To be clear I am not asking ofr a medical diagnosis

A few years ago after a long day of work my arm felt tired and weird with no pain and when I was asleep that night I had a horrific stab of pain in my lateral deltoid area followed by intense pain down my arm for the whole week. After the intense pain subsided my Dr said it was a grade 2 bicep strain near my ac joint. During this time I had pain with external rotation with strong pain up my neck . The severe pain was gone but my arm just kept getting really tired to exhaustion fast but not really any pain. After about 4ish weeks my trap and other muscles slowly started to spasm and compensate and I developed SLAP and a winged shoulder. I have been trying to piece together what might of happened to me as I am still struggling to work and live day to day due to my limitation. Below is what I have gathered to try to paint my picture as I believe I was misdiagnosed and would love to hear the thoughts of others professional that might understand a potential nerve related injury more. Thanks to all

A. Original injury mechanism

·        Patient was pushing a cart quickly down aisles while holding a scanner in the right hand.

·        Patient repeatedly reached high for containers/boxes, often half-jumping or straining upward.

·        Left foot was planted; right foot often was not planted due to the reach/strain position.

·        Many containers were too heavy to come down with a normal pull. When the first jerk did not move them, patient threw the whole body backward, whipping the body to pull the item down toward herself.

·        This happened repeatedly throughout the day, especially during an intense day of extra-hard work.

·        No clear pop, tear, or single sudden “oh no” moment was noticed.

B. Same day, night, and first week

·        Near the end of the day or after finishing, the whole left arm felt like “TV static,” tired, and weak. It did not initially hurt, so patient assumed it was fatigue.

·        Later that night the arm still felt tingling/static-like and tired/weak.

·        Patient went to bed and woke from a dead sleep with horrible 9/10 pain on the outside of the left upper arm, about one-third down the humerus.

·        After that, the whole left arm burned “like fire” for about a week, especially when sitting.

·        After about a week the worst initial fire pain started to calm down, but patient still made and kept a doctor appointment because the initial pain was severe.

·        First doctor appointment occurred about two weeks after the incident.

C. First doctor visit and early shoulder diagnosis

·        At the first visit, patient explained reaching/grabbing/pulling high items at work.

·        Doctor tested arm strength and noted left arm weakness, especially with resisted pressure testing.

·        At that first visit, patient did not have neck pain and does not remember major trouble lifting the arm forward/overhead or behind the back yet.

·        Pain was mainly provoked when resisting pressure, with some shoulder/arm pain.

·        Doctor diagnosed a grade 2 long-head biceps strain based on physical exam only, before imaging.

·        When describing the suspected injury, doctor pointed near the top/outside end of the collarbone near the AC joint and later described it as “torn near the AC joint.” This wording is anatomically unclear and should be treated as the doctor’s explanation, not imaging proof.

D. PT and early neck/scapular nerve-type reactions

·        Doctor sent patient to PT.

·        External rotation was very difficult. Patient had to perform isometric external rotation rather than normal resisted movement.

·        During external rotation/isometric external rotation, burning would occur up the back of the neck; later the neck would ache badly.

·        Triceps/back-of-arm nerve-zap pain occurred especially with rows or scapular retraction/pulling shoulder blades together.

·        Neck symptoms were first clearly noticed during external rotation exercises, then became gradually more obvious outside PT.

·        Car rides, shaking, jostling, or someone shaking patient could trigger similar pain, but patient initially assumed this was a torn/strained shoulder muscle being shaken.

E. Return to work, fatigue, and pressure intolerance

·        After the first doctor appointment, when patient returned to work, the arm generally did not hurt much while using it, but it got tired very fast.

·        Around five weeks after the incident, patient noticed the work carry-pack/vest caused pain in the shoulder/neck region.

·        The first noticeable clue was that reducing weight on the top of the shoulder gave relief.

·        Vest/hoodie/bra/top-shoulder pressure caused immediate discomfort. The longer the pressure stayed, the worse symptoms became.

·        Pain pattern with shoulder pressure included front shoulder/collarbone/biceps line, down the inner border of shoulder blade, and possibly a neck/shoulder-to-arm line.

·        Removing weight gave almost immediate partial relief, but if symptoms had built up, they could linger for hours.

