Weird Pain Through Clavicle into Right Arm

[purpurite]

I'm 53 and in what I would call decent shape—I know I could definitely be in better condition. I spent the winter riding a fat bike to try to improve conditioning, while getting out in the dark and cold and I actually loved most of it. I really got into packing up and heading out on the fat bike with lights ablaze. Was riding in snow and ice comfortably down to about 5° without wind. Masochistic, I know, but it really was enjoyable.

Last fall, before starting on the fat bike, I was riding an old school mountain bike on local trails. And could see I wasn't where I wanted to be with my conditioning. I developed some weird issues that I'm wondering if anyone else has experienced.

On the start of any ride, I'm at 100% perfectly fine and comfortable until about the 5 minute mark where all of a sudden, I feel a pain through my clavicle from my left shoulder to my right shoulder, then down my right armpit under the bottom of my right arm, as if someone was giving me a tattoo from my right armpit to my right elbow. It's a slight breathing struggle for a few minutes, with this strange pain down my arm where it hurts to hold the bars. I have been wearing and tracking heart rate and it never spikes or does anything strange through this time other than normal ride/workout BPM.

This lasts for a few minutes and then recovers to where I feel almost 100% again for the rest of the ride. There is some residual pain in my right arm for the remainder, but it's not terrible.

I have seen a cardiologist thinking it was heart, and had a cholesterol test, an EKG and calcium test, along with a stress test. Everything came back not only normal but low in many cases. The stress test running on an inclined treadmill couldn't even reproduce the sensation well past my calculated max HR, though I was able to going up the parking lot stairs 5 minutes after the test.

I have low cholesterol, no odd EKGs, low blood pressure, almost no calcium buildup in my cardio system and nothing out of the ordinary that my general doctor or cardiologist could find. They pretty much stopped there and said, "you're fine, it's not your heart." My general MD said it should could be a case of "un-conditioning," which I guess is certainly possible. I love doctors.

Has anyone else experienced anything like this? I'm thinking a pinched nerve of some sort, but I am just throwing darts at this point. It is making for really uncomfortable rides, no matter what bike I'm on. Kinda tired of not knowing what's causing this feeling.


Would love to know if anyone else has experienced something similar.



Doug

[Turkle]

I was also thinking pinched nerve.

The problem with nerve issues is that even if they do manage to find what the problem is (very difficult to do, often impossible) there's an even smaller chance that they'll be able to do anything about it anyway. Corrective surgeries for nerve stuff have a very low success rate and a very high rate of causing additional problems.

It sounds like the issue, whatever it is, goes away when you're fully warmed up.
Best case scenario is that there's some stretching or warming up you could do before you ride so that you can start in your pain-free place rather than getting there on the bike. Trial-and-error with some arm circles and neck/shoulder stretches is likely where I'd start...

Take that for whatever it's worth, medical advice given over the internet is generally worse than useless!

[mjf]

Originally Posted by purpurite

On the start of any ride, I'm at 100% until about the 5 minute mark where all of a sudden, I feel a pain through my clavicle from my left shoulder to my right shoulder, then down my right armpit under the bottom of my right arm, as if someone was giving me a tattoo from my right armpit to my right elbow. It's a slight breathing struggle for a few minutes, with this strange pain down my arm where it hurts to hold the bars. I have been waring and tracking heart rate and it never spikes or does anything strange through this time other than normal ride/workout BPM.

This lasts for a few minutes and then recovers to where I feel almost 100% again for the rest of the ride. There is some residual pain in my right arm for the remainder, but it's not terrible.

I have seen a cardiologist thinking it was heart, and had a cholesterol test, an EKG and calcium test, along with a stress test. Everything came back not only normal but low in many cases. The stress test running on an inclined treadmill couldn't even reproduce the sensation well past my calculated max HR, though I was able to going up the parking lot stairs 5 minutes after the test.

I have low cholesterol, no odd EKGs, low blood pressure, almost no calcium buildup in my cardio system and nothing out of the ordinary that my general doctor or cardiologist could find. They pretty much stopped there and said, "you're fine, it's not your heart." My general MD said it should could be a case of "un-conditioning," which I guess is certainly possible. I love doctors.


Doug

Few more details might be helpful.

Describe the breathing issue that you're having.

Pain toward the outside of your hands (pinky/ring finger?)

What labs came back low?

I have a lot of misgivings about treadmill stress tests (hate them myself), especially in the context of specificity. The problem is that a lot of clinics don't have cycling ergometers, so you aren't going to be able to replicate the stress you're experiencing since you're exercising in a different manner than what produced the original problem.

