Nerve pain in left arm after new PM

More on Nerve Damage

by donr - 2012-08-27 01:08:49

Rover: If you go to You Tube, you can find a video of them installing the leads. They use a syringe w/ a needle on it to enter the vein, then remove the syringe from the needle & insert various wires into the vein through the needle. The needle has a valve in it so it won't let blood escape while the syringe is off.

They are working w/ less than good visual contact w/ the vein, so if the surgeon has poor aim, they could easily nick one of the many nerves in the vicinity.

On a point like this, I'd cut no one any slack - you have an uncommon side effect from the surgery. I'd at least go ask about it.

If you are dealing w/ the UofPA hosp, it is probably a teaching hospital, so you could well have had a trainee w/ little experience doing the job under an attending physician's guidance & supervision.

Just ask yourself, how many folks have had this complaint? Not many. It is worth asking about.

Don

Noted

by rovercar - 2012-08-27 01:08:56

Noted!

More on nerve damage

by donr - 2012-08-27 10:08:54

Rover: Wrote a comment for you in response to your first post. The below is something I wrote for another member on the same day! The title says it all.

Based on your latest description, sounds like you MAY have TWO nerves involved. They both run through the surgery area, so it's completely possible. There is a fair chance that more than one of those nerves was affected, since none of the nerves serve both fingers & upper arm.

To have numbness in just the two fingers, instead of all 3 1/2 is unusual.

Still say you should go see the Dr & ask him/her. A decent diagnosis requires a physical examination.

Don


Begin Cut & Paste:
We've had a lot of this today!
Comment posted by donr on 2012-08-25 18:14.
Nancy - try some nerve damage or impingement on a nerve.

I want you to SEE this so you can appreciate what could have happened during surgery. Google on "Subclavian vein." When it opens go to the top entry - should be the Wikipedia entry. Open that up & you'll see a couple rows of photos/drawings. Open the left photo in the bottom row - it's a photo of an opened RIGHT chest, but the left side is close enough that you'll see what I want you to.

Notice that the vein they need is buried beneath a potfull of nerves. To get to that vein, they have to MISS all those nerves. Depending on the skill of the surgeon, the size of his/her fingers (How did he put himself through college? As a football lineman weighing 300 lbs? Or as a woman gymnast weighing 125 lb?) A lot of the work in getting into this vein is done blind, w/ the possibility of some fingers & a scalpel or two going into the area. The Subclavian vein is also beneath the collar bone (hence its name) & takes a lot of skill to get at.

There are 4 nerves that route themselves through this area.
1) Radial - serves feeling in thumb, index, first & INSIDE of ring fingers.

2) Median - serves the palm side of hand & is the victim of whatever causes carpal tunnel syndrome.

3) Ulnar - serves the feeling in OUTSIDE of ring finger & pinky.

4) Brachial nerve - serves the back of the arm & other parts down the arm.

Google on each of those nerves & read for yourself which one you think it may be, based on what hurts.

Nerve pain can be very severe & should not be ignored. If it goes on too long, due to being pinched, it could become permanent. If your surgeon cannot or will not listen to you, get to a neurologist! ASAP. You should not come out of this procedure w/ any nerve pain like you describe. If I were to guess, I'd start w/ the Brachial nerve.

End Cut & Paste

Thanks

by rovercar - 2012-08-27 11:08:04

Thanks for your input, Amanda. Don, thanks for both of your responses. Very helpful. I'm trolling for responses, here, because there's so little mentioned on the web about nerve pain. Based upon the images you link to and others I have found, it's hard to see how they do the job and avoid damaging the nerves. I will definitely demand a proper response from my doctor in the long run, but it's just coming up on one week since the surgery, and I think things need to settle down a bit to see how bad the problem is after the trauma stage is past. There has definitely been improvement in the past few days, but it is just as definite that something's going on in there. I'm leaning toward the nerves having been somewhat traumatized due to pushing and shoving during the surgery. I'm not going to assume there is actual damage at this point. I'm dealing with the Hospital of the University of Pennsylvania, and I'm willing to cut them a little slack at this early stage. As I said, I am a bit surprised that my symptoms aren't more common. Heart-wise, the PM seems to be doing a good job.

ty donor

by davegann - 2012-08-31 09:08:39

ty for the info. i think you gave me what i was lookin for under battery's and leads, several there are having same issues.

