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Thread: Sudden muscle use loss?

  1. #1

    Sudden muscle use loss?

    I'm a C5 incomplete 30 year post. I've been weakening slowly over the past 7 years from being able to walk with crutches to not being able to stand now. A couple of days ago I completely lost the use of the muscle that pulls your elbow in to your side. This make doing a number of things quite hard. What could cause this? I suspect a syrinx. I had an MRI and CT scan done fairly recently which showed nothing, but I have a wire on my C5 vert. whch messes up the image. What gives? What next? The suddeness of this really has me worried.

    Thanks
    brian
    Who are these time beings? And, why are we always doing things for them?

    If it wasn't for C, we'd be using BASI, PASAL and OBOL.

  2. #2
    Hi,

    This must have you really worried. A syrinx is one possibility but is usually seen on a CT. If the imaging did not get adequate visualization, perhaps a myelogram could be ordered. I would definitely see your neurologist with any sudden change in function such as what you've described.

    AAD

  3. #3
    Quote Originally Posted by slowtuna
    I'm a C5 incomplete 30 year post. I've been weakening slowly over the past 7 years from being able to walk with crutches to not being able to stand now. A couple of days ago I completely lost the use of the muscle that pulls your elbow in to your side. This make doing a number of things quite hard. What could cause this? I suspect a syrinx. I had an MRI and CT scan done fairly recently which showed nothing, but I have a wire on my C5 vert. whch messes up the image. What gives? What next? The suddeness of this really has me worried.

    Thanks
    brian
    Brian,

    The loss of shoulder adduction is very likely to be related to a peripheral nerve injury. Are you using a manual wheelchair? You should get an EMG to make see if there is a change in the peripheral nerve to the pectoral muscle.

    Regarding the slow loss of neurological function over 7 years, there have been numerous anecdotal reports of people with long-time spinal cord injuries who have lost function as they aged. The pattern of these changes seem to be more consistent with aging-related losses rather than a more rapid process such as the post-polio syndrome.

    I did a literature survey to see if there are any recent studies reported late neurological loss in spinal cord injury. Here are abstracts of several papers that I found.

