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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 22115
Experience:  Over 20 yrs of Family Practice
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I HAVE A QUESTION-IT IS RATHER LONG AND COMPLICATED BUT I

Customer Question

I HAVE A QUESTION-IT IS RATHER LONG AND COMPLICATED BUT I NEED YOUR OPINION MY HUSBAND SLEPT ON HIS RIGHT HAND 8 OR 9 WEEKS AGO-IT WOKE HIM FROM A DEEP SLEEP-IN THE NEXT COUPLE OF DAYS HE EXPERIENCED TINGLING AND NUMBNESS IN THE RIGHT HAND-HE FIRST WENT TO HIS MEDICAL DOCTOR TO MAKE SURE IT WAS NOTHING MEDICALLY WRONG-HE REFERRED HIM TO AN ORTHOPEDIC PHYSICIAN. This physician performed x-rays of the neck and an MRI-both tests indicated arthritis which was no big surprise because he has a history of osteo and rheumatoid. He also did an arthrogram which was negative. Along with all that he did an emg which showed no significant changes from the past one performed last year when had carpal tunnel/ulnar nerve (surgery) do you have an idea what could be wrong with the arm-he does have weakening in his right arm any suggestions would be greatly appreciated because his doctor can't figure it out


 


the mri showed the following -sponydolitic changes narrow the exiting foramen C4-C-5 bilaterally CS-C6 left and C6-C& right


 


x-rays showed considerable degenerative change from C4-C7

Submitted: 2 years ago.
Category: Health
Expert:  Anthony Bray, MD replied 2 years ago.

Anthony Bray MD :

Hello!

Anthony Bray MD :

The narrowing of the foramen and the degenerative changes in the neck COULD be an explanation for the weakness that he has experienced in his right arm...

Anthony Bray MD :

These could produce nerve impingement resulting in these changes...

Anthony Bray MD :

The question of a nerve compression injury due to sleeping too long in a bad position is also a valid question.

Anthony Bray MD :

Such injuries can ocasionally occur for example in surgical procedures...

Anthony Bray MD :

You might have a neurologist evaluate his progress over time and the distribution of his symptoms as compared to his sleep position vs the MRI findings. This will probably give the answer in time...

Anthony Bray MD :

He would be more likley to see improvement in symptoms from a brief compression of a nerve during sleep than in an ongoing problem such as a compresion within the neck.

Anthony Bray MD :

I hope this helps. Let me know if you have further questions. If my answeer has been helpful and to your satisfaction then please remember to press the "ACCEPT" button. Thank You and Best Regards,

Anthony Bray MD :

Anthony Bray MD

Customer :

i would think that the emg would have shown any problem with nerve compression-the emg was normally according to the orthopedic surgeron so that kind of rules out the nerve problem

Anthony Bray MD :

I agree that you would expect the EMG to be abnormal if he has weakness. I do not have a good explanation for this descrepancy.

Anthony Bray MD :

Perhaps the correct source of the problem was not tested....

Customer :

what would be the correct source

Anthony Bray MD :

Well perhaps they failed to test the right set of muscles/nerves....

Customer :

the doctor did many needle sticks

Anthony Bray MD :

How is he weak currently?

Anthony Bray MD :

What does he lack? What has changed?

Customer :

his arm is not extremely weak-it is the numbness and tingling that bothers him

Customer :

nothing has changed in the last several weeks

Anthony Bray MD :

OK, where exactly does he feel this?

Customer :

it is his right forearm where the tingling and numbness occurs

Customer :

when i rub my hand on his arm-he can barely tolerate it

Anthony Bray MD :

Not in the hand as well?

Customer :

no-it is mainly confined to the forearm

Anthony Bray MD :

OK that would be a hypersensitivity.

Anthony Bray MD :

I would recommend that he consult a neurologist rather than an orthopedist here.

Anthony Bray MD :

He sounds that he has a sensory problem that is more neurological in origin.

Customer :

i don't understand-what is a sensory problem

Anthony Bray MD :

Only his right and not his left?

Customer :

only his right hand-that is the hand that he laid on several weeks ago

Anthony Bray MD :

This is the nerve process that carries sensations to the brain....

Customer :

how does a neurologist determine if is a sensory problem

Anthony Bray MD :

It could relate to to a radiculopathy >this would be a nerve compression that originated in the neck. This sounds like a liklely source.

Anthony Bray MD :

Nerve injuries can be motor (strength) or sensory(sensation or both (mixed....

Customer :

wouldn't the mri have shown that problem

Anthony Bray MD :

Physical testing would be the first step.

Customer :

what kind of physical testing

Anthony Bray MD :

There are abnormalities in the report that might explain his symptom. Have a neurologist actually examine a copy of the MRI report and examine him as the next step. That is how i think you should proceeed.

Anthony Bray MD :

Sensory testing>> light touch, vibration, 2 point descimination, hot and cold sensation are examples...

Anthony Bray MD :

The neurologist would examine for areas of abnormal responses.

Customer :

i can tell you one thing-his right hand which is the source of the problem is always extremely cold and i do mean cold-the orthopedic surgeon has tested him to some extent for the touch part-he does have feeling in the arm and hand-it just tingles

Anthony Bray MD :

The tingling sensation is called medically "paresthesia" . The cold part can be due to temperature regulation of the skin which goes back to a possible neurological origin vs a circulatory issue...

Anthony Bray MD :

A cervical support pillow to help keep his neck in a more neutral position at night during sleep may be of some help to him and it would not hurt anything...

