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Bilateral
elbow pain and swelling |
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For
about 4 years now I have had pain on the inside of my
elbow--you know where they usually draw blood? It wakes
me up at night and it swells. Sometimes there is a hard
knot there. I have it in both arms but my right is the
most painful. I have tried to find out exactly what is
there that could hurt but haven't found anything. Any
help would be appreciated.
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Answer
1 |
It
sounds like a pain and swelling in both elbows, which
does not go with a nerve problem. This is outside my specialty,
however, I would suggest a consultation with Rheumatologist.
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Answer
2 |
I
agree, this doesn't sound like nerve in nature. In cases
like this, it might be tendinitis (the Biceps tendon is
in that area) or joint disease. |
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Comment |
Thank
you both so much--at least I have an idea now what to
look for. I forgot to mention that sometimes the pain
radiates down the inside of my arm to the palm of my hand--it
feels like someone has ripped my arm open with a knife.
Thank goodness it doesn't last more than about 30 minutes.
Ascriptin AD helps a lot.
Thank you both very much. |
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Cold
hands and feet with tingling in arms and back |
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I'm
writing this because I'm at my last end. My symptoms have
been...nerve pain in my thighs and tingling, cold feet
and cold hands. I recently have been feeling tingling
in arms and back. The doctor has run ten and ten of test
and I even went to a nerve doctor and he ran electric
test and the results were all normal but I still have
the pain in my thighs. This is really starting to be annoying.
HELP! |
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Answer |
These
symptoms, in cases like yours, could be caused by a peripheral
neuropathy, a condition that can have many causes, such
as diabetes, alcoholism, toxic exposure, metabolic and
other nutritional conditions.
For symptoms such as yours, it is best to start with
a good internist and then have them refer you to a good
neurologist. Many things could be at the origin of these
symptoms.
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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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Neck
pain with upper limb radiation |
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I
was hit by another driver 2 years ago and have suffered
with neck pain, left arm pain from forearm to fingers,
numbness in left hand and shoulder pain. I've been seeing
and orthopedic doctor until recently when he ordered another
MRI and it was normal. I was told to live with the pain
or see one of the Partners. He didn't know where the pain
was coming from. The first MRI showed three bulging disc
in my neck. Before the recent MRI I was told I had a nerve
impingement of neck. I'm frustrated and confused as to
why a doctor would drop a patient that is in pain. I told
him I would go through any tests is he would just find
the cause of the pain. I had to go back to my medical
doctor and she has referred me to another orthopedic doctor
in the same group but she has ordered a nerve conduction
test due to left arm numbness and shoulder pain. What
can I expect? To left arm numbness and shoulder pain.
What can I expect? Also, both MRI where open, is there
a difference in the open MRI and closed MRI and closed
MRI, as far as result? |
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Answer |
EMG
and nerve conductions are helpful. They may show pinched
nerve in your case. However, I would recommend consulting
a neurologist as second opinion either before or after
doing the EMG and nerve conduction studies. Regarding
the open or closed MRI, I do not know.
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Shoulder/arm/hand/finger
pain and numbness |
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I
woke one Morning with painful R arm, (Mar 98) like if
I had pulled a muscle. By the time I got to TX, my R arm
was numb and painful, also like if it was paralyzed. I
was over the road truck driver at the time but only for
6 months. I went to the Drs and after several tests I
was told I had C5-C6 Slight herniated disk. So had the
surgery in September of 98; the pain in my shoulder never
did go away nor did the numbness in the hand. After several
more tests I was told that I have impingement, so again
after several physical therapy Sessions and no result.
Surgery was done and about a half inch on bone was taken
off of the shoulder. That was almost a year ago and still
pain in shoulder and numbness in hand. Now it is in the
left hand (numbness) involving the pinky, ring and middle
finger, which go up to the elbow area. Although this numbness
is more like a sleeping feeling, but is constant and so
far no matter what has not gone away. So again more tests
EMGs X-Rays and possibility of MRI and CT scans. I have
had bone scans and arthritis has been ruled out. What
is a DMG as that has been mentioned? I'm 45/female and
normally very active. |
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Answer |
I do not
know what DMG, but probably you meant EMG (Electromyography),
which is a test for nerve and muscle. You will find details
in the previous emails, particularly the last one. Anyhow,
from your symptoms (left side), it is likely that you
have pinched nerve, hence EMG is requested as well as
other radiological studies. All the best.
