OpenHealth Q&A

Long-Term Breach of Health: Persisting Double Vision and Muscle Issues

I appreciate your patience as I share my experience, which has been prolonged and truly challenging. I’m a 34-year-old man residing in Texas, and my troubles began back in 2019. It all started during a workout at home. While performing dumbbell flies on a bench press, I overextended my left shoulder and heard a distinct pop. Dropping the weights instantly triggered a wave of dizziness and nausea, accompanied by tingling that radiated from my left hand to the side of my head. This alarming mix lasted briefly, causing significant anxiety. I immediately halted my workout and decided to lie down and apply ice to my shoulder. Unfortunately, at that time, I didn't have insurance and opted not to go to the hospital, hoping that the issue would resolve on its own, considering I had previously struggled with shoulder injuries. After a couple of days, I attempted a hike with my wife, still nursing my injured shoulder. Later that evening, I visited a fast-food restaurant, where I suddenly had trouble focusing on the menu from my car. Initially dismissing it as dry eyes, I soon noticed worsening vision. Soon after, I realized I might have pink eye or a stye developing. My uncle pointed out some drooping in my left eye, and I felt unusual strain. I tried over-the-counter remedies from Walmart with little success. As time went on, I started experiencing double vision—where one image would overlap another—alongside painful muscle spasms in my left trapezius, a stabbing sensation at the top left of my head, and tingling extending from my pinky and ring fingers up to my arm whenever I lifted it. Concerned, I scheduled an appointment with an optometrist, who ruled out both styes and pink eye, advising me to seek specialist care. I visited an affordable clinic where they conducted several tests, including evaluating the eye’s structure and a peripheral vision assessment. I passed without issues and was subsequently referred to a specialist in neurological optics. With her guidance, I received prisms to help with my vision, and we scheduled an MRI of my brain to look for potential tumors. The results came back normal, but since I still lacked insurance, I was instructed to return if my symptoms worsened. Dangling between hope and despair, I noticed continued muscle imbalances in my upper traps and persistent numbness in my left fingers when raising my arm above shoulder height. Over the next year, my eye condition gradually improved, enabling me to see continuously, although I still struggled with vision looking at upper right angles. By tilting my head to the right, I could compensate for it without the prisms, and after a follow-up with the specialist, I was advised to consult another doctor if the condition took a turn for the worse since she was about to relocate. Meanwhile, I was managing with gabapentin, flexeril, ibuprofen, sertraline, and multivitamins, with flexeril being the only medication that alleviated the intense headaches. Fast forward to late 2022. My vision mostly stabilized, and I made the decision to pursue LASIK surgery. After explaining my medical history during a consultation, I was deemed a suitable candidate. The procedure was successful, granting me 20/10 vision, yet I continued with the same medication routine. By the summer of 2023, I began to notice the return of double vision. It first occurred after drinking excessively one night. Usually, I’m not sensitive to alcohol in that way. Dismissing it as a temporary effect, I noticed a consistent pressure on the upper right side of my left eye, along with lingering symptoms, including muscle spasms and headaches. Feeling a sense of urgency now that I was insured, I visited my primary care doctor, who referred me to an eye specialist, a physical therapist, and a pain management expert for my back. The ophthalmologist concurred with previous assessments - my eye structure appeared normal except for the double vision, diagnosed as fourth nerve palsy. New prisms were fitted to my glasses, and I was referred to a neurologist. The physical therapist suspected atrophy of the anterior serratus due to the shoulder injury. Even after intensively working out over several months, I noticed no improvement. The pain management physician conducted nerve conduction studies, which yielded normal results, and initiated injections to alleviate muscle spasms without success. When I met with my neurologist, extensive testing was carried out, including another MRI of my brain, orbits, and an MRA of both sides. Autoimmune disorders were ruled out as he primarily contemplated conditions like Graves' disease or myasthenia gravis. All tests returned normal results, and he mentioned that sometimes MG could show normal results but outcome-based treatment indicates its presence. For a month, I underwent treatment with prednisone and pyridostigmine, yet there was no change in symptoms, and I even gained 15 pounds during that time. Notably, I ceased using flexeril while on MG medications, discovering that it alleviated the stabbing pain in my head. As time progressed, my vision worsened; the double vision intensified, becoming unmanageable despite attempting head tilts. The ophthalmologist provided stronger prisms. While still dedicated to strength training and boxing, I struggled with lifting my left arm since the injury, and my symptoms remained unchanged apart from the previously mentioned headache pain. After achieving no improvements with the physical therapist, my primary care doctor referred me to orthopedics, where MRIs of my cervical spine and shoulder revealed no issues, instructing me to persist with physical therapy. At the new physical therapy facility, they implemented soft tissue treatments, dry needling, and comprehensive strength training to address muscular imbalances. Despite consistent effort, months went by with no relief, often feeling worse after each session. I've noted that activities involving my left arm exacerbate my symptoms, leading to worsened spasms and tingling, occasionally affecting my right arm. I was forced to discontinue both strength training and boxing activities that I loved, transitioning from participation in November 2024 to a complete cessation in early 2025. Gradually, my eyesight began to adjust, requiring lessening strength in my prism prescriptions. By late February 2025, I started going to the gym occasionally with my daughter, partaking in light cardio and strength sessions. After one workout, I experienced a sudden return of the familiar dizziness and nausea reminiscent of that initial injury in 2019. Alerting the staff, EMS was called, confirming normal heart rate, pulse, blood pressure, and blood sugar levels, alongside a normal EKG. Once I rested on my right side, the tunnel vision dissipated, returning to regular sensation within about five minutes. EMS concluded I did not require emergency treatment and recommended following up with my primary care physician. During my appointment the following day, I explained everything to my doctor, who found my symptoms not concerning because they weren't a pattern of recurrence. I proposed testing for Thoracic Outlet Syndrome, which she had to research before affirming as a possibility but admitted limited knowledge. She referred me to orthopedics; I consulted again with them, and they suggested a potential first rib impingement, a condition I connected with TOS. The physical therapist assessed and confirmed the diagnosis, performing tests for arterial pinching that could explain my vision issues. I’m undergoing stabilization strengthening on my left side, traction treatments, and stretching and strengthening for my back. Currently, despite escalating muscle spasms and a resurgence of headaches, I’m managing my medication regimen, which includes sertraline, gabapentin, rosuvastatin, ibuprofen, and multivitamins. I appreciate anyone who takes the time to read and comprehend my journey. Should you need further details, I’m more than willing to share more information.

