Solve the Medical Riddle: Her Left Shoulder and Arm Are Painful and Her Fingers Tingle, Third Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported her symptoms to a doctor who referred Diane to a physiatrist, a specialist in non-surgical physical medicine and rehabilitation. The second week, the physiatrist proceeded with the examination using the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the specialist will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“The doctor and the specialist didn’t mention whether or not Diane has thyroid disease. I was diagnosed with hypothyroidism that contributed to a condition called median neuropathy that impinged on my nerves and caused symptoms a lot like what Diane describes.”

— Lillian K.

“Maybe Diane has bursitis. About a year ago, I started having pain in my upper right arm that turned out to be bursitis. I was aware that bursitis meant ‘inflammation of the bursa sac’ but I thought those fluid-filled sacs were only at our joints. My doctor told me that there are bursa sacs under muscles to facilitate gliding of the nerves. Who knew? Interesting! My bursitis was under the part of the dorsal muscle in the arm. As far as we could tell, I got it from repetitive stress. I’m an avocational violinist and I bow with my right arm. Rest is what finally cured me.”

— Katie R.

“Does Diane have a long neck? My sister, who is now in her late 50s, was a ballerina and she has that typical ballerina long neck. When she was 52, she got something called age-related cervical spondylosis, which means an arthritic neck that can cause nerve encroachment and arm pain. Diane’s X-ray did show some arthritis of the neck, so maybe that’s the problem.”

— Suzanne J.

“I hope I’m wrong, but maybe Diane has cancer. I have a friend who had spinal metastases – bone cancer in her vertebra.”

— Georgia M.

“I was going to say carpal tunnel because she types a lot but that’s usually affects just the wrist and hand, I believe. She does have tingling in her fingers, though, so may she has carpal tunnel and also some repetitive stress all the way up her arm from playing tennis, especially if she hits the ball overhand.”

— Maureen D.

“Don’t laugh, but Diane might have Saturday Night Palsy. Seriously, that’s what people sometimes call radial nerve compression in the arm that can happen because of direct pressure against something firm. For example, you might fall asleep on your arm or fall asleep with your arm hanging over the arm of a chair. The popular term comes from the fact that people typically get drunk on Saturday night! The reason I know this is that my friend’s son got drunk at a college frat party and passed out in a chair. He woke up with the nerve compression. His friends Googled and found the colloquial term for it! They thought it was hilarious. But I’m not saying Diane was necessarily drunk. Anybody could sleep on an arm the wrong way and wake up with pain, I would assume.”

— Mary Jo T

Come back to ThirdAge.com next Thursday when the physiatrist will reveal the actual diagnosis and treatment plan.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.