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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
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...
These could produce nerve impingement resulting in these changes...
The question of a nerve compression injury due to sleeping too long in a bad position is also a valid question.
Such injuries can ocasionally occur for example in surgical procedures...
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...
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.
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
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
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.
Perhaps the correct source of the problem was not tested....
what would be the correct source
Well perhaps they failed to test the right set of muscles/nerves....
the doctor did many needle sticks
How is he weak currently?
What does he lack? What has changed?
his arm is not extremely weak-it is the numbness and tingling that bothers him
nothing has changed in the last several weeks
OK, where exactly does he feel this?
it is his right forearm where the tingling and numbness occurs
when i rub my hand on his arm-he can barely tolerate it
Not in the hand as well?
no-it is mainly confined to the forearm
OK that would be a hypersensitivity.
I would recommend that he consult a neurologist rather than an orthopedist here.
He sounds that he has a sensory problem that is more neurological in origin.
i don't understand-what is a sensory problem
Only his right and not his left?
only his right hand-that is the hand that he laid on several weeks ago
This is the nerve process that carries sensations to the brain....
how does a neurologist determine if is a sensory problem
It could relate to to a radiculopathy >this would be a nerve compression that originated in the neck. This sounds like a liklely source.
Nerve injuries can be motor (strength) or sensory(sensation or both (mixed....
wouldn't the mri have shown that problem
Physical testing would be the first step.
what kind of physical testing
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.
Sensory testing>> light touch, vibration, 2 point descimination, hot and cold sensation are examples...
The neurologist would examine for areas of abnormal responses.
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
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...
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...
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
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...
I can opt out and this would encourage other providers to examine your question if you would like?
that would be fine
I HAVE HAD NO RESPONSE FROM ANYONE ELSE
Let me try to refer you to one of my colleages...hold on...
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
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
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
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
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
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"