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Anesthesia

Severe neck/shoulder/arm pain after c-section

12/01/2006

Question:

After delivering by cesarean section because of severe pre-eclampsia, I started feeling severe pain in my right neck/shoulder/arm shortly after coming back in my hospital room after surgery. The pain continued for the rest of my stay in the hospital and became so severe at home I could barely take the pain and would cry myself to sleep at night. Even the 2 vicodin plus the Rx strength ibuprofen I was taking day and night for the incision pain did not help one little drop in pain relief. It was extremely hard to just care for my new little baby boy. I could barely hold my little 8lb 9oz bundle of joy. I would rate this pain worse than the incision pain because if I sat down and held still I could`t feel that, and the pain killers helped to keep the pain at bay, but the arm/shoulder pain would not let up. It hurt to move even the slightest big.

It is now 4 months after surgery and the server pain has gone away, but my arm is still not back to normal. It still hurts when lifting things, even light things like my purse, etc. There is just no strength and endurance in that arm.

I went in to the ER finally approximately 2 weeks after coming home and the ER doctors suggested that it could be phantom pain up under the diaphram? and sent me home. A check up with my family doctor at 3 months after has him perplexed as to what this pain might be. He did have me go in for an ultrasound to rule out possible blood clots and I haven`t heard back from them, so I guess that test was a negative. My OB/GYN has never come across this with any other patients. I am content to wait this out longer if it will go away on its own, but will it? What would be your take on this?

Answer:

Pain is usually resistant to ibuprofen and may require a different medication that vicodin. A possible cause for the pain may be a disc herniation in the neck that may be affecting the nerves to the right shoulder and arm. However, other causes may be responsible for the pain. Disc disease can be easily diagnosed by MRI of the cervical spine and sometimes by a nerve conduction test done by a neurologist (EMG). If disc disease is ruled out, other diagnoses may be entertained. I suspect from your note that you may have swelling in the right upper extremity since you had workup for a blood clot. There is a relatively rare entity that can result in pain, swelling and discoloration of the extremity. Evaluation by an expert pain medicine specialist may be helpful if disc disease is ruled out. However, first you may benefit form an evaluation by a neurologist.

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Response by:

Salim M Hayek, MD, PhD Salim M Hayek, MD, PhD
Associate Professor of Anesthesiology & Perioperative Medicine
School of Medicine
Case Western Reserve University