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Dr. Mark
Dr. Mark, Doctor (MD)
Category: Health
Satisfied Customers: 11946
Experience:  U.S. Physician/Surgeon in Neurosurgery
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pain like sensation in ring finger if arm is fully stretched

Customer Question

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Submitted: 5 years ago.
Category: Health
Expert:  Dr. Mark replied 5 years ago.
Is it only the ring finger? Which side of the ring finger (the pinky side or the thumb side, or both)?

Did the MRI of the cervical spine, brachial plexus or nerve conduction study show any abnormalities?
Customer: replied 5 years ago.
Dear Dr. Mark

In fairness to you I really think you should have the history behind this issue. I am not sure if I am allowed to go into details. It might be too much information to post here. My issue could be a mis-diagnose between shoulder versus neck/nerve issue by all my treating doctors/specialists. I was involved in a rear collision automobile accident.

I have also done MRI for shoulder in 2005, and same year a Chiropractor did some thrusting around my neck bottom part, left side, C7 or T1 region, I am not sure, and my right shoulder (top part) throbbing pain stopped next day but not grabbing pain around upper arm however; numbness and incoordination of the pinky finger was present for about 3 months before it settled. Throbbing pain came back months later and went away since then. Grabbing pain still there since 2004

If I to answer your questions directly then the current pain like sensation of the ring finger at full stretch is present at the top section of the finger and it is more towards the pinky side. I cannot duplicate the ring finger symptoms every time my arm is fully stretched.

If I bend my elbow 90 degrees and hold my arm behind my head with hand above left shoulder i.e. right shoulder pushed "West" then all fingers have the numbness sensation more strongly the thumb and along the forearm from the hand to the elbow. Again I cannot duplicate it every time I try this arm position.

1st rib elevation was suggested and treated with no avail.

Cervical spine MRI 10 Feb 2007 report:
Technique: Sagittal T1, T2, gradient echo, axial T2 and coronal T1 weighted sequences through the cervical spine, On T2 there is some straightening of the cervical spine noted with minimal loss of the normal cervical lordosis, There is noted to be disc dehydration of the cervical discs with some ossification of the posterior longitudinal ligament noted, At C3/4, there is a very mild broad based disc bulge causing no significant impingement on the thecal sac or the exiting nerve roots, At C4/5 as above, At C5/6 as above, At C6/7 there is a mild broad based disc bulge causing mild impingement on the thecal sac but no impingement on the exiting nerve roots, At C7/T1 no significant disc bulge is noted, Cervical cord appears of normal signal intensity on all sequences, Cervico-medullary junction has normal appearance, Conclusion; mild disc bulge as described but no definite evidence of impingement on the exiting nerve roots at C6/7, C7/T1 or elsewhere in the cervical spine.


12 December 2007 Nerve Conduct Study was done at a Neurologist office and I was told it is normal, couldn't print the report as PC or program playing up and report had to be manually or hand-written. It stated; The upper limb median and ulnar NCS and EMG of right C7-T1 innervated muscles were normal,
EMG studies: R triceps = 1 + polyphasia, R EDC = NAD, R FDI = NAD

I have had shoulder specialists saying it is neck issue and neck specialists saying it is shoulder issue i.e. cancelling each other......

5 May 2008 Brachial Plexus MRI report comments or summary: there is moderate cervical spondylitic change with disc desiccation from C3/4 through to C6/7. At C5/6 and C6/7 there are small to moderate broadbased left posterolateral disc protrusions encroaching on the thecal sac contents, but not causing any significant nerve or cervical spinal cord compression. No significant structural abnormality is seen in association with the right brachial plexus.

I did a bone scan on 02 June 2008 (1% radiation injection, reason for study: pain in cervical spine, right shoulder radiating down to righ arm and fingers. Dynamic and blood pool images was unremarkable. Static images: Demonstrated a triangular shaped area of moderate increase in soft tissue tracer uptake in the region of right pectoralis major which is suggestive of muscular inflammation/tear involving right pectoralis major and right serratus anterior overlying right 4th to 7th ribs. MRI correlation would be worthwhile.

