Can't bring arm across body

Hi everyone,

I just had my first PM implanted on 12 Sep (3 days ago). I've noticed that when I try to bring my left arm (affected arm) across my body, it's extremely uncomfortable (ie, far more comfortable than any other movement with the arm). My PM is implanted subcutaneously in the area where that movement occurs (below the collarbone, above the armpit, very close to [almost seems to be along the line of] where my shoulder bends to allow pulling the arm across the body). 

When I try to make this movement, it feels that the PM is not in the right place and is physically interfering with this flexion. The movement seems to be disrupted by a combination of extreme discomfort and a physical barrier (ie, the PM spanning the space where that bending should occur) - although maybe it's just the pain causing me to stop the movement. As instructed, I took the sling off after the first day and tried to use the arm for light tasks. Everything else is mildly sore, as expected, but this movement seems impossible.

I'm a tiny adult (almost 5'0" and around 100 lbs) and I'm wondering if what I'm feeling is typical for the early days of recovery or if the device placement is a bit too close to the arm for someone my size.

I'm not happy about the scar, but I can live with that. However, a loss of function/range of motion would be devastating.

Anyone have a similar experience? Is this normal? Resovlable over time with some light "exercises" of the arm? How long? Abnormal?

Thank you!


10 Comments

can't bring arm across body

by new to pace.... - 2019-09-15 11:44:32

Unfortuantely that is normal,well it was for me.  Took a while and one day on it's own moved that way.  Am now approaching my 4th week after  PM implanted.  Still having trouble lifting left arm upward.  Can feel the pull near the armpit.

   That said you should keep moving the arm.  Was told to move the arm  while it is dangleing in circles to keep from getting a frozen shoulder.

It's only been three days

by AgentX86 - 2019-09-15 13:39:22

Give yourself a break.  You just had your shoulder sliced open. Of course it's objecting. Keep moving it, within the restrictions you were given, and you'll be fine. If it's still causing problems at your checkup, let them know about it.

Pretty early post op

by RedRocksGirl - 2019-09-15 15:03:24

Yep, agree with AgentX86, you're only a few days out, swelling still has to go down and the device will "settle in" to place as time goes by.  I am small like you (under 5'2', 90 pounds - I'm missing a leg - otherwise would be around 105 lbs), had mine put in in January, then had to have a pocket revision in April, so I am 5 months out from that placement and at times, depending on what my arm movement is, still feel like it's "in the way" when I reach my left arm across my chest. So, I'd say its pretty normal. I'm just now able to lay on my left side for up to abut 10 minutes before I have some discomfort from it.

As far as the scar goes, again pretty early post implant for you to know what it will end up looking like. After my first one, it healed up so nicely it looked like just a cat scratch. Its a little thicker now that there was a second incision on top of the first but still looks pretty good. As soon as the dermabond glue that my EP used to close the incision all came off (about 6 weeks after) I started using BioCorneum Silicone scar cream that has a 30 SPF on it every day. Just wait till the incision is healed up, (I didn't have sutures).

More pain today

by Ellie_9 - 2019-09-15 19:11:27

Thanks. The location feels like it'll always interfere with that cross-over motion, but I guess I need to give it more time. If I can't eventually regain full motion with this arm, I'm gonna hate this thing!

I guess I'm feeling discouraged overall because the nurse made it sound like I should feel ok by now and said I shouldn't need the percocet after Day 1. The Tylenol was enough during the daytime on Days 1 and 2, but now on Day 3 the pain feels worse and I'm needing the percocet during the daytime today.

They never told me to ice it, but with all the swelling and bruising, I'm going to try ice.

This has been the roughest day so far, and I feel so discouraged.

Pain management

by AgentX86 - 2019-09-15 21:46:13

We're all different but you're still in the very early stages of healing.  They gave me percs in the hospital (I was an overnighter) and a prescription to take home but I did need any.  I didn't even need NSAIDS.  Other than having to sleep in a recliner so I wouldn't roll over on it (I'm a stomach sleeper), I had no issues at all. 

Ice is a good thing.  I'm surprised they didn't tell you to use it.  I didn't but probably should have.  I had quite a bit of swelling and it took forever for it to go down and it was very sensitive for nine months.  Perhaps I could have avoided some problems if I'd iced it down. Use all you want.

Lovin the ice, and all the input

by Ellie_9 - 2019-09-15 22:51:08

The ice was great! I'm definitely going to continue that; I had so much swelling.

Thank you, everyone. I'll keep icing it, moving the arm, and be a bit more patient.

A little more time

by TreLL65 - 2019-09-17 17:52:46

Hi Ellie,

Hope the feel is still improving for you.  I'm similar to you...5', about 105lbs, small boned, no extra fat in the chest area.  My pacemaker is in the same area as yours.  I've had about 4 in this area.  The good news, a lot of your current problem is due to swelling and the newness of your device.  It will definitely feel better and you will definitely regain range of motion with time.  My two-handed backhand is my best shot in tenns. :-)  Um, that means I have no trouble sweeping my left arm across my chest.  The pacemaker placement doesn't impede me at all.

The bad news, most likely you will always feel the pacer and it may always inhibit some small range of motion.  Part of the problem is our size and the size of the dumb devices.  This is an example of why pacemakers are implanted in children's abdomens.  They are too small in the chest area.  I always feel the pacer, unlike my single chamber pacers that were placed farther down in the chest area and I hardly felt.