·        Tolerance for pressure on top of shoulder decreased until patient could not wear the work vest and avoided hoodies or anything adding weight to the top shoulder/bra-strap region.

F. Shipping-station hand/cold/swelling phase

·        At the shipping station, triggering tasks included pulling labels/stickers off backing, squeezing boxes closed, taping boxes, and lifting/picking up items with the left arm.

·        Pain would travel in a line from neck/trap down toward collarbone and from collarbone/front shoulder into the biceps/upper arm; arm would ache.

·        Usually shoulder/front shoulder/biceps pain increased first; hand/forearm tingling/coldness followed; later grip weakness became more obvious.

·        Hand could become ice cold and tingling. Pinky became visibly swollen, and forearm may have been slightly swollen.

·        Symptoms could be felt within minutes of working and could become work-limiting within a few hours. They often stayed irritated for most of the night and then settled with rest.

G. Weakness, deltoid contour, external rotation, and behind-back motion

·        Before the shoulder MRI/arthrogram, while the arm was getting weaker, patient noticed the rounded outside deltoid/shoulder-cap area looked smaller/flatter, almost with a groove.

·        Overhead arm motion initially did not hurt, but the arm felt heavy/exhausted and could not stay up for hair washing/brushing. It felt like the arm had already been worked out to exhaustion and would give out.

·        External rotation was painful with any resistance and felt blocked/stuck/hard-stopped when tried; very light effort could provoke symptoms.

·        Reaching behind the back became physically impossible, making coat use hard.

·        At one point, the left hand was too weak to open a can with a can opener. Pulling/stretching the neck to the right, bringing the right ear toward the right shoulder and cracking the left side of the neck, improved hand strength immediately within seconds; benefit lasted a while/hours at most.

H. Shoulder-to-ear jerk and stinger setback

·        During a slow improvement phase, while tugging tight pants, patient accidentally jerked the left shoulder upward toward the ear.

·        After that, weakness returned/worsened.

·        Patient had a nerve-like “stinger” / two-prong sensation most prominent down the front of the shoulder and down the inside/inner-border area of the shoulder blade.

I. Neck support and guarding

·        When symptoms were bad, patient began supporting the bottom/base of the neck with the left hand when bending over or getting up.

·        This mainly reduced arm weakness, and also reduced shoulder-blade pain, hand nerve sensations, zapping/tingling/numbness, and flare risk.

·        Patient described the back of the neck as feeling like it was being “stitched back together” when supported.

·        Over time the back of the neck felt extremely tight, “like a brick.”

·        A later muscle relaxer felt good at first, but within one to a few hours it seemed to relax the guarding too much and brought back thumb/index zaps, upper-arm numbness, unsupported neck feeling, and shoulder-blade burning.

·        Patient suspects the guarding knot/tightness may have acted as a crude brace - not healthy long-term, but protective/stabilizing.

 

3. Imaging, Tests, and Provider Notes

A. Shoulder MRI - 03/10/2023

·        Regular left shoulder MRI showed supraspinatus tendon thickening/tendinosis without discrete tear.

·        Subscapularis tendon thickening/tendinosis without discrete tear.

·        Infraspinatus and teres minor intact.

·        Biceps tendon intact, including intracapsular component.

·        AC joint intact, no significant inferior spurring.

·        No bone contusion, osteochondral defect, soft-tissue mass, or abnormal fluid collection.

·        Labral evaluation was limited because it was not an arthrogram; questionable anterior-superior labral signal was noted.

B. MR/CT Arthrogram - 03/22/2023

·        No fracture or shoulder dislocation.

·        No contrast tracking into labrum.

·        Long head of biceps tendon in bicipital groove; intra-articular course uncomplicated.

·        SLAP lesion not identified.

·        Anterior and posterior labral tissue aligned appropriately; no perilabral ganglion; no labral displacement.

·        Supraspinatus, infraspinatus, and teres minor muscles/tendons intact.

·        PD hyperintense signal in subscapularis tendon near lesser tuberosity insertion.

·        AC joint unremarkable.

·        Impression: findings suggestive of subscapularis insertional tendinopathy.

·        Report age line appears to contain a typo (Age/Sex listed as 21Y/F).