    • Amsters DI, Pershouse KJ, Price GL and Kendall MB (2005). Long duration spinal cord injury: perceptions of functional change over time. Disabil Rehabil 27: 489-97. PURPOSE: To investigate perceptions of functional change over time held by individuals with long duration spinal cord injury (SCI) living in Queensland, Australia. METHOD: A retrospective telephone questionnaire was administered to 84 individuals who had sustained a SCI more than 20 years previously and were older than 15 at the time of injury. Motor subset scores of the Functional Independence Measure (FIM) and a single scale measuring mobility aids status (MAIDS), were collected for three points in time--post discharge from initial rehabilitation (D/C point); approximately 10 years post injury (Mid point) and currently (Current point). RESULTS: A significant number of participants perceived that their function had increased between the D/C and Mid points and had subsequently decreased between the Mid and Current points. Participants also reported an increasing dependence on mobility aids between the Mid point and the Current point. Those who reported functional decline between the Mid and Current points were significantly older than those who did not report functional decline but did not differ in duration of injury or age at onset. CONCLUSIONS: The results support the need for services that provide assessment and intervention for functional changes throughout the life span of people with SCI. Spinal Outreach Team, Princess Alexandra Hospital, Brisbane, Australia. delena_amsters@health.qld.gov.au http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16040553
    • Krause JS and Broderick L (2005). A 25-year longitudinal study of the natural course of aging after spinal cord injury. Spinal Cord 43: 349-56. STUDY DESIGN: Longitudinal; Survey. OBJECTIVE: The purpose of this study was to investigate the natural course of changes in activity patterns, health indicators, life satisfaction, and adjustment over 25-year period among people with spinal cord injury (SCI) in the USA. SETTING: The preliminary data were collected from a Midwestern United States university hospital of the USA, whereas the follow-up data were collected at a large Southeastern United States rehabilitation hospital. METHOD: The Life Situation Questionnaire was used to identify changes in education/employment, activities, medical treatments, adjustment, and life satisfaction. RESULTS: Adjustment scores, satisfaction with employment, satisfaction with finances, years of education, and employment indicators significantly improved over time. In contrast, satisfaction with sex life, satisfaction with health, and then number of weekly visitors significantly decreased and the number of nonroutine medical visits and days hospitalized within 2 years prior to the study significantly increased over the 25-year period. CONCLUSION: Given the mixed pattern of favorable and unfavorable changes, the findings challenge the assumption that aging will inevitably be associated with the overall decline in outcomes and quality of life. Medical University of South Carolina, Charleston, SC, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15711611
    • Drake MJ, Cortina-Borja M, Savic G, Charlifue SW and Gardner BP (2005). Prospective evaluation of urological effects of aging in chronic spinal cord injury by method of bladder management. Neurourol Urodyn 24: 111-6. AIMS: Risk of treatment-related problems in spinal cord injury (SCI) mandates assessment of complication rates of different bladder management methods (BMMs). The current study evaluated aging-related complications of various BMMs over a 6-year period in a population with spinal cord injury for at least 20 years. MATERIALS AND METHODS: Clinical parameters were compared using a linear mixed effects model, controlling for various confounding variables, to establish complication trends with aging and their association with BMM. Results for people whose BMM was changed during the study were evaluated separately as well as in combination with the whole population. RESULTS: One hundred and ninety six people (mean age 57.4 and years post injury (YPI) 33) were evaluated on three occasions. Both age and YPI were significantly associated with rising complication rates regardless of BMM. The BMMs assessed differed in terms of complication rates. In comparison with balanced reflex voiding, straining was significantly better for renal structural abnormality. Intermittent catheterization was associated with significantly worse renal function, possibly for demographic reasons. Overall, 28.8% changed BMM during the study period, particularly, those using straining or balanced reflex voiding. The probability of change increased with age and YPI. Reasons for change of BMM were varied and there was no specific association between reason for change and BMM. CONCLUSIONS: Aging and duration of injury substantially influence urological complication rates, and BMM options differ in respect of prevalence and incidence of complications. At a late stage post injury there remains a high probability of change in BMM. The findings indicate the importance of long-term planning from the time of injury to minimize late complications. School of Surgical Sciences, University of Newcastle, United Kingdom. m.j.drake@ncl.ac.uk http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15605371