I did MRI on 17 June 2008 and outcome is: Right pectoralis major and pectoralis minor muscles are normally defined. There is no evidence of abnormal signal to indicate an intramuscular haematoma or muscle strain injury. Serratus anterior muscle also defines normally. Intermuscular fat-planes are preserved. Subcutaneous tissues are also intact.

The bone scan saying MRI proves I don't have cancer even though their recommendation was for possible inflammation/tear, my GP says cancer shows as spots not shaded triangle and I don't have cancer, Bone scan saying may be I should see shoulder specialist and take medication and re-do bone scan in 2-3 months time, i.e. more exposure to radiation? I have no idea what these so-called doctors are saying.

Regards,
Tony
Expert:  Dr. Mark replied 5 years ago.
This is a lot of information.

The problems with the thumb suggest a C6 nerve root irritation. The ring finger could be C7 or C8 nerve root.

The slight polyphasia on EMG in the right triceps could narrow down the culprit to C7.

The problem is the MRI does not correspond with the clinical symptoms at C6/7:

"At C6/7 there is a mild broad based disc bulge causing mild impingement on the thecal sac but no impingement on the exiting nerve roots"

Because while you may have a disc bulge, it does not impinge on the nerve root, specifically the right side.

Given your symptoms, it seems as if you are getting transient irritation of either the C6 or C7 nerve root, and unlikely to be muscle related or shoulder related. Unfortunately, none of the tests that have been done can definitively point to a source of the problem.
Dr. Mark, Doctor (MD)
Category: Health
Satisfied Customers: 11946
Experience: U.S. Physician/Surgeon in Neurosurgery
Dr. Mark and 3 other Health Specialists are ready to help you
Customer: replied 5 years ago.
What is transient irritation mean exactly?
-- In your opinion is there anything left that should be looked at or examined differently or re-examined?

-- Is it possible Brachial Plexus MRI is not accurate or not fully revealing tissue scar or muscle stranglation of blood vessle? Is this conclusive to rule out TOS (Thoracic Outlet Syndrom)?

-- Does Cervical Spine + Brachial Plexus + NCS cover examination of nerves at all levels?

-- Should I get the Labral examined and/or Bicipital tendon checked?

-- Or is it possible I have degenerative shoulder issue with rotator cuff bursitis, or whiplash to neck which radiological studies cannot reveal? or is it possible I had issue with perpherial nerve but has re-generated and thus symptoms somewhat are vague?

Regards,
Tony
Expert:  Dr. Mark replied 5 years ago.
What is transient irritation mean exactly?

Means with certain positions of the arm/neck - nerve compression can occur, and with other positions, the nerve may be free.

-- In your opinion is there anything left that should be looked at or examined differently or re-examined?

You've undergone all the studies to look at these symptoms.

-- Is it possible Brachial Plexus MRI is not accurate or not fully revealing tissue scar or muscle stranglation of blood vessle? Is this conclusive to rule out TOS (Thoracic Outlet Syndrom)?

MRI may or may not have taken a good picture of that area (it really depends on the scan quality). good scan quality MRIs should be able to see signs suggestive of TOS, though the diangosis is based on the clinical symptoms and exam.

-- Does Cervical Spine + Brachial Plexus + NCS cover examination of nerves at all levels?

Yes, along with the EMG, you have covered the nerves starting from the nerve roots all the way out to the peripheral nerves.

-- Should I get the Labral examined and/or Bicipital tendon checked?

You can, but I'm not sure they would be the cause of pain in your fingers.

-- Or is it possible I have degenerative shoulder issue with rotator cuff bursitis, or whiplash to neck which radiological studies cannot reveal? or is it possible I had issue with perpherial nerve but has re-generated and thus symptoms somewhat are vague?

Perhaps you may have a component of shoulder pathology and whiplash, but your examinations seem to point out to a C7 possible cause, though nothing is glaringly obvious.
Customer: replied 5 years ago.
Thank you for your informative answers

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