Shoulder-imaging interpretation to preserve • A suspected SLAP injury was exam-based and was not supported by MRI arthrogram. • Imaging did not show a confirmed labral tear, SLAP tear, biceps tendon tear, AC joint injury, or rotator cuff tear. • The main confirmed shoulder finding was subscapularis insertional tendinopathy, with earlier supraspinatus/subscapularis tendinosis/thickening.

 

C. EMG/NCS - 04/12/2023 available summary

·        Available uploaded document is a visit summary, not the complete electrodiagnostic tables/report.

·        It lists reason for visit as LUE EMG NCV and diagnosis/problem as paresthesia.

·        Assessment summary states: normal study; no left CTS; no ulnar neuropathy at left elbow; no cervical radiculopathy/brachial plexopathy left upper limb; no generalized neuropathy or myopathy.

·        Recommendation states no clear peripheral nerve injury in the left upper limb, but “referral from the cervical spine still a possibility.”

·        Patient remembers no needle portion, only a hard nub/probe device, raising concern that the available summary may reflect a limited or at least undocumented study. The summary lacks nerve tables, waveforms, muscle list, and confirmation of cervical paraspinals/root-matched needle EMG sampling.

Action item: prior EMG/NCS documentation • Request the complete electrodiagnostic report, not just the visit summary. • Ask for nerve conduction tables, needle EMG muscle list, muscles tested, findings, and final impression. • Clarify whether cervical paraspinals and root-matched limb muscles were sampled, or whether this was mainly a peripheral nerve screen.

 

D. Medication response

·        Diclofenac and another NSAID did not meaningfully help the pain pattern.

·        Prednisone/steroids repeatedly made overall pain much better; patient could move around with far less pain.

·        Even when prednisone improved overall pain, some pain persisted as a line from collarbone toward chest.

·        Hydroxyzine seemed to help when patient happened to have some.

E. Spine doctor visit ( Recent)

·        Reason for visit: neck pain, arm pain.

·        HPI recorded neck pain going down left inferior shoulder blade/posterior arm, with tingling in left small, middle, and ring fingers.

·        HPI recorded jostling/bumping can produce right leg pain and medial left big-toe/medial calf pain to knee.

·        Original injury history was recorded: working fast/running down aisles, reaching/straining with left arm, leaving work with whole left arm numb/no pain, then waking with excruciating left deltoid burning and a week of whole-arm fire pain.

·        Exam documented left deltoid weakness 4/5; other upper/lower extremity strength largely 5/5.

·        Positive left Spurling’s with some tingling into posterior left arm.

·        Decreased sensation to left small finger.

·        Some difficulty with rapid grip and release on the left.

·        Gait/tandem/Romberg/reflexes/Hoffmann/clonus/Babinski/Lhermitte were documented as normal/negative.

·        Cervical flexion/extension limited with pain.

·        Plain cervical/scoliosis X-rays: mild spondylosis with mild upper thoracic coronal asymmetry.

·        Plan: MRI C-spine due to failed PT and weakness of left arm; if no surgical pathology, consider neurology referral; defer work restrictions to PCP, consider FCE.

Record/source note: This section is based on the uploaded OSU spine progress note dated 03/10/2026.

F. Cervical MRI / neurology interpretation

·        Cervical MRI reportedly said no significant findings / no structural explanation.

·        Neurologist did not review images/report in detail with patient at the visit.

·        Neurologist recommended repeat EMG/NCS.

·        Neurologist pushed rotator cuff/shoulder/tension explanation, while also saying something may have been missed, possibly brachial plexus.

·        Neurologist said MRI “should have shown something,” which patient found frustrating because symptoms feel positional/dynamic.

·        Primary care separately said X-ray showed mild arthritis/degenerative change/spondylosis, possibly around C5-C6.

 

4. Current Symptom Map and Behavior

A. Patient-marked symptom map

Blue = numbness; red = nerve pain/zaps; green = pressure-intolerance area.

B. Current numbness / sensory symptoms

·        Main numbness: front upper arm/biceps area.

·        Also numb/altered sensation in outer/deltoid upper arm area.

·        Thumb pad is pretty numb; nail/back side of thumb is also numb.

·        Pinky nail/back side is numb; pinky previously had coldness/swelling/tingling episodes.

·        Some back upper arm/triceps-area numbness/altered feeling, less intense than front upper arm.