    • Capoor J and Stein AB (2005). Aging with spinal cord injury. Phys Med Rehabil Clin N Am 16: 129-61. The years after SCI may be associated with acceleration of the aging process because of diminished physiologic reserves and increased demands on functioning body systems. Clinicians with expertise in the treatment and prevention of SCI-specific secondary complications need to collaborate with gerontologists and primary care specialists and need to invest in the training of future physicians to ensure a continuum of accessible, cost-effective, and high-quality care that meets the changing needs of the SCI population. Managed care payers often do not adequately cover long-term disability needs to prevent secondary SCI-specific complications. In this era of increasing accountability, evidence-based clinical practice guidelines are needed to document scientific evidence and professional consensus to effectively diagnose, treat, and manage clinical conditions; to reduce unnecessary testing and procedures; and to improve patient outcomes. Longitudinal research is needed to minimize cohort effects that contribute to misinterpretation of cross-sectional findings as representative of long-term changes in health and functioning. However, longitudinal studies confound chronologic age, time since injury, and environmental change. Thus, time-sequential research, which controls for such confounding effects, is essential, as is research on the effects of gender,culture, and ethnicity. If we consider how much progress has been made over the past 50 years with respect to SCI mortality related to infectious disease, we can expect to achieve even greater progress against the effects of aging in the next 50 years. Recent developments in molecular biology regarding growth and neuro-trophic factors are bringing us closer to the goal of repairing the damaged spinal cord. The challenge remains for rehabilitation professionals to provide the most comprehensive and holistic approach to long-term follow-up, with an emphasis on health promotion and disease prevention, to postpone functional decline and enhance QOL. Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029, USA. jc1058@columbia.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15561548
    • Charlifue S, Lammertse DP and Adkins RH (2004). Aging with spinal cord injury: changes in selected health indices and life satisfaction. Arch Phys Med Rehabil 85: 1848-53. OBJECTIVES: To document the impact of age, age at injury, years postinjury, and injury severity on changes over time in selected physical and psychosocial outcomes of people aging with spinal cord injury (SCI), and to identify the best predictors of these outcomes. DESIGN: Retrospective cross-sectional and longitudinal examination of people with SCI. SETTING: Follow-up of people who received initial rehabilitation in a regional Model Spinal Cord Injury System. PARTICIPANTS: People who meet the inclusion criteria for the National Spinal Cord Injury Database were studied at 5, 10, 15, 20, and 25 years postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Number of pressure ulcers, number of times rehospitalized, number of days rehospitalized, perceived health status, satisfaction with life, and pain during the most recent follow-up year. RESULTS: The number of days rehospitalized and frequency of rehospitalizations decreased and the number of pressure ulcers increased as time passed. For the variables of pressure ulcers, poor perceived health, the perception of pain and lower life satisfaction, the best predictor of each outcome was the previous existence or poor rating of that same outcome. CONCLUSIONS: Common complications of SCI often herald the recurrence of those same complications at a later point in time, highlighting the importance of early intervention to prevent future health and psychosocial difficulties. Craig Hospital, Englewood, CO 80113, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15520980
    • Liem NR, McColl MA, King W and Smith KM (2004). Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living. Arch Phys Med Rehabil 85: 1567-77. OBJECTIVES: To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: General community, international. PARTICIPANTS: Volunteers (N=352) with SCI for more than 20 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The need for more help with ADLs. RESULTS: The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI. CONCLUSIONS: People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time. Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada. n_liem@tricolour.queensu.ca http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15468013
    • Imai K, Kadowaki T and Aizawa Y (2004). Standardized indices of mortality among persons with spinal cord injury: accelerated aging process. Ind Health 42: 213-8. We conducted this study to compare survival rates and morbidity of persons with spinal cord injury (SCI) versus general population, and to clarify the risk of SCI persons. The subjects of this study were 960 men with SCI who had been accommodated in the eight Labor Accident Rehabilitation Centers in Japan during the period of 1965-1995. The surveyed items were the year of birth, the year of injury, level of spinal cord injury and survival status. The classification of cause of death was taken from ICD-10. The cumulative survival rate by life table method was calculated. In order to compare the risks of each cause of death in SCI persons with general population, cause-specific standardized mortality ratio (SMR) was examined. The leading cause of death was malignant neoplasms at 28 persons, and SMR (general population=100) was 184, followed by the circulatory system disease, external cause (including suicide) and the genitourinary system disease. In the subgroups of malignant neoplasms, the SMR was 6,619 for cutaneous carcinomas and 1,482 for bladder carcinomas (p<0.01). Thus aging-related diseases which had close correlation with lifestyle and environment were the major cause of deaths in SCI persons. School of Health Sciences, Gunma University, 3-39-15 Showa-Machi, Maebashi, Gunma 371-8514, Japan. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15128171
