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Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5364
Experience:  American Board Certified Neurologist, Internal Medicine
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Hi, I have pain in my left shoulder blade,elbow and my left

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Hi, I have pain in my left shoulder blade,elbow and my left hand has its thumb, pointer and middle finger numb. Sometimes it goes into pins and needles but mostly it is numb. I have heniated discs in C4,5 and c5,6. Usually i only get a shooting sensation down an arm which is more like a scratch that lasts a second or two. The shoulder blade became very sore initially to sleep on , so i just lay on my side, then the elbow would ache and then the hand would be get pins and needles- not continuously just if i had my arm in certain positions. Now it is constant and the pain can be excruciating like a burning sensation even though the fingers arm numb. I went to chiropractor who did the back and neck reallignment , but symptoms got worse, that was 5 days ago. I have tried ice, neck traction, and inversion table- please help

Dr Sathya :

Hi

Dr Sathya :

This is Dr Sathya and I am very glad to help you with your question.

Dr Sathya :

Have you tried other treatments like ESI (epidural steroid injection) or nerve-pain pills?

Dr Sathya :

For the hand & finger symptoms (which could be from the pinched spinal nerves) have they also ruled out CTS (carpal tunnel syndrome)? I am sking like this because even CTS can produce these hand & finger symptoms. Some patients with cervical spine (neck spine) conditions like pinched nerve also have CTS.

Dr Sathya :

sorry for the typo above - I actually meant "I am asking" (not "I am sking")

Dr Sathya :

Take your time and when you are ready type your reply in the below “chat box” and then hit the “enter” button on your computer keyboard.

Dr Sathya :

Are you encountering any technical problems in accessing this chat or in posting your message here?

Dr Sathya :

Take your time.

Customer:

No I haven't tried ESI, the pain starts in my shoulder blade- like theres something between my blade and ribs then travels to my arm pit then arm , hands. I have had an MRI which shows the herniated discs C4-5 and C5-6. Would these seem to be the most logical causes as if I stretch my chin to my chest this seems to accentuate the symptoms? Would the ESI then be a better way to treat the problem?

Dr Sathya :

Okay I am going through these details now.

Dr Sathya :

This is a good point you are mentioning

Dr Sathya :

Do you experience any neck pain, or no neck pain at all?

Dr Sathya :

I am asking the above question to make sure whether this is just the pinched nerve in the neck or something else at the shoulder blade level.

Dr Sathya :

Take your time.

Dr Sathya :

Are you encountering any technical problems in accessing this chat or posting your message?

Dr Sathya :

It appears you are facing some technical difficulties to access this chat so what I will do now is switch this chat format to Q & A format hoping that you may be able to access my above question through that format at least. Please answer it when you get some time and then we will discuss further about your case in more detail (the possibilities to explain your symptoms, the treatment options etc).

Customer: replied 4 years ago.
Very limited neck pain is experienced, sometimes a sharp instant pain but then nothing.Like I said moving my neck forward seems to pull on my shoulder blade, and where my lat connects under my shoulder/arm pit area and tricep. My pointer finger seems the most numb of the three fingers.

Okay based on these additional info I feel you may be suffering from a condition called as TOS.

 

TOS (thoracic outlet syndrome) is a condition where compression of the nerves supplying the upper limb takes place at an area called thoracic outlet. This area corresponds roughly to the upper chest, lower neck & the shoulder areas. This is an area where compression of the nerves supplying the upper limb may take place and this condition will present with pain in the shoulder/shoulder blade area that radiates down the arm to the hand & fingers. Neck movements too can trigger or worsen these symptoms. Since you mentioned bending the neck seems to precipitate or worsen your symptoms so I am suspecting TOS possibility too (especially considering you are not having much neck pain too). The nerves in the thoracic outlet area get compressed by structural problems like a ligament band, an extra rib called cervical rib, thickened muscle or other soft tissues in that area causing the compression & the symptoms.

 

You need investigations including an MRI specially to look at Thoracic outlet area and an EMG/Nerve conduction study (a nerve & muscle test) to confirm the diagnosis. The EMG test can look for TOS, pinched spinal nerve & CTS etc (one test that looks for all possibilities) and the MRI of the thoracic outlet will show whether there is any structural pathologies in that area causing the TOS (if you indeed have this condition).

 

Once a final diagnosis is made appropriate treatment will be started. If you indeed have TOS then depending upon the mri result you may need a decompression surgery (to decompress the compressed nerves). If you have pinched spinal nerves based on emg test then ESI can help (even if neck pain absent). If CTS is too present it will be treated appropriately (CTS brace or splint using etc). For the pain and other symptoms you may also use nerve-pain pills like Gabapentin or Amitriptyline. A muscle relaxant like Baclofen or Tizanidine too may help for symptoms like soreness.

 

You may please discuss all these above points with your clinic-drs, preferably with a neurologist for the further needful (clinical evaluation/examination, investigations like MRI of thoracic outlet area and EMG test etc) and once a final diagnosis is made it will be treated appropriately including the above mentioned symptomatic treatments.

 

Please go through the above information and ask me if you have any further questions. If you feel you have received the information you are looking for and feel satisfied with my answer click on the smiley face to compensate me for the time and effort put by me in answering your question.

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