·        Left posterior neck numb patch, mid-to-upper back of neck on left only. Pinch/prick sensation is barely felt there. It has been present for a long time and stays about the same during flares.

·        Newer mild right-arm symptoms: right upper outer arm numbness and maybe mild right pinky numbness, usually after neck flares/carrying/sitting posture strain.

C. Current nerve pain / zaps / lines

·        Red nerve pain/zaps: left neck, collarbone/chest line, shoulder-blade line, upper arm/triceps, thumb/pinky spots.

·        Baseline/current shoulder-blade line: starts at base of neck/trap and runs down inner shoulder blade, almost to scapula tip. It usually begins as tingling, then escalates.

·        Bad flare “prong” pattern: front shoulder/collarbone/biceps line plus inner shoulder-blade line.

·        Looking down sequence: shoulder-blade line tingles, then arm numbness increases, then the line burns like fire or hot popcorn popping, then thumb/index zaps can start.

D. Current weakness / motor coordination

·        Left deltoid/upper-arm weakness is present at baseline and worsens with triggers.

·        Left strength improves when pain is controlled but does not feel fully normal either way.

·        Current active symptoms most relevant to repeat EMG/NCS: left deltoid/upper-arm weakness, left front upper-arm/biceps numbness, shoulder-blade line burning/tingling, and neck-position-triggered symptoms.

·        Left hand: no history of dropping objects, but baseline coordination impairment is present and worsens with flares/repeated use.

·        Fine-motor issues: rapid grip/release, smooth finger tapping/wave motion, drawing a clean spiral, fingers lagging/not staying rhythmic, and overall hand being less precise.

·        Patient is mixed-handed/nearly ambidextrous, so left-hand control loss is functionally meaningful.

·        Does not carry much in left hand mainly because the weight aggravates the neck.

E. Pressure intolerance

·        Top left shoulder/bra-strap region cannot tolerate pressure, including bra/vest/hoodie weight.

·        Shoulder pressure causes immediate discomfort and worsens over time; removal gives immediate partial relief but symptoms can linger.

·        Direct pressure around the neck/trap is very bad. Sudden jostle/movement and pressure around the neck/trap are worse than simple touch.

 

5. Triggers, Relievers, and Flare Behavior

A. Dominant current disability

·        Vibration/jostling intolerance is the most disabling problem by far.

·        Next worst: neck-position triggers, especially looking down, and carrying/load intolerance.

·        Pain/burning and numbness are still significant but less disabling than vibration/jostling, looking down, and carrying.

B. Jostling/vibration

·        Worst jostling movement: head/neck suddenly thrown toward the left.

·        Also bad: left shoulder hiked up toward ear, body jolts left while neck tries to stabilize, someone shaking patient, car bumps/vibration, floorboard vibration during current flare.

·        Current vibration reaction: whole left side guards/tightens and immediate neck spasm; closely followed by shoulder-blade line tingling/burning and top shoulder/trap ache; if worse, progresses to finger zaps/tingling and increased arm numbness.

·        Being shaken/bumped/hugged too hard: immediate neck spasm; top shoulder/trap ache; increased arm numbness/heaviness; shoulder-blade line tingling/burning almost always; bad jostle can produce finger zaps.

·        Small jostle/irritation can trigger symptoms for 30-60 minutes. Bad day/strong jolt can trigger a multi-day or longer flare.

·        Current flare is so sensitive that even floorboards from someone else walking can irritate symptoms.

C. Neck-position triggers

·        Looking down is the worst current trigger by far. Symptoms start within about one minute currently; with stronger guarding knot, patient tolerated a few minutes.

·        Looking down sequence: shoulder-blade line tingles → arm numbness increases → line burns like fire/hot popcorn popping → thumb/index zaps.

·        Turning neck left and side-bending left are also bad.

·        Chin tucks, even towel-supported, provoke intense nerve-like neck pain like squeezing a nerve and usually lead to migraine/back-of-head pressure. Providers have suggested towel support/keep trying, but it remains intolerable.

·        Unsupported/jostled neck movement is bad, especially shaking.

D. External rotation trigger

·        External rotation remains a massive trigger.

·        Position: elbow tucked at side, forearm rotating outward, especially band/resistance external rotation; isometrics can trigger it too.

·        Even barely pressing/very light isometric effort can trigger symptoms, especially if neck is already flared.