[2LeftCleats]

Kind of an odd pattern. One thought that comes to mind is thoracic outlet syndrome but can’t explain the shortness of breath. After your testing it sounds like coronary disease is unlikely.

[Louis]

Originally Posted by purpurite

My general MD said it should could be a case of "un-conditioning," which I guess is certainly possible.

Assuming he was serious, what in the world is "un-conditioning?" I've never heard of it.

Good luck, Doug.

[robt57]

Ever break left clav? If yes, any hardware left in there??

>almost no calcium buildup in my cardio system

Almost?

Or plaque in your subclavion artery? Time for some echos maybe...

[robt57]

Originally Posted by 2LeftCleats

Kind of an odd pattern. One thought that comes to mind is thoracic outlet syndrome but can’t explain the shortness of breath. After your testing it sounds like coronary disease is unlikely.

Adrenaline? Any acidic taste in mouth?

[mjf]

Originally Posted by Louis

Assuming he was serious, what in the world is "un-conditioning?" I've never heard of it.

Good luck, Doug.

Deconditioned is the appropriate term.

[charliedid]

Frozen Shoulder?

[purpurite]

Originally Posted by mjf

Few more details might be helpful.

Describe the breathing issue that you're having.

Pain toward the outside of your hands (pinky/ring finger?)

What labs came back low?

I have a lot of misgivings about treadmill stress tests (hate them myself), especially in the context of specificity. The problem is that a lot of clinics don't have cycling ergometers, so you aren't going to be able to replicate the stress you're experiencing since you're exercising in a different manner than what produced the original problem.

Hard breathing, but like I was climbing, not anything out of the ordinary. The strange part is that after it happened, it would go back to normal and I could finish my ride without issue.

Sharp pains, like a tattoo needle or an Xacto knife. On really bad days, it would run down my arm into my ring and pinky finger on my right hand, yes.

My cholesterol was low, blood pressure was normal to slightly lower than normal. EKGs came back fine.

Originally Posted by 2LeftCleats

Kind of an odd pattern. One thought that comes to mind is thoracic outlet syndrome but can’t explain the shortness of breath. After your testing it sounds like coronary disease is unlikely.

Yeah, calcium test was a 1, and the cardiologist said my scores were similar to guys in their 20s. He wasn't concerned.

Originally Posted by robt57

Ever break left clav? If yes, any hardware left in there??

>almost no calcium buildup in my cardio system

Almost?

Or plaque in your subclavion artery? Time for some echos maybe...

No breaks, no injuries, nothing ever in that area.

Calcium test scored a 1 (negligible, but not zero). EKGs showed no issues at all.

Originally Posted by robt57

Adrenaline? Any acidic taste in mouth?

Nope. I spent enough time racing in the 90s and I know my body pretty well to rule out being amped up. That's what's so weird, I've never dealt with anything like this.

Originally Posted by mjf

Deconditioned is the appropriate term.

That's the one. It's possible that I'm just older and more out of shape than I thought, but I don't think so. This doesn't feel like "out of shape."



Here's something I failed to mention previously... I have had this exhausted, out of breath feeling with the arm/hand pain from last summer performing the following tasks:

• mowing the lawn
• raking leaves
• going up and down a flight of stairs carrying boxes

ALL of them were with my right arm extended and performing a task, like holding on to handlebars with an elevated heart rate. I don't experience this working at my desk or doing mundane things. I don't experience pain in my arm from everyday walking up and down stairs. It comes when they are all present—arm extended, lifting or holding something tight and exerted efforts.

Which has me thinking about pinched nerves or something similar.

[thwart]

Originally Posted by 2LeftCleats

Kind of an odd pattern. One thought that comes to mind is thoracic outlet syndrome but can’t explain the shortness of breath. After your testing it sounds like coronary disease is unlikely.

After reading the history above, I was thinking possible TOS as well. So it was interesting to read down the thread and see this post.

I had something somewhat similar (other than the shortness of breath) when I was dealing with rotator cuff issues with my right shoulder back in ‘08-‘09. Intense radicular pain that would improve with muscle warm up.

Seeing a good physical medicine/rehab medicine doc may be worthwhile.

[mjf]

Originally Posted by purpurite

Hard breathing, but like I was climbing, not anything out of the ordinary. The strange part is that after it happened, it would go back to normal and I could finish my ride without issue.