Customer :

okay-not the answer i was looking for because i still have no clue as to what is actually wrong with his arm-you sound kind of like his doctor because she doesn't know what the exact problem is either despite all the testing

Anthony Bray MD :

Well it is hard to imposssible to give you any exact diagnosis without being able to examine him and see his test results. I try to be helpful but there are just limits. Sorry if I have left you disappointed...

Anthony Bray MD :

I can opt out and this would encourage other providers to examine your question if you would like?

Customer :

that would be fine

Customer :

I HAVE HAD NO RESPONSE FROM ANYONE ELSE

Anthony Bray MD :

Let me try to refer you to one of my colleages...hold on...

Expert:  Dr. Chip replied 2 years ago.
Hi--exactly what part of the hand is having the symptoms and was an MRI of the neck and brain considered?
Customer: replied 2 years ago.

THE FOREARM PART OF THE HAND IS WHERE THE TINGLING AND NUMBNESS OCCURS-IF I RUB MY HAND ON HIM HE CLAIMS LIKE IT PINS AND NEEDLE FEELING

AN MRI OF THE CERVICAL SPINE WAS PERFORMED AND SHOWED

SPONDOYLITIC CHANGES NARROW THE EXITING FOREAMEN C-4, C-5 BILATERALLY C-5 AND c-7 RIGHT

 

MY HUSBAND IS POSITIVE IS HAS TO DO WITH THE NERVE IN HIS ARM

BUT THE EMG WAS NORMAL

Expert:  Dr. Chip replied 2 years ago.
And what did the neurologist have to say?
Customer: replied 2 years ago.
WE HAVE NOT SEEN A NEUROLOGIST-THE PRIMARY PHYSICIAN REFERRED HIM TO AN ORTHOPEDIC SURGEON, THEY WERE THE ONES WHO ORDERED THE X-RAYS OF THE NECK AND THE MRI AND DID THE EMG
Expert:  Dr. Chip replied 2 years ago.
So a neurologist never interpreted the exam? Was it just an EMG or was a nerve conduction study also done?
Customer: replied 2 years ago.

NO, IT WAS DONE BY AN ORTHOPEDIC SURGEON WHO IS BOARD CERTIFIED IN "emg"

 

I AM NOT SURE IF IT WAS BOTH-IT INVOLVED STICKING OF NEEDLES AND A FEELING OF ELECTRICAL SHOCK

Expert:  Dr. Chip replied 2 years ago.
OK--i think an overread of the testing is warranted since it would me unusual, unless perhaps we're talking about multiple sclerosis or even a stroke, for there to be a completely normal testing with these symptoms
Customer: replied 2 years ago.

ACCORDING TO HIS MEDICAL DOCTOR, THERE WAS NOTHING MEDICALLY WRONG WHEN HE REFERRED HIM TO THE ORTHOPEDIC PHYSICIAN

AND WHAT DO YOU MEAN BY OVERREAD OF THE TEST.

HE DID HAVE A STROKE IN JULY BUT THE STROKE DID NOT AFFECT HIS RIGHT ARM

Expert:  Dr. Chip replied 2 years ago.
I think he should actually see a neurologist and bring the test with him. And if he had a stroke in the past, he's at risk for having another.
Customer: replied 2 years ago.

I REALIZE HE WILL ALWAYS BE AT A RISK FOR A STROKE-THAT IS WHY HE CURRENT ON A BLOOD THINNER AND CHOLESTEROL MEDICATION

PER HIS MEDICAL DOCTOR THE STROKE HAS NOTHING TO DO WITH THE PROBLEM. THIS PROBLEM DID NOT OCCUR UNTIL HE SLEEP ON HIS HAND INCORRECTLY AND WOKE UP FROM A DEEP SLEEP IN PAIN

THEN IN THE NEXT COUPLE OF DAYS HE EXPERIENCE THE NUMBNESS AND TINGLIN

Expert:  Dr. Chip replied 2 years ago.
Not saying it's from a stroke, but if he had a stroke in one area of the brain, another could occur in a different area. If he just slept wrong on the hand and compressed the nerve, that should be resolving itself by now, and still something should have shown up on the test.
Customer: replied 2 years ago.

ANOTHER COULD OCCUR-ONCE AGAIN WE BOTH REALIZE THE FACT BUT THE MEDICAL PHYSICIAN IS SURE THIS PROBLEM HAD NOTHING TO DO WITH THE STROKE AND LIKE I HAVE SAID NOTHING SHOWS UP ON ANY OF THE TESTS

SO WE ARE LEFT WITH NOTHING EXCEPT A LOT OF DOCTORS GUESSING ON WHAT COULD BE WRONG

Customer: replied 2 years ago.

ANOTHER COULD OCCUR-ONCE AGAIN WE BOTH REALIZE THE FACT BUT THE MEDICAL PHYSICIAN IS SURE THIS PROBLEM HAD NOTHING TO DO WITH THE STROKE AND LIKE I HAVE SAID NOTHING SHOWS UP ON ANY OF THE TESTS

SO WE ARE LEFT WITH NOTHING EXCEPT A LOT OF DOCTORS GUESSING ON WHAT COULD BE WRONG AND WE THOUGHT WE WOULD ASK THE "EXPERTS"

Expert:  Dr. Chip replied 2 years ago.
Well, it's not so much guessing as only being able to take what information you provide and offering possible causes, and it isn't often that I can give a for certain diagnosis. All I'm saying is that the possibility of a completely normal test with these symptoms, while there, is highly unlikely and it is possible that a repeat test or another opinion as to the results of the present one may show the problem. All the same, I'd still get an MRI of the brain.

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