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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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Thoracic
Outlet Syndrome |
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I
just wish I could find out what is wrong with the twitching
and cramps in my thumb, and was hoping may be someone
could let me know if they have ever heard or seen this
condition before. Today I went to see another doctor to
get my stitches out, and my fingers were ice cold and
were blue and purple and had no feeling in them. The new
doctor said he talked to my other doctor and a few other
doctors and they all think I have Thoracic Outlet Syndrome.
He noted that's what he was thinking I had. He said after
reading my report, and seeing me today he is almost positive
I have Thoracic Outlet Syndrome, and trying to locate
just how far up my arm it goes. Right now he wants to
give me some time to heal, and wait a little longer before
he goes any further. I just had high hopes in this surgery,
and guess I just need to give it more time. Just Looking
for answers. |
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Answer |
The combination
of CTS, which is a distal lesion, may rarely be associated
with a Thoracic Outlet Syndrome (TOS), which is a proximal
lesion of brachial plexus. The finger skin changes supports
that. EMG can also occasionally help to confirm that.
Whether to advocate for TOS surgery or not and when, this
is a surgical decision. The surgeon should make sure how
much benefit the patient would get out of the surgery. |
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Role
of cortisone injection for intense neck and head pain
accompanied by arm numbness |
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I
have been reading your forum messages on arm, neck and
shoulder pain. I had C5-6 fused in '98 and continued to
have severe neck and head pain to this day with numbness
in my arm. My physician (neurologist) is treating the
situation as the effects of surgery in the area with pain
killers that are not very effective. Physical therapy
only seemed to be limited help for a short while. I sought
another opinion. The second neurologist has suggested
a cortisone injection to the nerve in my neck to stop
the pain which was viewed as a possible pinched nerve.
I have also been experiencing "dropping" of things from
my left hand. I have not seen this injection listed in
any of the forums as a possible answer to the pain. I
am scheduled to have this done in about a week and a half.
Is this recommended? |
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Answer |
Cortisone
injections reduce the swelling which may be causing the
pain symptoms but do not treat the cause of the swelling.
It is also useful to have an EMG in instances such as
yours to find out if there is still any nerve damage and
the extent and location of it. Carpal Tunnel is to known
to cause the dropping of objects from the hand.
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Is
surgery sufficient for treatment of DeQuervain’s
syndrome |
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I
was recently diagnosed with DeQuervains' Syndrome on my
right hand. I previously have had carpel tunnel release
surgery on both hands. My doctor gutter splitted my wrist
and I can't use my right arm for 3 weeks. I guess my question
is this, After the 3 weeks is over, Is there usually more
treatment and therapy involved, or does the split take
care of the problem?? |
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Answer
1 |
DeQuervains'
Syndrome surgery should take care of your problem. However,
physiotherapy is usually done afterwards. Orthopedic surgeon
decides this.
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Answer
2 |
You
can learn more about DeQuervain's Syndrome by going to
our main page, and clicking on
the Patient Education Material link, which will take you
a list with the DeQuervain's Tenosynovitis link.
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Long
thoracic nerve vs. dorsal scapular in asymmetric scapulae |
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I
have an asymmetric scapula that is low and prominent at
the inferior medial edge and looks farther away from the
spine than my other scapula and causes me lots of pain
and problems. My EMG showed a single repetitive discharge
from the LTN at the end of the test. The tester thought
that clinically it didn't seem to account for the way
my scapula looked. I also showed moderate to severe weakness
in all muscles tested on the right side of my back-scapular
region. My rhomboids and levator were also tested. This
has been ongoing for 2 years and I am quite impaired by
the problem. I really need help to figure this out. I
am not improving and although my scapula is not a typical
textbook example of winging I have pain and weakness down
the arm, and pain and looseness around the scapula. Could
I have some dorsal scapular nerve injury too that is simply
hard to find. My trapezius also looks a little sunken
in on that side. Thanks |
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Answer |
Sorry
for delay in replying. Now, winging of scapula can be
due to long thoracic nerve or dorsal scapular injury.
It depends on findings clinically and EMG. However, in
your case you mentioned that trapezius is sunken a little,
this muscle is not supplied by either nerves. This is
against those possibilities. I think good neurological
examination should help, but we should keep in mind that
injury of nerves not the only cause of winging scapula.
All the best.
