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Puncture
to nerve in inner elbow area |
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I
was in for a routine physical on March 29th. And upon
a blood draw I experienced intense pain shooting to my
left hand. I thought right away it was my nerve. The lady
that took the blood said she had never experienced that
either. I have been seeing an intern and he had his dad
who semi-retired and is a neurologist do a nerve conduction
test last Wednesday. The test came out negative. I have
numbness in my hand and fingers I have had what my therapist
call a lot of trigger points in all areas of my lower
and upper arm all the way to my underarm. I have been
going to therapy for three weeks being treated with heat
and electro therapy. Should I be as concerned as I'm on
Vioxx for the inflammation if I don't take it by the end
of the day my arm is clinched so close to my side because
my whole arm hurts. Is there another test I should have
done? Should I continue the therapy and give it time?
Would an MRI tell me what is going on in there, could
she have got a tendon also? I thought I should give you
all of my symptoms. It started with tingling in my hand
and fingers shortly after it happened. The tingling started
spreading up my arm and I started getting increased discomfort
in my elbow area. Within 5 day's the muscles in my arm
started hurting. Today my fingers are numb and are very
sore and stiff. My muscles in my underarm hurt a great
deal as well as my forearm and bicep. The discomfort in
my arm changes spots. The pain in my fingers is consistent
I'm sorry to post twice before a response but I just found
this forum and I have been searching for answers to insure
I am getting the right treatment. I have never had something
like this. It's been a month. I have been told it takes
a long time for nerves to heal. I guess I just want to
know how long, and is it my nerve. Will an MRI show what
it is or would you recommend an EMG? Thanks so much, I'm
scared! Thank you for any advises you can give me. |
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Answer |
According
to your symptoms, it seems like a nerve lesion by injury
or pressure, probably the median nerve was injured during
needle puncture. I wonder did you have an EMG needle examination
of the muscles or just nerve conduction studies. If it
is so, then I think you need to see your neurologist again
to do (or repeat) EMG needle examination of the muscles,
which should be helpful to exclude nerve lesion and its
degree. I think the EMG is more helpful in your case than
MRI.
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Comment |
I
went to a Neurologist yesterday and was diagnosed with
a median nerve lesion. I have been treated for 6 weeks
for ulnar neuropathy. Lots of therapy and taking Vioxx
but I still had a lot of pain. You suggested I see a neurologist
and get an EMG. I found a sharp Dr. and the Dr. agreed
he will be doing the test on the 22 of May.
My question is He gave me a prescription for Neurontin,
I was wondering if it will interfere with the test in
any way.
I am very thankful for this forum and for all your help.
I will keep you posted. I still have a great deal of pain
in my whole arm and I hope the Neurontin will help. |
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Answer |
I
hope all the best for you and to get well soon. About
the Neurontin, it does not interfere with EMG test at
all. |
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Comment |
Hello
Dr., I have appreciated all of your advise in the past.
I went to the Neurologist Wednesday he does believe I
have a Median Nerve lesion. He did a nerve conduction
test and told me it did not show any concerns of permanent
nerve damage or motor skill damage. He has me on Neurontin,
I am up to 4x/300mg per day. I was told He does believe
I have pain and that the nerve will take time to heal.
I was very relieved to hear that and left his office feeling
good, then when I got home I started thinking why did
nothing show up when I have so much pain.
The pain is mostly in my finger index, middle, and ring
finger. If I wait to long before I take the medicine I
have a lot of discomfort in my elbow and lower arm.
The Doctor said, “be patient”. Those nerves
heal an inch a Month.
I called the office back today and asked if he would send
me for an MRI and he had the nurse tell me he would not
OK it. I was hoping I would have someone tell me exactly
what is happening in there.
Should I just give it time he wants me back in 2 Months.
Thank you in advance, |
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Answer |
Thank
you. I am pleased that you feel better. All the best |
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Comment
poster later
from same
Patient |
I
have post several times in the past and you have been
very helpful. I currently am healing I hope from a puncture
during a blood draw. I am concerned and have asked my
Doctor about a tingling in my cheek that started shortly
after the injury. It is not always there and changes to
different areas of my left cheek. The elbow that was injured
is my left elbow. It has been 5 months.
Is this something that can happen when you have an
injury of this kind?
I have the physical therapist tell me everything is
connected and as long as I take the Neurontin I am on
regularly it is not as noticeable.
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Answer |
I
cannot see a relationship between the problem at the elbow
and the tingling in your cheek. I am not sure why do you
have cheek tingling. It seems coincidental. |
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Comment |
I
got my injury to my nerve back at the end of March (blood
draw, elbow). I have had a lot of different stages of
healing, and strange feelings at different times. I get
jabs and pains in my fingers but I also get jabs and pains
in my toes. Do you think this is all a normal part of
healing? I had an EMG in May and I was told it did not
show any sign of Permanente damage.