    • McColl MA, Charlifue S, Glass C, Lawson N and Savic G (2004). Aging, gender, and spinal cord injury. Arch Phys Med Rehabil 85: 363-7. OBJECTIVE: To identify differences in the aging experiences of men and women with spinal cord injury (SCI). DESIGN: This study is part of a longitudinal international study of aging and SCI. SETTING: Five centers in England, Canada, and the United States. Three were spinal cord rehabilitation facilities (Stoke-Mandeville Hospital, Southport Hospital, Craig Hospital) and 2 were community agencies (Ontario and Manitoba divisions of the Canadian Paraplegic Association). PARTICIPANTS: A matched sample of 67 men and 67 women with SCI for at least 20 years. The 2 groups were matched on age, country of origin, and duration of disability. Participants had an average age of 57 years and an average disability duration of almost 33 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two measures were taken by interview: demographic form and current status interview. Five others were self-administered and returned by mail: the Perceived Stress Scale, Craig Handicap Assessment and Reporting Technique, Index of Psychological Well-Being, Current Problem Questionnaire, and Life Satisfaction Index. RESULTS: Although both sexes rated their quality of life about equally, women characterized their aging experience as "accelerated," while men characterized it as "complicated." Women reported more effects of pain, fatigue, and skin problems and more transportation problems. Men experienced more health problems, more diabetes, and more adaptive equipment changes. Older men and women with SCI spent their time differently, consistent with traditional gender roles. CONCLUSIONS: These results underline the need for gender-specific consideration of aging experiences associated with SCI and further emphasize the need for primary and preventive care to promote health and well-being as people with SCI survive into old age. Queen's University, Kingston, ON, Canada. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15031818
    • McColl MA, Arnold R, Charlifue S, Glass C, Savic G and Frankel H (2003). Aging, spinal cord injury, and quality of life: structural relationships. Arch Phys Med Rehabil 84: 1137-44. OBJECTIVE: To quantify relationships among 3 sets of factors: demographic factors, health and disability factors, and quality of life (QOL). DESIGN: Part of a program of longitudinal research on aging and spinal cord injury (SCI) involving 3 populations: American, British, and Canadian. The present analysis uses data from the 1999 interval. SETTING: The Canadian sample was derived from the member database of the Ontario and Manitoba divisions of the Canadian Paraplegic Association. The British sample was recruited from a national and a regional SCI center in England. The American sample was recruited through a hospital in Colorado. PARTICIPANTS: A sample of 352 participants was assembled from 4 large, well-established databases. The sample included individuals who had incurred an SCI at least 20 years earlier, were admitted to rehabilitation within 1 year of injury, and were between the ages of 15 and 55 at the time of injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A combination of self-completed questionnaires and interviews. Data included demographics, injury-related variables, health and disability-related factors, QOL, and perceptions about aging. RESULTS: Using linear structural relationships modeling, we found that QOL was affected both directly and indirectly by age, health and disability problems, and perceptions of aging. Two surprising findings were as follows: those who experienced fewer disability-related problems were more likely to report a qualitative disadvantage in aging, and the younger members of the sample were more likely to report fatigue. CONCLUSIONS: Fatigue is a concern because of the relationship of fatigue with perceived temporal disadvantage in aging, health problems, and disability problems. This finding highlights the need for clinical vigilance among those just beginning to experience the effects of aging. Queen's University, Kingston, ON, Canada. mccollm@post.queensu.ca http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12917851
    • McColl MA, Charlifue S, Glass C, Savic G and Meehan M (2002). International differences in ageing and spinal cord injury. Spinal Cord 40: 128-36. DESIGN: The present study is part of a programme of longitudinal research on ageing and spinal cord injury involving three populations - American, British and Canadian. The design was multivariate. OBJECTIVE: To identify international differences in outcomes associated with ageing and spinal cord injury. SETTING: A sample of 352 participants was assembled from five large, well-established databases. The Canadian sample was derived from the member database of the Canadian Paraplegic Association (Ontario and Manitoba divisions). The British sample was recruited from Southport Hospital's Northwest Regional Spinal Injuries Centre and Stoke-Mandeville Hospital's National Spinal Injuries Centre. The American sample has been recruited through Craig Hospital in Denver, Colorado. METHODS: The sample included individuals who had incurred a spinal cord injury at least 20 years previously; were admitted to rehabilitation within 1 year of injury; were between age 15 and 55 at the time of injury. Data were collected using a combination of self-completed questionnaires and interviews. Data included medical information, general health, hospitalisations, and changes in bladder and bowel management, equipment, pain, spasticity, the need for assistance, and other health issues. RESULTS: Clear international differences existed between the three samples in the three different countries. After controlling for sampling differences (ie, differences in age, level of lesion, duration of disability, etc.), the following differences were seen: (1) American participants had a better psychological profile and fewer health and disability-related problems; (2) British participants had less joint pain and less likelihood of perceiving they were ageing more quickly; (3) Canadians had more health and disability-related complications (particularly bowel, pain and fatigue problems). CONCLUSION: These differences are discussed in terms of socio-political, health care system and cultural factors that might be used to explain them, and to generate hypotheses for future research. Queen's University, School of Rehabilitation Therapy, Kingston, Canada. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11859439