Like you, I was not a happy camper when I got my first dual chamber with its new position.  I have adapted though, and I don't find that it inhibits any of my motions.  I feel comfortable doing weights, playing tennis, stretching...I'm just always aware that the darned thing is there. :-)

As for the pain getting worse...I didn't need anything post op (just got a new generator on 9/13), but we're all different and this is your first one.  Maybe you needed more by day three because all the hospital meds had flushed out of your system by then?  I don't know.  Continue all the treatment that's been suggested here, but if you continue needing more pain meds, I'd verify with the doctor whether he/she considers that normal...

Good luck!

 

Petite XS/XXS - my wish for my next PM

by Ellie_9 - 2019-09-17 20:07:45

Thank you TreLL65. It's helpful hearing the experiences of you and another member (thank you also RedRocksGirl) around my size, ie, the size of a typical 10 or 11 year old! :-)

I think there was a lot of manhandling and manipulation to get this PM in place as I'm bruised and sore in several others areas on my arms, chest, and back. And there was definitely a lot of bleeding (not unusual for me) from what I was told - and what I can see. So I'm optimistic I'll see some improvement with time.

That said, I still suspect the device will interfere somewhat with my range of motion long-term. I don't know much about these, but it would seem that moving it over even half an inch or an inch or an inch closer to center would get it out of my armpit(ish) area. Anyway... the pain is more manageable today, which is a good sign, and the EP said that unless the device shifted (which I don't believe it did), I should wait until my 6-week follow-up appointment before deciding anything about the placement.

I've danced my whole life (except when I was too sick to stand up [although even then, I still sorta danced]), so full movement of the arm (without hesitation or grimacing in pain) is really important to me. Glad to hear that your 2-handed backhand is good; that's encouraging!

petite pacer...if only

by TreLL65 - 2019-09-19 20:52:05

Size of a 10 or 11 year old – I love it!  I actually reached my full height at 9.  Over the years, went from the tallest in class to the shortest.  I don’t know what your PM needs are, but you ought to ask your doctor about the micro PM that resides inside the heart.  It’s only a single lead type right now, and still new, so who knows if it will become the new standard.  But, I’m anxiously hoping for a safe, tested dual chamber version.  The Medtronic tech that attended my recent replacement said I was a perfect candidate for one.

I wish I had some good advice for your PM placement issue.  Everyone is right that you need to give the placement more time to recover and yourself more time to adjust to having something foreign in your chest.  But, also, none of us can see you and your PM, or experience exactly what you’re feeling.  It’s like the advice of others saying eventually you’ll hardly know it’s there…yes, that may be the case for people with plenty of chest space for the little monsters :-), and maybe people who have the implant below the muscle.  But for petite people who have the ‘surface’ implant, I bet they will all say they always feel it.  I’m not picking on anybody’s advice, I promise!  I’ve been so impressed with the down-to-earth, common sense replies I’ve read on this site, they are a huge part of why I joined.  I just want to emphasis how everyone’s perspective is different based on so many extenuating factors.

But, feeling it when you do things and hurting are two different things.  You shouldn’t hurt – after you’ve fully healed and adjusted.  I’ve lived with this placement for about 20 years, and I’d had better placed generators in the chest for almost another 20 before that.  I play tennis at a socially competitive level.  I do a lot of stretching exercises, especially for the chest and core.  I do light weights including the one where you hold a weight behind your head then extend your arms straight up.  I’ve never had any trouble with social dancing – if yours is more professional level, that obviously could make a difference.  I do pilates; I spent the last winter taking ‘reformer’ pilates classes that are done on a bench with straps that you hang from, on and off the bench.  I’ve done introductory yoga poses.  I will often ‘feel’ the generator, but I don’t think it hinders my movements.

That said, at my recent change, my new EP said my placement was wrong and he worked like a dog to get the new generator lower.  I can’t decide if he succeeded or not.  One day I’ll think ‘yes, it’s sitting lower, more like my single chamber ones!’  The next day, I’ll think ‘well, it doesn’t stick out as far, but it still sits pretty high.’  I’m very curious to see if I notice it less once I resume all activities.  Still, if mine needed better placement maybe yours does too…

I’m glad your doctor is willing to consider your concerns after the healing time.  Some would just shrug and say that’s where the generator has to be and you have to adjust.  In their defense, they’re weighing the very real dangers in opening a person up a second time versus what they believe is a minor quality of life change.

If you do need to have it moved, you might talk to your doctor about whether the same team is a good idea, or if you should be looking around for a surgeon with more experience with ‘smaller people.’  Second opinions never hurt!

Good luck.  Hope you have good news to report in the future.

Feeling optimistic

by Ellie_9 - 2019-09-21 20:58:13

Thanks, TreLL65. <<Personally, it took me until age 18 to achieve my towering almost 5'0" stature; thank goodness I didn't stop at 9!>>

As for my PM, I need a dual chamber device, so I can't go Micro. But who knows what'll be available by the time I need a replacement. (Wow, just over a week in and I'm already looking forward to the upgrade.) Anyway, the surgery was done by a great EP at a leading medical center in the Northeast (US), so I feel like he knew what he was doing, but now I need to wait and heal and see...

It helps to hear how active you are and how functional your arm/shoulder are with your placement. My range of motion has been very slowly improving these last few days, so that's promising, but I do have a ways to go in terms of having a more functional "across the chest" range of motion in that arm. I don't dance professionally, but I used to belong to a performance troupe that practiced and performed frequently, and I'd like to get back to performing - especially now that I should be able to tolerate more activity!

Anyway... Thanks to the encouragement from everyone here, I'm optimistic - and not nearly as freaked out as I was on Day 3! :-)

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