IN PAIN

by loco - 2012-09-02 03:09:23

I ALL SO HAD A ICD PUT IN 7 17 12 MY LEFT ARM HURTS SO BAD SOMETIMES I CANT RAISE IT UP. I HAD MY CHECK UP AND THE DR. SAYS EVERYTHING LOOKS GOOD, I TOLD HIM ABOUT MY ARM AND HE DIDNT THINK IT WAS FROM THE ICD, BUT I DIDNT HAVE IT BEFORE.
b

Original Poster Update

by rovercar - 2012-09-02 03:09:25

Not quite two weeks since my pacemaker insertion. My left index finger definitely is numb and or pins and needles. Pain in my arm seems to be lessening, although it seems to bother me most when I am walking. I also think my discomfort is partly due to the motion restrictions, and I tend to find my shoulder tense and held high. My doc says that it is not at all uncommon to have some pain in the arm due mainly to the fact that you can't really get to the lead insertion vein without disturbing the nerves to some extent (be it major or minor). He says that most patients who have this sort of pain see it gone within a month but that it could take as long as six months for something like my index finger discomfort to go away. He also volunteered that the pacemaker could be impinging on a nerve or nerves and need to be repositioned within the pocket which, of course, means surgery. So, I have him on notice, and he is not discounting my discomfort or implying that I am imagining it. I'm content for now to take it a couple of weeks at a time since my doc actually calls me and discusses thing with me by phone without having to have his arm twisted. My present thinking (which could change at any time) is that my 58-year-old shoulder was not in optimal shape to begin with and that all of the arm positioning during surgery and the basic trauma involved in the surgery have induced a temporary condition that will improve fairly rapidly. If not, I'll be on their cases.

Update 2 from Original Poster

by rovercar - 2012-09-15 05:09:46

I'm following up on my progress for anyone wondering how they might progress in the first few weeks. It is now three weeks and two days since my pacemaker insertion. The deep, aching nerve pain in my arm has pretty much disappeared. The numbness in my left fingers became isolated to my left index finger, then rather abruptly changed to pins and needles. It has steadily improved. After three weeks, there is just a tiny bit of pins an needles in my fingertip, and it is just barely sore to the touch along the back of the finger. I have full normal sensation in the fingertip, and I expect the issue to be entirely resolved in a couple of days.

Now, here's a story for you. My pacemaker was maxing out at 130 bpm and then dropping down and sticking at 75 bpm (at which rate I had to stumble half a mile home). I was wearing a finger pulse-oximeter to monitor my pulse rate. I had my doc's email address from his card and emailed him the details. The next morning (on a Saturday), a rep from Boston Scientific came to my HOME and reprogrammed my device. Talk about service! They upped my max rate to 150 bpm, and I'm doing much better. Apparently, when the device maxes out of bpm, you can get into a timing issue where you effectively miss every other beat (which was my original issue). I'm very pleased with the care I am getting.

Same here, only this last time

by Sig27 - 2020-07-31 00:10:53

Hi all, 

I had my PM replaced and first lead extraction with replacement. So, I have a new, very uncomfortable symptom this time around. My entire ulnar nerve is super sore, from inside front shoulder to back by the tricep above the elbow, to under the elbow and down to tingling in the ring and pinky fingers. Super painful in the front shoulder and near the elbow (both above and below). I'm only 1 week post-op today, and this has not happened the last two times. But, it's definitely related, I had no problems like this before and already went to the ER with a sore, firm, bluish left arm the same day I was released. So, my 2 week checkup is next Wednesday, I will definitely mention this and not let them talk me out of it being related. Super uncomfortable and they need to give me some idea of what can be done about it. Good luck to you.