Brief Answer:
Differential Diagnosis of disease and approach

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. After reading your complaints, it seems you are having bilateral neuropathy. It could be due to

: Cervical spondylosis - Cervical spinal cord and nerves compression due to age related changes in disc, bone and ligaments. It manifests as sharp shooting pain which radiates from back of neck to both arms/forearms/hands, burning pain, current like sensations, more pain on forward bending/flexing neck/lifting weight.

If your other symptoms are such that, consult neurologist. He will advise

: MRI cervical spine
: Nerve conduction velocity to know exact nerve involvement

Treatment will depend after confirming diagnosis.

: Diabetic neuropathy - If you are a diabetic and sugar value was uncontrolled in past, diabetic peripheral neuropathy can present like that. Other symptoms are burning pain, bilateral involvement, no radiation and no neck pain, sensory loss on both sides, some functional loss may also occur in lower limbs also.

Consult neurologist for evaluation and confirmation. After checking your nervous system, he will advise
: Blood sugar level, HbA1c level
: Nerve conduction velocity
: Blood sorbitol level if diagnostic confusion
: X ray shoulder may be advised if cause of loss of range of arms is "Frozen shoulder". It is a condition specifically caused in diabetic patients shoulder due to diabetic neuropathy/joint effusion/cartilage changes. It leads to gradual restriction of all movements at shoulder.

: Neuropathy due to alcohol, B12 deficiency, toxin exposure like industrial chemicals/paint/lead/pesticides - Features may resemble that of diabetes. It is usually suspected if no diabetes, but neuropathy present.

I can help you in reaching some conclusion if you can provide me little more details pf your complaint like

: Duration of complaint?
: Any neck pain radiates to arms?
: Loss of range at shoulder or elbow?
: Any history of diabetes, alcohol, drug intake?
: Any aggravating or relieving factors?

Hope you will understand my point. If any doubt, do let me know.

Thanks. Take care.

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Brief Answer:
Differential Diagnosis of disease (Revised list)

Detailed Answer:
Hi XXXX, welcome back.

Thanks for answering my questions. I have read the detailed description of your symptoms. Based on your symptoms, we can rule out

: Cervical spondylosis
: Neuropathy

It seems more like a "Musculoskeletal disease". As involvement is bilateral and X ray shoulder is normal, it can be

: Polymyalgia Rheumatica - Polymyalgia rheumatica (PMR) is an inflammatory condition of unknown cause which is characterised by severe bilateral pain and morning stiffness of the shoulder, neck and hip. It usually affects males/females >50 years.
The most characteristic presenting complaint is bilateral shoulder pain and stiffness of sudden with bilateral upper arm pain. Symptoms are at their worst in early morning just after waking up. The stiffness may make it difficult to get out of bed, or raise their arms sufficiently to brush their hair.

Your symptoms are resembling its features.

Kindly consult orthopaedician for it. Investigations are essential to support the diagnosis of PMR but also to rule out any other possible diagnosis, so he may advise few investigations like

: Inflammatory markers: ESR, plasma viscosity and/or CRP
: LFTs
: Bone profile
: Protein electrophoresis
: TFTs
: Creatine kinase
: Rheumatoid factor
: Urinalysis

Treatment is usually conservative. It includes

: Exercise
: Steroids like Prednisolone
: NSAIDs like Ibuprofen, Diclofenac sodium, Aceclofenac

Hope it will help you. If still in doubt, do let me know, I would be happy to help you.

Thanks. Take care.

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