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Dr. Mark
Dr. Mark, Physician / Surgeon
Category: Medical
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Experience:  U.S. Surgeon / Neurological Surgery
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Severe pain in right shoulder, right upper arm, and tingling

Resolved Question:

For 4 years: Severe pain in right shoulder, right upper arm, and tingling in lower arm and fingers. MRI's of area have been looked at by two neurosurgeons who cannot correlate the pain on the right side with slight compression C5/C6 and C6/C7 on the LEFT side. Brain MRI shows no lesions so MS is ruled out. Conductivity tests for nerves show no damage and diagnosis is that pain is not neuropathic. Where do I go from here? Pain killers (Lyrica) have no effect on the pain at all.
Submitted: 6 years ago.
Category: Medical
Expert:  Dr. Mark replied 6 years ago.
Which fingers are affected?

I assume your nerve tests included a "EMG" -- where needles were stuck into your muscles.

How long have you had this pain? Did it start suddenly? Do you have weakness in your arm?
Customer: replied 6 years ago.
Right thumb, index and middle finger. Pain started gradually 4 years ago but it's been constant now for 3 years. Weakness in right arm (not too severe). Weakness (wobbly feeling) also in legs which started about 6 months ago.
Yes - needles were stuck in my arm and electric shocks sent through wires.
Expert:  Dr. Mark replied 6 years ago.

Well, issues with pain that travels down into the thumb, index, and middle fingers would suggest a C6 nerve root irritation (thumb, index finger) and C7 (middle finger).

Of course, if your pain has been going on for three years, the EMG testing would have likely showed some issues with nerve injury in those distributions.

If there were cervical spine issues causing this - it would be from a C5-6 and C6-7 disc herniation. Also to be examined on the MRI would be for evidence of "foraminal" stenosis on the right side at those levels.

Unfortunately, it appears you have had much of the conservative therapy so far -- one thing that hasn't been tried are epidural steroid injections and nerve blocks in that area, to see if your pain improves. And a new MRI for evaluation if your MRI is significantly old (more than a year).
Customer: replied 6 years ago.
MRI only shows congenital canal stenosis. Mild to moderate degenerative spondylosis throught cervical spine. Should I be investigating Lupus? Fibromylagia (spelling?), or anything else? Why is not possible to diagnose where this pain is coming from?
If I do have stroid injections, how long will the effect last? Thank you for at least giving me another option to deal with pain (even if I don't want to go the steroid route!).
Expert:  Dr. Mark replied 6 years ago.
Well -- those conditions generally wouldn't tend to cause such specific pains -- as you are describing (e.g. into certain fingers, but leaving others fine).

With steroid injections it's hard to say -- because if the pain is coming from the spine, you could get good relief for weeks to months. But if the pain is coming from elsewhere, then you may not have relief at all.

And one other possibility would be a brachial plexus neuropathy, which could cause pain in specific distributions:

but generally this would also cause EMG abnormalities.
Customer: replied 6 years ago.
Thank you! I've got a million other questions, but since I'm not paying much, and you've given me more info than I had before, I'll let you go to answer other patients' questions! Much appreciate your time.
Expert:  Dr. Mark replied 6 years ago.
You're welcome.

Best of luck to you. (Hitting the "ACCEPT" button would be appreciated).
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