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Axonal
Peripheral neuropathy |
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Need
help understanding EMG report - please. Ending comment
states abnormal EMG exam & nerve conduction studies. Two
problems noted - 1) Mixed motor-sensory - but principally
sensory neuropathy. With decreased amplitude & normal
latencies - axonal in form. Changes shown by low-amplitude
conductions and on motor side by marked increase in irritability
distally bordering on denervation. Patient also has bilateral
carpal tunnel syndrome with prolonged median sensory &
palmar latencies. Can anyone put this in non-medical -
simple English terms? Having problems understanding what
is meant by "decreased amplitude & normal latencies" and
also irritability distally bordering on denervation. Is
this bad? Also, does anyone know where you can obtain
standard nerve msec readings - for instance I have 4.1
msec for sensory distal latency - how bad is that? I really
appreciate any and all help on how to understand what
is going on. |
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Answer |
You
are not alone in your confusion in interpreting this report.
You definitely need to post more of the data (amplitudes,
latencies and conduction velocities, as well as needle
EMG results) to be more definitive. To answer partially...
1. Your nerves are built somewhat like a piece of wire,
an insulating outer layer (myelin) and a bunch of small
wires on the inside (axons). In general, if the myelin
is being affected by some process, the conduction velocity
will be slow and latencies will be prolonged. If the inner
wires (axons) are being affected, the amplitudes of the
response recorded are decreased. The description would
indicate that you have some widespread process affecting
the axons of the sensory nerves, although without the
data I hesitate to say this.
2. The sentence about "marked increase in irritability
..." makes no sense. Sounds like a reference to the
EMG study (the needle part) but I can't tell.
3. Normal values are dependent on many factors (technique,
temperature etc), so again this is hard to comment on.
Generally, 4.1 ms across a 14 cm distance (a typical distance
for a distal sensory latency) would be mildly prolonged
(but some reports would call this normal).
Confused yet? Again, need more data to be more definitive.
Hope this helps.
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Comment |
Thank
you very much for your initial response. I didn't know
how much info to give as I am new to all of this but in
a nut shell here is the report:
Results: Upper extremities-Irritability was normal, without
fibrillations or positive sharp waves.
Lower extremities - Irritability was markedly increased
in the intrinsic muscles of the feet with runs of positive
sharp waves on needle insertion, but none were sustained
with the needle at rest. Irritability elsewhere was normal.
Nerve Conductions: Right Median Nerve - Motor distal latency
at 8cm was 4.1 msec; Sensory distal latency at 13cm was
4.1 msec; Palmar sensory latency at 8cmm was 2.6 msec
Left Median Nerve - Motor distal latency at 8cm was 3.0
msec; Sensory distal latency at 13cm was 4.2 msec; Palmar
sensory latency at 8cmm was 2.8 msec
Right Ulnar Nerve - Motor distal latency at 8cm was 3.1
msec; Sensory distal latency at 13cm was 2.9 msec
Left Ulnar Nerve - Sensory distal latency at 13cmm was
3.1 msec
Sensory responses for the ulnar nerve were moderately
reduced in amplitude and median responses were markedly
reduced in amplitude.
Right Sural Nerve - Sensory distal latency at 14cm was
4.0 msec
Left Sural Nerve - Sensory distal latency at 14cm was
3.7 msec
These values were obtained only by the use of averaging
techniques and were markedly reduced in amplitude.
The balance were the comments mentioned initially. The
patient is my husband and he has been exposed to chemicals
at work which we believe is the cause of the peripheral
neuropathy as he is not diabetic and has never been a
heavy drinker. He is 49 and has been very healthy his
entire life - until now. He works construction so has
worked hard and while thin is very muscular. He does have
allergies (dust, grass, etc) but has also been found to
have a 35% loss to his lungs. This was a 2nd opinion doctor
required by the workers compensation carrier for a case
that has gone on since July 1999. In seeing the various
docs we are told that he has nerve damage and not much
treatment other than for pain is available. His doc has
told him that he is 100% disabled due to the constant
pain in hands, arms, legs & feet and nothing to rehab
him into. Obviously the W/C carrier wants to fight that
diagnosis. The part of this 2nd opinion report that worried
me the most was the denervation comment. From the tests
in Oct 1999 & Feb 2000 it looks like the condition
is getting worse as the numbness/loss of feeling is going
higher up the arms and legs. Any insight you can give
me is appreciated. (Sorry for the length of this note.)
God Bless you! |
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