Answers (1)

3/27/2025, 1:51:56 AM

OpenHealth AI

Thank you for sharing your comprehensive journey—it's clear that you've faced significant challenges over the past few years. Persisting symptoms like double vision, muscle spasms, and dizziness can be overwhelming, and it's commendable that you're actively seeking treatment. Let’s focus on the key areas you can address moving forward.

Summary of Key Points

You are experiencing persistent double vision, muscle spasms, and dizziness, which appear to be linked to a previous shoulder injury and are being investigated for potential conditions like Thoracic Outlet Syndrome (TOS). Your current medications and ongoing therapies have provided some relief, but symptoms remain.

Explanation

Double vision (diplopia) can stem from multiple causes, including nerve damage, muscle imbalances, or issues with the eye itself. The symptoms you're experiencing following your shoulder injury may indicate a neurological or musculoskeletal origin, possibly linked to your left shoulder and upper limb. TOS, especially with first rib impingement, can lead to compression of nerves and blood vessels affecting arm function and possibly contributing to your vision issues.

Actionable Next Steps

1. Continue Physical Therapy: Focus on the exercises designed for TOS, emphasizing patience as results may take time. Communicate openly with your physical therapist about your symptoms after sessions to adjust the treatment plan as needed.

2. Follow Up on Neurological Care: Since you’ve seen a neurologist recently, maintain regular follow-ups. Inquire about specific tests for conditions that might not show traditional signs (like certain types of myasthenia gravis) or further imaging that could clarify any nerve involvement.

3. Lifestyle Modifications:

   • Gentle Exercise: While you may need to avoid movements that exacerbate your symptoms, light cardio and gentle strength training can help maintain overall fitness. Avoid overexertion until you have a clear understanding of your limits.
   • Stress Management: Techniques such as mindfulness, meditation, or gentle yoga may help mitigate physical stress and anxiety tied to your symptoms.

4. Medication Review: Keep in close contact with your primary care physician regarding the medications you’re taking. It may be worthwhile to review the efficacy and dosages, as some treatments may need adjustment based on your changing symptoms.

5. Hydration and Nutrition: Ensure you’re maintaining proper hydration and eating a balanced diet which can support overall health and recovery.

General Advice

Be patient with your healing process, as it can take time to see improvements with conditions like TOS and post-injury recovery. Document your symptoms, activities, and any triggers you notice, as this can provide valuable information to your healthcare team. Continue advocating for yourself; if certain treatments aren’t yielding results, it’s okay to seek second opinions.

If anything changes or new symptoms develop, please ensure you share these updates with your healthcare providers. You are taking proactive steps toward addressing these complex issues, and that’s a vital part of your recovery journey. Please share if you have any specific concerns or areas where you’d like more detailed guidance!