·        Reaction: upper trap tightens from neck to shoulder tip; pain travels up back of neck; inner shoulder-blade line can join; too much can trigger migraine.

·        It is not as sensitive as looking down but remains a major reliable trigger.

·        Stopping immediately, neck support, arm-on-head position, and THC/topicals/patch can reduce symptoms, but true flare settling mainly requires time.

E. Carrying/load intolerance

·        During current flare, almost anything over a few pounds can trigger symptoms.

·        At better baseline, patient may tolerate a grocery bag if held close to chest and posture is not crunched.

·        Worse when load hangs at side, is held away from body, or involves reaching forward. During flare, almost any carrying position may be bad.

·        Better with arm overhead/hand-on-head or close to chest if posture stays open; cross-body can hurt if patient crunches up.

·        Carrying with either arm can trigger left-sided symptoms: left base-of-neck/inner shoulder-blade line tingling down almost to scapula tip, then neck fire, sometimes original upper-arm zap area numbness.

·        Even carrying with the right arm can provoke the left base-of-neck/shoulder-blade line.

F. Relieving positions and strategies

·        Forearm across top of head with elbow out to the side is most relieving. Simple hand-on-head helps somewhat. Hand behind head and elbow-forward positions help much less.

·        Arm-on-head/overhead position improves arm numbness/heaviness, shoulder-blade line tingling/burning, front shoulder/collarbone/biceps-line symptoms, and whole-left-side tension.

·        At height of pain, patient would sit with pillow behind back and left arm above head and accidentally fall asleep because the position relieved symptoms enough.

·        Neck support with left hand at base/bottom of neck while bending/getting up reduced arm weakness and nerve symptoms.

·        THC/topicals/patches can reduce pain/tingling but do not fully eliminate persistent numbness.

G. Flare duration

·        Small flare usually settles by that night or within about one day.

·        Major flare can last much longer. Current major flare after returning to nonstop Prime shopping has lasted about one month to one and a half months and is only slowly simmering down.

·        True flare resolution mainly requires time, even when unloading strategies reduce symptoms.

 

6. Functional Impact

A. Work / Prime shopping

·        Current major flare began after returning to nonstop Prime shopping. Before that, work was more split between trainer duties and part-time paperwork/admin tasks, which was more tolerable.

·        Aggravators in Prime shopping: looking down at phone/scanner, pushing/pulling cart, lifting bags/items, fast pace/no rest breaks.

·        Most consistent feature through the injury: inability to tolerate jostling.

B. Car rides

·        Car rides are one of the top three life impacts of jostling intolerance.

·        Worst part is anything that makes neck bounce, especially toward the left. Bumps/potholes are also bad.

·        Helpful car positions/strategies: sitting very upright, using hand to support neck, leaning neck slightly right, arm overhead/hand-on-head, and driving self rather than being a passenger.

·        Driving self is better likely because patient can control speed, braking, and turning; passenger seat/headrest is worse; patient can brake/slow more protectively. It is not because holding the wheel stabilizes upper body - patient cannot drive with left hand now because it hurts too much.

C. Sleep

·        Patient often must sleep alone on couch due to movement transfer/vibration from another person.

·        Sleeping next to someone triggers symptoms mainly because the other person rolling/moving jostles patient and movement transfers through the bed/couch into body/neck. It also makes it harder to keep the right-supported neck position.

·        Best sleep position: stomach sleeping with head turned right, very thin firm pillow, neck leaning toward the right. This lessens everything.

·        Worst sleep triggers: pillow too soft/high, head turned left, lying flat on back, straight/unsupported neck. Bad pillow triggers shoulder-blade line tingling/burning and whole-left-side guarding; if maintained, it may progress to back-of-head pressure/migraine.

 

7. Leg / Bladder Symptoms to Preserve

·        Patient dislikes bringing up leg/bladder symptoms because they have been dismissed, but they are part of the history.

·        At the height of disability, while driving, left leg would jerk, including a sensation like the big toe jerking.

·        Patient also had urge incontinence during that worst phase.

·        As patient began supporting neck and overall condition improved, leg shaking/tingling reduced less and less.

·        During current flare, leg/bladder symptoms may be slightly back but not nearly as bad as during the worst phase.

·        Leg symptoms can be felt again when turning neck and looking down.

 

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