Far more often, the problem is in the neck or shoulder. The major nerves to the shoulder and arm run through the neck, and if these are compressed or damaged, then pain may feel as though it is coming from the arm. The physical exam can help sort it out, but sometimes we need imaging (X-ray, CT or MRI) to figure it out. Occasionally, nerve conduction studies or EMG tests are necessary.
DEAR DR ROACH: I am a 65-year-old man, and two weeks ago I developed a painful hemorrhoid almost overnight. I had never had hemorrhoids before.
My primary-care doctor examined me and said I had a “thrombosed hemorrhoid.” It is not very large and in the past week, the pain has diminished, but the bulging vein is still present, albeit less tender. Should I have this removed surgically, or will it eventually disappear? — S.D.
ANSWER: A hemorrhoid, a normal vascular structure, can develop a blood clot (”thrombosis”), and then can be exquisitely painful. Often, the clot is removed at the time of examination, giving immediate relief. In most cases, the clot will be reabsorbed within a few days. However, in very large hemorrhoids, occasionally surgery is necessary.
There is some suggestion that thrombosed hemorrhoids may indicate a higher risk for colorectal cancer. You should be sure that you have had a recent colonoscopy.
The booklet on Alzheimer’s disease gives a detailed presentation of this common illness. Readers can obtain a copy by writing: Dr. Roach — No. 903, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
Dr. Keith Roach is a syndicated columnist.