Triceps weakness from cervical radiculopathy

[chaloney]

I have had a right c7 radiculopathy for several years. I started my LP at the beginning of the year and it had been going well. After a month we took a trip to visit friends and a combination of moving suitcases and sleeping on the most absurdly soft bed I've ever encountered (I prefer a very firm bed) I had the worst flare of the radiculopathy I've ever experienced. In the past is have a week or less of shoulder pain and it would go away with some ibuprofen or Advil. This episode included parasthesias of my right index finger, right arm weakness and loss of coordination, and the worst pain I have ever experienced. After a month of NSAIDs and rest the pain subsided and I was left with the parasthesias and noticeable weakness in my right triceps. I reset my bench and press significantly and am making 2.5 lb jumps. The last few inches of extension have been the weak point of both press and bench (squat and deadlift have been fine, up to 325 and 330 lbs respectively). My question is will additional triceps work on the effected side help even things out and allow me to progress any faster?

Thanks

[Mark Rippetoe]

Stop fucking around with this and see a neurosurgeon.

[chaloney]

Point taken and I got that much from having read previous threads on the topic. However, it doesn't address the question at hand and it didn't come up in any. Will triceps specific accessory work speed the equalization of strength between the effected and unaffected sides or should I just continue my LP alone? This is your area of expertise. I've got the medical side covered.

Thanks again

[stef]

Will triceps specific accessory work speed the equalization of strength between the effected and unaffected sides or should I just continue my LP alone? This is your area of expertise. I've got the medical side covered.

It looks like you've missed the scope of the "medical side" you think you've got covered - you won't get better results from hammering on a neurological defect. You'll get stronger when you fix the neurological situation, at least to the extent that it is not permanent already due to the accumulated damage.

[chaloney]

Ok, let me clarify. I was trying to keep it brief and apparently made it sound worse than it is. Before the episode this winter the only symptom I had ever had was shoulder pain and it got better with a few days of NSAIDs. I thought I had a rotator cuff injury that never properly healed (as they are wont to do) and would occasionally reinjure. Maybe that's still the case but the symptoms never really fit quite right (location and reproducibility).

This winter's episode was much more painful but in the same area and surrounding areas, but also had new parasthesias and extensor weakness at the right elbow joint. A bit of research led me to the conclusion that this was a c7 radiculopathy, and was likely never a rotator cuff injury. Initial treatment of a radiculopathy is conservative: anti-inflammatory meds and PT once the pain subsides. Based on the data it is actually likely that in most cases that symptoms improve in spite of treatment rather than because of it, but the Advil and Tylenol made it much more tolerable. If pain is debilitating, a short course of oral corticosteroids can be tried, but this was not necessary.

My pain resolved and I resumed my LP rather than fucking around with rubber bands in a physical therapists office and it has gone well except as I stated in the original post. My bench and press have each increased by almost 30 lb since restarting at the end of March (2.5 lb jumps are all I've been able to make). So I don't have the remotest need for a neurosurgeon at the present. Indications for surgery include worsening neurological symptoms despite conservative treatment (mine are stable or improving), uncontrolled radicular pain (i.e. Pain shooting down the arm, following deem ottoman distributions) along with MRI evidence of nerve compression.

Truthfully, press and bench LP has been going fine and today's bench workout I was back to where I started a month before the injury and the difference between right and left was not very big, so I'm not sure an answer to my question will help me very much but it occurred to me today and I thought it might help someone else in the future.

Also, I am an actively practicing physician so I am not lying to you or myself when I say I've got it covered.

Thank you for your time

[Mark Rippetoe]

along with MRI evidence of nerve compression.

Is there some reason you feel as though a cervical MRI study is a bad idea? In all likelihood you have an osteophyte at C7 that will eventually need to be dealt with, and it would be a good idea to know the situation. A lot better idea than a Medrol dosepak.

[chaloney]

Is there some reason you feel as though a cervical MRI study is a bad idea? In all likelihood you have an osteophyte at C7 that will eventually need to be dealt with, and it would be a good idea to know the situation. A lot better idea than a Medrol dosepak.

If I had an mri now it might show something, but I still don't have symptoms that warrant surgical intervention, so at the present it wouldn't alter any treatment decisions. If I develop symptoms in the future, any surgeon would want a new mri to see what was going on at that point in time, causing the new or worsened symptoms, so an mri now is basically a waste of money. This is especially so because when you look at cervical mri studies done (for other reasons) in patients without symptoms of cervical radiculopathy, you often find osteophytes and disc bulges that appear to cause foraminal narrowing, even though they never had any symptoms. So if my hypothetical mri today showed something there is no way of knowing if the finding was the cause of of the now resolved symptoms or just an incidental finding.

[Mark Rippetoe]

Got it.

[Will Morris]

If I had an mri now it might show something, but I still don't have symptoms that warrant surgical intervention, so at the present it wouldn't alter any treatment decisions. If I develop symptoms in the future, any surgeon would want a new mri to see what was going on at that point in time, causing the new or worsened symptoms, so an mri now is basically a waste of money. This is especially so because when you look at cervical mri studies done (for other reasons) in patients without symptoms of cervical radiculopathy, you often find osteophytes and disc bulges that appear to cause foraminal narrowing, even though they never had any symptoms. So if my hypothetical mri today showed something there is no way of knowing if the finding was the cause of of the now resolved symptoms or just an incidental finding.

An EMG / NCS would be of great importance in this particular case. Have you noticed any overt atrophy of the triceps, or of the lat or pec on the same side?

[chaloney]

Will- No muscle atrophy that I can see or feel and the strength is improving. Coordination has long since returned to normal. Bench strength has been equal left and right except for locking out my right elbow, hence my original, still unanswered question. And as I said, even that difference is nearly gone.

I'm not really sure how an emg/ncs (electromyelogram/ nerve conduction study) would be helpful. My understanding is that it's a diagnostic test that can be helpful when the cause is unclear. Based on symptoms and response to treatment, the etiology does not seem to be much in question.

Rip- any thoughts on the utility of accessory work to speed up the strengthening of the residual triceps deficit, or just do the program?