Should I have another test done? I am on Neurontin
600 mgs three times a day. I get these pains if I go
to long between doses.
Should I get another EMG?
Is this normal?
Should I see another Doctor?
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Answer |
I
can understand the pain in the fingers but not the pains
in the toes. Therefore, it would be good idea to consult
another doctor before you proceed to another EMG. |
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Comment |
I
have posted before and you have given me good advice.
I the best advise you gave me was to see another Doctor.
I did and was given diagnoses of Venipuncture RSD, are
you at all familiar with this? I am hoping I have not
waited to long to get the right Doctor. I have had two
visits with Dr. who is in Florida and he has treated RSD
in patients for 30 years. I feel I am getting the proper
treatment although he has said that my type of RSD is
the most vicious type to have. He has me on 4 medications
and I am in Physical therapy and I am using a heat pad
and feel somewhat better. I have stopped taking the Neurontin
that was making me very tired all the time and that caused
me to gain 20 lbs. in 8 months. I have a very scary health
problem that might be with me for life.
I had told you and you asked me to keep you posted
so I am doing that. I hope that if there are other patients
out there that don't feel the Doctor understands their
pain that they get other help and with someone that
knows about RSD.
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Curious
about electrodiagnostic study for CTS |
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Hello,
I'm going to take the EMG / Nerve conduction study in
a couple of days for carpal tunnel. I was just curious
in how big the needles are, and how far the needles are
inserted. And how thick they are. I hate needles and I'm
really afraid to take this test, so any information to
help me prepare myself would be appreciated. Thank you
so much. |
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Answer |
In
your case of carpal tunnel syndrome, the diagnosis is
dependent on electrodiagnostic tests. Think that the test
will help to reduce your suffering and does not hurt.
One more point, needle electrode examination is not always
performed in such case, depends on the symptoms and signs.
The electrode (needle), in your case, is quite thin like
a small pin (even thinner) and its length is about 2 cm
for hand muscles and very little of the electrode is inserted.
Good luck. |
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Comment |
Thanks
for the reply. And they are going to do both studies,
needle and just the normal nerve conduction study. But
if the needle isn’t that big I should be okay. But
once the needle is in, does it move around inside the
muscle, if so wouldn’t that be a tremendous amount
of pain? Thanks for any information that you give. Everything
is greatly appreciated. |
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Answer |
Thank
you. Once the needle electrode is in, it does not, actually,
hurt more than that, but we do move the electrode little
bit inside. |
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Comment |
I
took the test today and it was pretty painful. But the
doctor said that he didn’t really see damage but
was going to look over and calculate everything. I know
I have the pain, and every symptom of carpal tunnel. So
if it does come out negative, what do you think the next
step will be? Is it possible for it to come out negative
when it’s really positive? It’s just that this
is a workman’s comp claim and it’s been on hold,
and they I guess need some kind of solid proof that something
is wrong. Only I know how much pain it is. But thanks
again for the advise. |
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Tingling
and numbness in both hands, is EMG important? |
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I
have recently had tingling and numbness in both of my
hands. It gets extremely painful at night. I woke up one
morning and my left hand was totally numb and it took
over an hour for feeling to return. Blood tests that I
have had in the past (unrelated to this) have had some
form of indication of possible lupus or other disease
as the doctors ask to do another test that will rule out
these things. When the tests are run, the results are
OK. I am being scheduled for an EMG for the hands and
the information in your forum has been very helpful in
knowing what that is all about. I'm just wondering if
these blood tests are telling us something and we're just
missing what it is? There is also extreme cramping in
the hands and feet. Thanking you in advance for any reply.
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Answer |
I
believe that your doctor is working in the right direction
to reach a diagnosis. The EMG study, however, should be
very valuable to rule out any nerve entrapment at the
wrist (carpal tunnel syndrome), as your symptoms do really
suggest that.
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Prognosis
of severe Carpal Tunnel Syndrome & repetitive motion
syndromes |
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I
had bilateral Carpal Tunnel Syndrome surgery, and a right
DeQuervain's syndrome surgery with a ganglion cyst removed
at the right carpal tunnel region back in April 1994.
My right hand has not been the same since. My Left hand
recovered fine. For the past few years, it has been getting
progressively worse. I recently talked to my doctor about
the problem, and she sent me to have another EMG. Conclusions
were 1. Mild to moderate delay of right median motor and
sensory latency consistent with right Carpal Tunnel Syndrome.