Sharp pains, like a tattoo needle or an Xacto knife. On really bad days, it would run down my arm into my ring and pinky finger on my right hand, yes.

My cholesterol was low, blood pressure was normal to slightly lower than normal. EKGs came back fine.

Here's something I failed to mention previously... I have had this exhausted, out of breath feeling with the arm/hand pain from last summer performing the following tasks:

• mowing the lawn
• raking leaves
• going up and down a flight of stairs carrying boxes

ALL of them were with my right arm extended and performing a task, like holding on to handlebars with an elevated heart rate. I don't experience this working at my desk or doing mundane things. I don't experience pain in my arm from everyday walking up and down stairs. It comes when they are all present—arm extended, lifting or holding something tight and exerted efforts.

Which has me thinking about pinched nerves or something similar.

The arm to pinky pain, is obviously common amongst cyclists, and could be ulnar nerve neuropathy/"cyclist's palsy". I have it myself in my left arm, specific to the elbow down, not necessarily painful, but more pins and needles.

With the arm pain, peripheral artery disease (PAD) is also a very easy thing to be tested for, and could help to rule out a circulatory issue.

Between your ECG+stress test, it's a good sign that there's nothing up front, or catastrophic. ECGs+stress are great as a baseline, although they can be incomplete in their story. ECGs are looking at electrical conductivity issues, and some things like a previous MI may show up because structural damage affects electrical conduction. But, ECGs can leave out a lot of information, because you can only suggest that there's a structural issue, especially if the heart's conduction is moving along as expected, confirmation comes from an echo or CT.

I do have some of pause with your description is the shortness of breath.

If you haven't, definitely describe the tasks and what causes this to happen in detail to your doctor. An echo/stress echo might be worth looking into, to get a better idea of what's going on in your heart both structurally and circulatory.

[jimcav]

which makes a mechanical pseudo-thoracic outlet syndrome possible. a good PT can help you figure out the issue, and if difficult then imaging to look for arthritis that may be contributing to positional compression

a very uncommon thing you could ask you doctor about ruling out is subclavian artery stenosis or aneurysm, but your symptoms would be an unusual presentation of either.

lastly, I've been dealing with C6 and occasionally C7 radiculopathy for almost 7 years, and it could be possible the positional issue is in your cervical spine, but again a weird presentation in that you seem to just warm up and it resolves. you can get radicular pain in the areas of your shoulder/arm/fingers as you described, and the phrenic nerve comes off C3 and C4, which does the diaphragm (ie your breathing muscle). again, it would be an unusual presentation involving multiple cervical vertebrae to account for the areas of pain, weakness, numbness, breathing issues etc., but you can ask your doc to check you for spondylosis and there are some positional tests he could do that might recreate the symptoms.

good luck figuring this out

[htwoopup]

This is going to sound really out of left field but I had something very very similar. After sooo many specialists and tests the guy who had a thought was the gastroenterologist and the person who figured it out was his nutritionist.

When I say tests and other kinds of specialists, I am not kidding. When I first went to my primary and described it she picked up the phone and called another doc who is a cardiologist and personally brought me to his office because she thought I was having an aortic aneurysm…and it goes from there.

The gastro team (who was not reco’d by anyone else but I was seeing him anyway for a regular pre-oscopy appointment and mentioned it to him) did some tests where I drank some stuff and then blew into a tube over 3 hours every so often.

As I have aged, I have developed (or it has exhibited itself) a fructose problem. Along with some other digestive system issues that have to do with reactions to certain things that I eat. This would cause my body to not pass things from my stomach to intestine to other intestine properly. Simplistically, the resulting blowing up of the organs would cause me breathing problems and weird pains as organs pressed against nerves and so on. Hip bone connected to the thigh bone/ It’s the third impact of organs against bones that kills in a car crash…etc…This was made worse when I would drink out of a water bottle while riding due to positioning while swallowing.

After different diet trial and error to identify the culprits in food so I can totally avoid the really bad ones for me and using xylose isomerase for the minimally problematic foods, I have no more issues that were very similar to what you describe in the OP although it was my left clavicle not my right.

[jimcav]

^^^ so Jon in your case a combo of delayed gastric emptying/progress through the GI system and bloating--I get that that could impact ease of diaphragm for breathing but it also caused compression of something that your brain interpreted as clavicle-into-arm pain. That is pretty interesting, similar to how the ischemia in a heart attack is misinterpreted as left arm pain in many cases

yours also improved with activity? I wonder if that simulated gut motility to help resolve the pressure effect. fascinating.

I hope this helps the OP