  4. #4
    Thanks. I hope it's the peripheral nerve because that can recover. I don't know what would have caused the injury, though. I do use a manual chair but push very little around the house. I am obsessive about lifting, but that doesn't seem to strain anything much. My arm often falls asleep at night just resting along my side and across my chest. Could tat do it?

    brian
    Who are these time beings? And, why are we always doing things for them?

    If it wasn't for C, we'd be using BASI, PASAL and OBOL.

  5. #5
    Sounds like peripheral nerve compression is a possibility. I have this in my arms from compression at the C5/6 level due to an osteophyte. It can also be caused by a herniated disc and the resulting material pushing on the exiting nerves. It can cause neuropathy and numbness like you describe. In the early stages my numbness was intermittent and was positional dependant as you describe. For example,I couldn't hold the steering wheel to drive (still can't) because my arms become dead numb and I am unable to move them. It also happens when I lay with my arms above my head. I say it is time for another MRI to check for disc herniation and other degenerative changes that happen with age. I have spoken to others with disc herniations etc... that DID NOT SHOW ON CT but did show on MRI. In the case of my osteophyte (which is a bone spur essentially) It is really large and it didn't show on XRay which is unusual but was plain as day on the MRI. If one scan doesn't show something and you know there is a problem, try a different approach. Remember also that a scan is only as good as the technologist who reads it. My osteophyte showed on an x-ray taken 12 yrs ago (was small then) but the technician described it as an UPPER THORACIC WHEN IN FACT IT IS UPPER CERVICAL!!!

    Tanya

  6. #6

    Update on sudden muscle loss

    After getting off that lumpy futon I was sleeping on, the muscle returned in 2 days. But, just 2 days ago I woke up to find my left arm numb - like when you hit your funny bone - which lasted 2 days. I sleep on my back and right side only. Does this seem more like neck position? Or is it some way I rest my arm? The numbness/tingling was mostly thumb, 1st finger and a spot on the ulna between elbow and wrist.

    Thanks everyone
    slow
    Who are these time beings? And, why are we always doing things for them?

    If it wasn't for C, we'd be using BASI, PASAL and OBOL.

  7. #7
    Hi Slowtuna,

    I (T-5 para) prefer sleeping on my right side too but force myself to sleep 30 to 40% of the time on my left side to spread out the pressure areas. I can't sleep on my back or stomach.... I just can't fall asleep in those positions and not sleeping on my back gives it a well needed break from sitting in this chair all day. But I will lay on my back every once in awhile with a pillow under the small of my back (lower back) to help straighten it out.

    Why don't you ever sleep on your left side? Switching sides is good for skin pressure relief plus it bends your spine in the opposite direction to help even out the alignment of it.

    After 23 years post-injury, almost outta the blue, I got neuro-pain in my right flank and back for which I'm now taking gabapentin. It helps quite a bit I'm happy to say. And I find if I put a pillow under the small of my back to kinda bend or stretch my spine in the opposite direction that my sitting slouch has created after all the years in a chair that it helps with the pain. It takes me about half an hour to get some pain relief using this technique... especially when I lay on my left side or back. Maybe if you used another pillow under your upper back (since you're a quad) it might straighten out your spine and perhaps align it better. Or sleep in a different manner or position for awhile and see if it helps. Of course keep seeing your doctor(s) and get all the tests done that they recommend.

    I think my neuro-pain is coming from my spine but manifests itself in my right flank and back.

    Our problems are different but may be related in that we need to start doing some homegrown chiropractics using pillows to realign our spines. 26 and 30 years post-injury are long times to have pressure on our spines and not being able to know by direct pain if they're aligned correctly.

    This is just a guess but it may help you with the weakness and numbness in your arm.

    My arms and hands used to fall asleep on me and I found it strange that it was usually the arm and hand that was facing upwards... the one with no pressure or weight on it. For some reason my arms and hands don't fall asleep or get numb anymore. Every once in awhile a good thing will happen!

    Except for my right hand.... but that's from using the mouse too much!
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  8. #8
    Thanks Bob, I think I will try a pillow under my back. As to which side I sleep on: my left side has way more function, I like my good arm free. Plus, it's much harder to get over to my left side. I like sleeping on my stomach, but it's so hard to roll back. Well, 2 outa 4 ain't too bad.

    so slow
    Who are these time beings? And, why are we always doing things for them?

    If it wasn't for C, we'd be using BASI, PASAL and OBOL.

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