Unexplained Arm Pain: Seeking Answers for Persistent Symptoms - Neurology

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Unexplained arm pain can be a frustrating and debilitating condition, especially when it persists despite various treatments. Based on your description, it seems that you've already consulted multiple specialists, including orthopedic, pain management, rehabilitation, and neurology, without finding a definitive diagnosis or effective treatment.
The symptoms you describe—sharp pain during specific movements, particularly when washing your left armpit with your right hand—suggest that there may be an underlying issue related to nerve compression, muscle strain, or even a referred pain from another area. The fact that the pain is exacerbated by certain movements but not others can provide clues to the underlying cause.


Possible Causes of Your Symptoms
1. Nerve Compression or Entrapment: Conditions such as thoracic outlet syndrome or cervical radiculopathy can cause pain that radiates down the arm. These conditions often result in pain that is aggravated by specific movements or positions.

2. Muscle Strain or Overuse: If you've engaged in activities that require repetitive motion or heavy lifting, you may have strained a muscle or tendon in your shoulder or arm.

3. Referred Pain: Sometimes, pain in the arm can be referred from the neck or upper back due to issues like cervical spondylosis or herniated discs.
4. Complex Regional Pain Syndrome (CRPS): If the pain is disproportionate to the initial injury or if there are changes in skin color, temperature, or swelling, CRPS could be a consideration.


Recommendations for Further Evaluation
Given that you've already seen multiple specialists, it may be beneficial to pursue a more comprehensive evaluation. Here are some steps you can take:
1. Consult a Pain Specialist: Since you've already seen a pain management physician, consider asking for a referral to a specialist who focuses on chronic pain conditions. They may offer advanced treatments such as nerve blocks or spinal cord stimulation.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the shoulder and improve mobility. A physical therapist can also provide modalities like ultrasound or electrical stimulation that may help alleviate pain.

3. Imaging Studies: If not already done, consider asking for advanced imaging studies such as an MRI of the cervical spine or shoulder to rule out any structural issues that may not have been visible on X-rays.

4. Neuromuscular Evaluation: A consultation with a neurologist specializing in neuromuscular disorders may be warranted. They can perform tests such as electromyography (EMG) and nerve conduction studies to assess for any nerve damage or dysfunction.

5. Multidisciplinary Approach: Sometimes, a multidisciplinary approach involving a team of specialists (orthopedic, neurologist, pain management, and physical therapy) can provide a more holistic view of your condition and lead to better outcomes.


Conclusion
Persistent unexplained arm pain can be challenging to diagnose and treat. It is crucial to continue advocating for your health and seeking answers. Keep a detailed record of your symptoms, treatments tried, and their effects, as this information can be invaluable to your healthcare providers. Don't hesitate to seek a second opinion or ask for referrals to specialists who may have more experience with complex pain conditions. Remember, effective treatment often requires patience and persistence, and you deserve to find relief from your pain.