Hello, I am having some symptoms that I can't explain, I would love some advice, or to know if anyone had a similar experience. Sorry for the long text, I just really not sure what I have so I don't want to miss any symptom from my story.

I am 25 years old. I don't have any background health issue. So starting two months ago, my thumb flexor is almost fully paralyzed. Incomplete AIN syndrome is suspected (or maybe some muscle injury that didn't show up on MRI). Anyway, even if it is a nerve compression, it was probably triggered by an injury in the gym (I didn't feel anything during the training, but the pain, which was not muscle injury pain, but some 'internal' serve pain along the whole forearm, from the wrist to the elbow, started one/two days later. I was in a lot of pain for a week, and ain nerve is motor only never and shouldn't cause pain)

But my question is not about that nerve. Three week later I had an EMG. sadly they didn't test the right muscle (but it did found out that I have some axonal neuropathy of the ulnaris at the elbow level with signs of active denervation of one muscle, but it is pretty much symptoms less and that muscle has ok strength so I am not worried about it right now) . But two days after that EMG I started to have symptoms of new nerve pain. On movement (for example when extending my arm), I got some serve sharp or burning or electric pain in my forearm, just above the wrist. Quickly I found out that there is an area in the upper part of my forearm, that if I tap on it I feel an electric shock traveling down my forearm (and the pain is really along that line). Today I know that it is called Tinel sign. But I don't have tingling sensation on the skin, I just sensation of the nerve in the distal area.

Anyway, the symptoms got better over the following week and half (less frequently, less painful, the tinel area got less sensitive). But after a bad movement with my arm (struggling putting on some shoes on from an high chair), I had serve pain, and after that (well I am not sure if it started immediately after or some hours later or even if it coincidence or related), I had a new symptom: dysesthesia, I have mild burning pain sensation on the skin along the nerve from the wrist up to the Tinel area, especially in the lower half of the forearm.

The symptoms of that also got better over the last month, but it is still there, the sensation is only a bit annoying, but beside that pretty normal. And the Tinel area is still there and static .(about the static, I think that I was able to trigger it a bit higher in the beginning but I am not sure about it, but the location is static for sure for the last month).
And the tinel area isn't a point, it is a segment that is 1/2 inch long. (with different sensitivity along it)

I had another EMG three weeks ago (because of the thumb, and the correct muscle is still not in the results, arggghh). sadly the neurologist didn't believe to my complaints of neuropathy symptoms. When I asked her to test that nerve she tested the median nerve (only later I found out by myself that the medial antebrachial cutaneous nerve fits to my description and location. a second neurologist didn't believe me too but two arm orthopedist agreed that it is a nerve issue, and the last one got to the same conclusion as mine from the symptoms [the first one blamed the ain nerve but it doesn't make sense because it is motor only nerve and it is very deep]).

It is annoying because that injured/sensitive nerve segment is irritated easily by the muscle near it and causes me to feel annoying sensation or mild pain above my wrist when I am using the muscles in my arm or stretching it.

Anyway, I hope that it will continue to get better, but I am trying to figure out what the hell happened to that nerve. I haven't got any answer. The only thing that happened in that area is the needle from the EMG test, but the closest insertion point was 2/3 inch from the nerve (to the direction of the nerve, but to the muscle below the muscle below it). I am 90% sure that the needle didn't get anywhere near that nerve. (I also got HPV vaccine on the same day that it started, but I doubt that it is related, maybe it was even a day after it started, don't remember exactly)

And what does the static tinel sign mean? As far as I understand, Tinel sign is usually happens in axonotmesis injuries, and it a sign for the regeneration of the axons (and it is static when it fails to regenerate), so if I have axon loss, why I had that sign pretty much from the beginning, before I had any sensation change? And why even now the sensation symptoms are so mild (and hopefully will continue to get better)? I understood that it can happens when the nerve is compressed too, but that nerve is just below the skin, so it can't be compressed, right?

Did anyone have any similar experience? Is it possible that the nerve got swollen or that it is some kind of inflammation of the nerve? would it explains my symptoms?

what do you recommend checking next? Should I test for something? (Right now I have an upcoming EMG in three weeks)

Thanks.

I can't post links, but I found a thread with the subject "Superficial radial nerve injury", which sounds very similar of the symptoms that I have (delayed onset of sunburn feeling, static tinel sign, just that in my case there isn't any known injury). I wonder how it worked out for him.

After more thought I am pretty sure that the Tinel signal is advancing. I mean it is still at the original location, but I don't think that it extended up to 1/2 inch below it at the beginning, but that it was more local.
And also I think that the signal is now bit stronger at the distal part, but not sure about it.
I hope that it will continue to fade at the 'injury' site and that I won't have any lasting neuroma. I should probably just be patient and give it time because it seems that it is healing very slowly.

But I am still baffled how I got axonal injury without any serious trauma.


As for the suspected AIN syndrome (rare upper extremity nerve palsy), I hope that I will finally get definite diagnosis after the next EMG. At least it is something that is treatable (with surgery) in most cases if it doesn't heal on its own, so I hope that it is nerve compression and not undiagnosed severe muscle injury. (Well but in both cases the worst case can be mostly solved with tendon transfer)
I didn't mention it but in the MRI there were hints of deveneration of the pronator quadratus muscle. this is one of the reasons why AIN syndrome is highly suspected. So I just hope that in my next EMG the neurologist will finally listen to the doctor instructions (and my verbal instructions...).

Wanted to give an update.
After 4 EMG tests the FPL muscle was finally tested properly and had signs of fibrillation.
After 6 months of no improvement at all I was about to get a surgery for the AIN syndrome (the medial literature recommends waiting 3 months before surgery). But than I suddenly saw a small improvement,, so the surgery was canceled in the new few months my thumb improved and healed.
As for the MACN nerve injury (the sensory nerve) - it improved over the next ~6 months too. (as the Tinel signal advanced along the arm).

So that is how that story concluded. For almost two years everything was fine. But two weeks ago I felt a similar sensation along my forearm.... the right arm this time. Over the next two weeks it got worse, sharp burning pain when I stretch my arm, burning sensation on the skin. Tinel signal at about the elbow. This time it seems that the LACN nerve has a lesion.

I went to a good Neurologist, and he pretty quick he brought up the diagnosis of recurring Neuralgic Amyotrophy, and recommended to check for the hereditary form of it. (but I don't have family history of it). He also did an EMG test, which revealed traces of some axonal damage in more muscles innervated by the brachial plexus in both arms.

From what I read online, the idiopathic form is more common than the hereditary form, but in most cases of the idiopathic form it doesn't recure. (but in some cases it does).

What caught my eyes was this sentence in the article "The neuralgic amyotrophy consultation" (I can't post links):
"Sometimes the only signs of an attack are annoying pain in the upper arm lasting a few hours with a subsequent loss of pinch grip for a few months, caused by a lesion of the anterior interosseus nerve."
Which is almost exactly what happened to me two years ago (my pain was in the forearm).
And also those sentences:
"NA can also present with pain and sensory symptoms only, frequently in the distribution of the lateral cutaneous antebrachial nerve"
"Any part of the brachial plexus, and clinically any muscle or skin area can be involved, in all sorts of combinations. Sensory symptoms or pain tend not to correlate with the localisation of the paresis."
Anyway after reading that article it seems that the diagnosis is spot on. The article describes everything that I had.

But I am not sure if this is another attack of it, because I didn't have that pain again, or is it still part of the previous attack or something like that?

So that is it for this update.