Shoulder Pain, Numbness, and Dizziness: A Neurology Perspective

Shoulder pain, facial numbness, and dizziness?

Sometimes I feel dizzy, but the surrounding objects do not spin.
Occasionally, I experience slight pressure at the back of my head, and my left arm, from the upper arm to the ring and little fingers, sometimes feels a bit numb, although my grip strength is normal, except for certain angles that cause more pain.
If the aforementioned symptoms become slightly more severe, my psychological stress increases sharply, and I may experience full-body trembling, palpitations, and fever (which is confirmed to be a fever).
These symptoms have not occurred for six months, but half a month ago, I woke up with abnormal pain in my upper trapezius muscle.
However, I can freely move my head and arms.
The next day, all the previously mentioned conditions recurred, and on the third day, I experienced additional shoulder pain that felt like electric shocks.
My left cheek felt slightly numb (limited to the jaw area).

Self-assessment:
1.
I can read normally (vocalizing).

2.
My facial features are not asymmetrical.

3.
I can drink water normally.

4.
My responses are normal.

5.
I can type normally.

My medical history: Three years ago, I underwent a carotid ultrasound in the neurology department due to dizziness and spinning sensations, which revealed a narrowing of about 25% in one area of the intracranial vessels.
Since I have a history of cardiology issues and regularly take aspirin, the neurologist advised me to continue my medication without concern and prescribed Cerebrolysin and Dexamethasone.
After several follow-up visits, I have already stopped taking the neurologist's medications as advised.

Lifestyle: I work night shifts and spend long hours sitting at the computer.
The conditions described in the first paragraph are particularly concerning to me, but the more I worry, the worse the symptoms seem to get.
I have even wondered if I might have panic disorder! I would like to ask Dr.
Jiang if there are any other forms of assistance I can pursue.
Thank you.

Lao Zhang, 50~59 year old female. Ask Date: 2018/09/12

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it may be necessary to consider degenerative changes in the cervical and thoracic spine causing compression of the nerve root at the first thoracic vertebra.
This is primarily due to prolonged poor posture with the head bent forward, leading to cervical curvature, narrowing, and deformation.
The intervertebral disc may compress the nerve root, resulting in symptoms of numbness, tingling, and weakness in the upper arm and the tip of the little finger.
As for the facial numbness you mentioned, it may be necessary to rule out compression of the nerve at the third cervical vertebra.
It is recommended to supplement with B vitamins to assist in nerve repair.
I suggest you consult with a rehabilitation specialist or a neurologist/neurosurgeon to discuss examination and treatment options.
Wishing you good health and peace.
Dr.
Jiang from the Department of Neurology cares about you.

Reply Date: 2018/09/12

More Info

Understanding shoulder pain, numbness, and dizziness from a neurology perspective involves considering various potential causes and their interconnections. Your symptoms, including occasional dizziness without the sensation of the environment spinning, numbness in the left arm, and episodes of increased psychological stress, suggest a complex interplay of neurological and possibly musculoskeletal issues.

Potential Causes of Your Symptoms
1. Cervical Spine Issues: Given your history of dizziness and the recent onset of shoulder pain, it’s possible that cervical spine problems, such as herniated discs or cervical spondylosis, could be contributing to your symptoms. These conditions can lead to nerve compression, resulting in pain, numbness, and even dizziness due to disrupted blood flow or nerve signals.

2. Nerve Compression: The numbness in your left arm, particularly in the forearm and fingers, could indicate ulnar nerve compression, possibly at the elbow (cubital tunnel syndrome) or at the wrist (Guyon's canal syndrome). This compression can lead to tingling and weakness in the hand, especially when the arm is in certain positions.

3. Shoulder Pathology: Conditions such as rotator cuff injuries or shoulder impingement can cause referred pain and discomfort that may radiate down the arm. The sensation of "electric shock" in the shoulder could be indicative of nerve irritation or inflammation.

4. Psychological Factors: Your mention of increased anxiety and panic-like symptoms suggests that psychological factors may also play a role. Anxiety can exacerbate physical symptoms, leading to a cycle of increased tension and discomfort. The body’s stress response can manifest as muscle tension, which may contribute to your shoulder pain and overall discomfort.

5. Circulatory Issues: Given your history of cardiovascular problems and the narrowing of a cerebral artery, it’s essential to consider vascular issues. While your neurologist has advised you to continue your aspirin regimen, any new or worsening symptoms should be evaluated to rule out any significant vascular concerns.

Recommendations for Management
1. Neurological Evaluation: Since you have a history of neurological symptoms, a thorough evaluation by a neurologist is crucial. This may include imaging studies such as an MRI of the cervical spine to assess for any structural issues that could be causing your symptoms.

2. Physical Therapy: Engaging in physical therapy can help address musculoskeletal issues. A physical therapist can provide exercises to strengthen the shoulder and neck muscles, improve posture, and alleviate nerve compression.

3. Stress Management: Since anxiety seems to exacerbate your symptoms, consider incorporating stress management techniques such as mindfulness, meditation, or cognitive-behavioral therapy (CBT). These approaches can help reduce anxiety and improve your overall well-being.

4. Regular Monitoring: Keep regular follow-up appointments with your healthcare providers to monitor your symptoms and adjust your treatment plan as necessary. If your symptoms worsen or new symptoms arise, seek immediate medical attention.

5. Lifestyle Modifications: Given your work environment (long hours at a computer), ensure that your workspace is ergonomically designed to minimize strain on your neck and shoulders. Take regular breaks to stretch and move around.

Conclusion
Your symptoms are multifaceted and may stem from a combination of neurological, musculoskeletal, and psychological factors. A comprehensive approach involving medical evaluation, physical therapy, and stress management will be essential in addressing your concerns. It’s important to communicate openly with your healthcare providers about your symptoms and any changes you experience. This collaborative approach will help ensure that you receive the most effective care tailored to your needs.

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