2. Chronic denervation and giant fasciculation suggestive
of injury or continued irritation of right distal median
at the wrist of the branch to thenar muscles. The problem
I'm having is in my thumb pad and my ability to grip,
hold and open things. I am having really painful muscle
fasciculation in my thumb pad. At times, my right hand
and fingers start having really painful charlie horse
symptoms - cramps - sudden tightening of the muscle involuntary
twisting movements, and uncontrollable hand motions. Any
reason I may be having this? What are my chances that
surgery will help? Please give me some advice. This is
really affecting my life. |
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Answer |
DEQUERVAIN'S
SYNDROME is an inflammation of tendons that control movement
of your thumb, caused by repetitive actions where the
thumb is required to move up and down, such using a computer
keyboard. It leads to pain and swelling along the thumb
side. Rest and cold therapy (to reduce swelling initially)
can help, as well as splints. Your symptoms sound like
a combination of the DEQUERVAIN'S SYNDROME and CTS. The
splint can, anyhow, help both. However, regarding the
surgery, you may benefit, but it is the decision of your
doctor or the surgeon.
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Comment |
Thank
you for helping me understand what my symptoms mean. I
had a EMG/NCS (Needle)(Nerve Conduction Study) last week,
and I did go see a surgeon, and they want me to have surgery
again, but I am hesitant. I went through a lot back in
1994, and had to give up a good job because of all this.
I worked in a factory as a machine packer, packing 300
sweet-tarts per minute, and picking up / gripping (using
my index finger and thumb) each box putting them on the
conveyer belt. I developed DeQuervain’s syndrome,
CTS, and a massive ganglion cyst due to this repetitive
work. My doctor diagnosed me with repetition motion syndrome.
I stayed off work for 6 years due to this injury.
I figured I would try and find a job this past year, and
work part time. I wanted to gradually get back to work,
and get use to using my hands again. The job I took was
just part time 4 hours a day doing light data entry. That
is when I started noticing my right hand having really
painful muscle fasciculations in my thumb pad. At times,
my right hand and fingers started having really painful
charlie horse symptoms - cramps - sudden tightening of
the muscle involuntary twisting movements, and uncontrollable
hand motions. One other thing that started was my hand
would get so cold, and lose all of it’s feeling,
where I couldn’t even feel my hand. Like it was dead.
The rest of my arm past my wrist was normal temperature.
This has been getting progressively worse over the past
year. You can feel my left hand and it is normal temperature
warm, and my right hand is ice cold. I also find it very
hard to write, and after holding a pencil or pen for very
long, my hand starts having painful cramps and gets ice
cold and becomes lifeless. I find it challenging to drive
a car, open doors, pick up my grand daughter and a lot
other daily activities are almost impossible.
May be all these new problems are because I’ve
tried to go back to work, and my hand isn’t use
do this type of use. My concerns are: do I keep trying
to work? I don’t want sound over concerned about
all this but my doctor back in 1994 told me he thought
I might have waited too long in seeking advice and it
may have caused permanent damage. After the testing
last week my doctor said my muscles at the base of the
thumb are starting atrophy and some of my sensation
is permanently lost. All this is so discouraging and
frustrating! Why is this happening? Am I going to loose
total use of my right hand? Why do more problems keep
arising?
I use Dragon Naturally Speaking preferred edition,
which can understand non-technical English, spoken at
a natural pace, at a very high recognition rate. Dragon
Systems http://www.dragonsys.com/
For Web browsing, I use a program called Conversa Web,
which is specifically designed for voice operated Web
navigation. You can simply read off any link that you
want to click. Conversational Computing Corporation
http://www.conversa.com/
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Answer |
As
you said, you have long standing problem causing your
symptoms. However, the idea of the surgery in your case
to salvage as much as possible what is remaining of the
median nerve. The surgery should also stop the pain. But
the return of sensation after surgery takes quite long
time to recover, if any, all depends on the degree of
damage prior to surgery. That is, I believe, why your
doctor is after doing the surgery for CTS again. You may
go to work but in very gradual fashion afterwards. |
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CTS
and Thoracic outlet syndrome? |
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I
am concerned that my CTS might indeed be TSO, I have heard
they can be confused, would an EMG be a tool to arrive
at a definitive distinction? If not in your opinion what
would be a useful diagnostic tool? |
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Answer |
Thank
you. Careful history, symptoms and signs can often differentiate
between them. Also, the electromyographer can quite easily
tell between CTS or thoracic outlet syndrome (TOS) by
nerve conduction tests and EMG. It is the best diagnostic
tool to diagnose either. However, you may need other investigations
(radiology) to see if there is extra rib (cervical rib)
that could be the cause of TOS. Practically, CTS is very
very common while TOS is very rare.
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Elbow
brace wearing in ulnar entrapment |
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I
just had an EMG and the Doctor told me that I had a severe
pinching of the ulnar nerve. I have had numbness in two
fingers since Christmas. Having difficulty picking things
up and typing. He suggested I wear an elbow brace for
one month and see him again. My question is what are the
chances that a brace will work? Has it worked for anyone?
