain 2

Depicting the area of pain on the outside of my arm: mostly only at the top of the forearm (lateral epicondyle); the area in blue is where the rotator cuff tear is (supraspinatus), which seems unrelated to this problem


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By jeff lebowski
Jul 18, 2013

Which specific tendons show Ca deposits on x-ray? I think this may be the key to your problems. If you're not sure have the Dr. send you a copy of the x-ray report. It's all very interesting. Edit: sorry, I meant ultrasound. report.


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By SDY
Jul 18, 2013

Yes, I think the supraspinatus tear was likely an unrelated incident. A few questions, can you describe the pain a bit more? I saw throbbing pain. You also describe a shooting sensation down to your fingertips. Can you tell me what fingers? Or where on the hand or arm? This is very important. If you are indeed pinching a nerve it could be sensory only, in which case you need to map where you feel numbness/tingling/burning to figure out which nerve you are affecting. It could also be mixed motor and sensory nerve, in which case you'd have some sensory symptoms and likely some weakness in muscles during these episodes. Unfortunately there are a lot of nerves running in the area you are describing, and the pain is high enough that it could be a brachial plexus problem. Starting with figuring out those symptoms will probably be best. Based on your symptoms and how quickly the pain disappears after climbing (tendonitis, torn muscle etc, I would expect to be very painful with movements of daily life), I am guessing you have a nerve problem. Of course, its pretty hard to tell from internet posts. If you make it to the States some time I suggest seeing a sports medicine doc, they will take it seriously and figure it out.


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By Nate Ball
Administrator
From Taipei, TW
Jul 18, 2013
Some route at Smith Rock

Calcification was initially found in my shoulder (deltoid) and upper forearm (lateral epicondyle), as that was where I was complaining of pain. But it always hurt in between, in a line from my elbow to my shoulder through the Coracobrachialis. Now, on the most recent ultrasound, they also found calcification in the Coracobrachialis and the rotator cuff. This is where the pain is now localized, for the most part.

When I massage the Coracobrachialis head in my armpit, I am definitely hitting some nerves, and that's the sensation I'm feeling. I do not have this sensation when it starts to hurt. As I massage it now, I can't reproduce the sensation of the tingle down my arm. It mostly happens after it's started to hurt or when the doc is doing the ECSWT (shockwave treatment).

Hopefully this information clarifies some things. Thank you very much for your posts.


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By jeff lebowski
Jul 18, 2013

I agree it sounds like a peripheral nerve injury. Brachial plexus traction injury (stinger) perhaps involving the lateral cord (musculocutaneus nerve). Is your brachialis involved? If I were in your shoes my next course of action would be an EMG test, especially of the coricobrachialis.

Don't know what to make of the Ca deposits in so many muscles. Also don't know anything about your shockwave therapy. Have you tried acupuncture? There is some evidence that it is helpful for partially denervated muscle. Might need to find an experienced acupuncturist to hit the coricobrachialis though. Also, the various nerve glides exercises are often helpful. Can you visit a physical therapist where you live? If not then perhaps YouTube median/radial/ulnar nerve glides and start slow. Good luck & keep us up to date with your progress.


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By Abram Herman
From Golden, CO
Jul 18, 2013
Viking helmet cover, yep.

Nate Ball wrote:
Don't mind the purple bruising. That's just from my masseuse.


I work in the massage industry (in social media, not as a practitioner). You shouldn't be getting bruising like that from any normal massage, so that picture is a little concerning. Also, "masseuse" is often a euphemism for a sex worker; legit therapists usually prefer the gender-neutral term "massage therapist".

My first suggestion though was going to be to talk to a massage therapist, as I've had a lot of success with my various aches, pains and injuries from climbing through massage work. Maybe look for someone with a focus on Neuromuscular Therapy—I've found that technique to be a particularly effective treatment for the weird referring pains you get from soft tissue problems.


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