Won't I be able to tell if it is working by the feeling
in my fingers? If the brace does not work and surgery
is required, how long is recuperation? We are going to
Scotland to golf in April and I sure would like to be
healed by then. Thanks for any information. |
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Answer |
EMG result
should be taken into consideration, among other factors,
before we could say anything about recovery time or surgery.
However, in general if the ulnar nerve compression is
mild then you would feel that brace works perhaps in a
week or two by having less or disappearance of numbness.
But if the lesion is severe, it takes longer time, months
(variable according to severity), or it might not work
then it is the decision of the surgeon. |
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Partial
hand sensory loss after fractured 5th metacarpal |
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My
son was in an MVA fracturing the base of his fifth metacarpal
on his dominant hand. Sensory deprivation in ulnar nerve
distribution of right dominant hand below the wrist. Protective
sensation absent, although NCV and EMG findings report
nerve is healed. He is now having difficulty with 4th
and 5th digital adduction and MP flexion with IP extension.
If the EMGs and NCVs are normal what would be an explanation
for his sensory loss and progressive motor loss? an aneurysm?
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Answer |
I am not
too sure whether the problem is in the ulnar nerve or
digit bones. I am inclined from your description to say
that it is NOT the ulnar nerve, as its study is normal.
But to explain the sensory loss, it may be due to very
distal lesion of digital sensory nerves that could be
missed by standard studies.
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Comment |
Thanks
for your prompt reply; What test other than standard EMG/NCV
would be appropriate? |
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Answer |
I
would not have other tests or to suggest any. Just a careful
neurological examination of the power and sensation should
be very helpful to rule in/out any sensory loss or motor
weakness. |
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Really
painful muscle fasciculation in my thumb pad involuntary
twisting & CTS |
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I
had a EMG/NCS (Needle)(Nerve Conduction Study) in Jan,
and I did go see a surgeon, and they want me to have surgery
again, but I am hesitant. I went through a lot back in
1994, and had to give up a good job because of all this.
I had bilateral Carpal Tunnel Syndrome surgery, and a
right DeQuervains syndrome surgery with a ganglion cyst
removed at the right carpal tunnel region back in April
1994. My right hand has not been the same since. My Left
hand recovered fine. For the past few years, it has been
getting progressively worse. I worked in a factory as
a machine packer, packing 300 sweet-tarts per minute,
and picking up / gripping (using my index finger and thumb)
each box putting them on the conveyer belt. I developed
DeQuervains syndrome, CTS, and a massive ganglion cyst
due to this repetitive work. My doctor diagnosed me with
repetition motion syndrome. I stayed off work for 6 years
due to this injury. I figured I would try and find a job
this past year, and work part time. I wanted to gradually
get back to work, and get use to using my hands again.
The job I took was just part time 4 hours a day doing
light data entry. That is when I started noticing my right
thumb having really painful muscle fasciculations in my
thumb pad. At times, my right hand and fingers started
having really painful charlie horse symptoms - thumb cramps
- sudden tightening of the thumb muscle involuntary twisting
movements, and uncontrollable thumb motions. I find it
challenging to drive a car, open doors, pick up my grand
daughter and a lot other daily activities are almost impossible.
I recently talked to my doctor about the problem, and
she sent me to have another EMG. Conclusions were 1. Mild
to moderate delay of right median motor and sensory latency
consistent with right Carpal Tunnel Syndrome. 2. Chronic
denervation and giant fasciculation suggestive of injury
or continued irritation of right distal median at the
wrist of the branch to thenar muscles. The problem I'm
having is in my thumb pad and my ability to grip, hold
and open things. I am having really painful muscle fasciculation
in my thumb pad. At times, my right thumb pad starts having
really painful charlie horse symptoms -thumb cramps -
sudden tightening of the thumb pad muscle involuntary
twisting movements, and uncontrollable motions of my thumb.
Any reason I may be having this? I did have another Carpal
Tunnel Syndrome surgery, on Feb 13, 2001. I know I should
not expect too much this soon, but I called my doctor
because my thumb pad is still twitching and jumping around
and having thumb cramps. He is telling me I have a rare
condition and he is not sure how to diagnose my condition.
He wants to send me to another Neurologist. I do feel
my Carpal Tunnel Syndrome will be better with the surgery
I had. He said I had a lot of scar tissue, and that was
probably my problem, but my thumb pad is still painfully
twitching and jumping around. I just wish I could find
out what is wrong with the twitching and cramps in my
thumb. |
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Answer
1 |
It
seems like you need to wait for possibly few more weeks
to see some improvement because your condition is chronic.
Now, if your surgeon is also suggesting a neurologist,
then go ahead and see him.
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