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Arm
pain due to pinched nerve in C6-C7 |
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I
have a pinched nerve in the C-6, C-7 area with pain radiating
down my right arm. My doctor recommended Ibubuprofen 600
mg. every 8 hours. Why is the pain so much more severe
at night when I'm relaxed and trying to sleep, and is
there anything else I can do for relief (and sleep)? I've
tried Flexaril 10 mg. and Benadryl 50 mg., which made
me groggy, but did not affect the extreme night pain.
I've also tried heat and ice, which didn't help much either.
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Answer |
This
is usual that pain is worse at night as the brain is not
busy or occupied with anything else except by one "activity";
the pain. Now, if the pain is still bad, you need to consult
your doctor again. Pain clinic is also of help. However,
the pain is usually self-limiting, but for variable period
between individuals. |
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Comment |
Thanks
so much for your response. I'm finally getting some sleep
thanks to Vicodin and Trazodone, and the sleep is making
a big difference in reducing the intensity of the pain.
During the weeks that I was experiencing the worst pain,
for the first time in my life, my blood pressure shot
up, 150's-160/90-100. It seems to be coming down as the
pain recedes. Could the hypertension be related to the
pinched nerve?
MRI report: broad based protrusions at C3-4 and C4-5 and
prominent C5-6 and C6-7 bilateral ulcinate spurring, most
marked at C6-7 within region of exiting spinal nerve.
I've never had any accidents, and have a very healthy
lifestyle. Could my work as a dental hygienist (33 years)
be a significant contributing factor in creating this
condition, and would you recommend changing to a less
physically demanding careers?
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Answer |
I
am glad that you feel better. Regarding the high blood
pressure, it could well be related to pain and stress.
Although, it seems not bad. It is age related. However,
you may consult an internist if needed. The other point
whether your condition is work related, it does add strain
to the neck. But, I cannot be certain. |
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Lost
distal UL sensations with normal electrodiagnostic studies |
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My
husband had an injury which left his right hand from the
elbow down with no feelings and cannot use it. The Drs.
have no idea what it is, all tests came back negative.
It has been 6 months now and we are very frustrated. We
just got back an EMG report which states all is normal
except for a decreased interference pattern in the first
dorsal int. muscle and a motor unit interference pattern
with a normal firing rate in the right abductor pol. brevis
muscle. Does this mean anything? |
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Answer |
EMG
result would rule out "significant" nerve or
muscle lesion that explain absence of sensation of the
right arm. However, the reduced interference pattern is
not specific and may be explained by weakness, pain or
poor cooperation by patient. The weakness can be due to
peripheral (nerve or muscle diseases) or a central lesion.
The peripheral lesion seems to be out, supported by normal
EMG (apart from reduced interference pattern). But it
is not clear if the central lesion is excluded or not.
This of course would need careful neurological consultation
and appropriate radiological tests. |
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Comment |
Thank
you so much for your reply, could you possibly recommend
what tests he should have so far he had an cervical MRI,
MRI of the upper and right arm (they originally thought
a brachial plexus injury) a cat scan without contrast
of the brain and will be having a MRI of the brain soon.
He had a neurological exam, which was unremarkable except
for loss of sensation in his arm, decreased sensation
in his left leg and serve back pain. The neurosurgeon
released him since there was nothing for him to fix. We
are very frustrated with trying to find out what this
is. Thanks for your time and reply. |
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Answer |
The
sympathetic nervous system may have an abnormal function
after an injury or trauma for unclear reasons. All investigations
are normal. I must emphasize that is difficult for me
to say that it is reflex sympathetic dystrophy, but because
no clear diagnosis was made and some features may suggest
it. Therefore, your treating physician must see, assess
and document both history and, if present, clinical findings,
in order to support the diagnosis, as he is looking at
the patient himself in better position. |
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Comment |
Thank
you, we will look into that. |
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EMG
rules out Ulnar Groove entrapment? |
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I
recently had a EMG, ordered by my PCP, to rule out causes
of a peculiar 'cold' feeling on the pinky side of my right
hand. No pain, no tingling, no weakness, no apparent loss
of sensation. The neuro did what I thought was a pretty
exhaustive study of sensory and motor conductions all
up and down both arms. She did needle exams in several
places: deltoid, biceps, pronater teres, triceps, opponens
pollicis, dorsal interosseous, flexor carpi ulnaris and
cervical paraspinals. The EMG came back 'fairly' clean.
There was minimal slowing of ulnar sensory conductions
across the right wrist, no motor slowing. The needle test
was clean with two exceptions.... 1) The Neuro stuck my
right dorsal interosseous once and got some insertion
activity, 1+ on both pos waves and fibs. She stuck it
several more times and was not able to reproduce the effect.
On each of the several re-tries, it was clean. She theorized
she may have hit a nerve end plate the first time, causing
the insertion activity. 2) Left side cervical paraspinals/posterior
rami showed +/- insertion activity +/- pos waves and +/-
fibs. Right side was clean. She attributed this to a possible
old nerve irritations, or possible mild lower cervical
radiculopathy w/o any affect on the upper extremity muscles.
My PCP seemed pretty unconcerned about this EMG/NCV result.
In large part, I guess so am I? I have had clean needle
exams on lower extremities in the past, except for mild
irritation in the bottoms of feet, which I understand
is quit common. However the insertion activity on the
left paraspinal does bother me. I have been diagnosed
with Benign Fasciculation Syndrome in the past. A few
questions; 1) What is cervical radiculopathy? 2) What,
if anything, would you recommend I do to follow up on
that finding? 3) Is it common to find minor abnormalities
in otherwise healthy 48 yr old males? |
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Answer |
1.
Cervical radiculopathy is pinching of nerve close to spinal
cord, after its exit from spinal cord. It is called nerve
root. It is commonly caused by spondylosis or protruding
disc.
2. Regular physio/exercises.
3. This is hard question, but in careful way, "yes"
possible in the feet, as in your case (in selected muscles),
and "no" for the changes in your arm. However,
the management depends on how much symptoms and signs
are there. Thank you.
Regarding title question. Yes EMG is used to exclude
ulnar nerve entrapment at elbow.
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Comment |
Very
interesting....
I wonder if those paraspinal insertion noises could
be a result of my recent training for a 300-mile Appalachian
Trail Backpacking trip. I've been carrying a backpack
weighing around 50 lbs. I have no other symptoms of
a spinal problem. I am quite active, physically....
swimming, running, hiking, setups, pushups, etc....
I also carry my golf clubs over my back around 12 miles/week.
Oh well, as long as it's not indicative or some serious
MND and I feel fine, I'm inclined to ignore it.
still trying to get a clearer indication on what I
should do regarding the 'old nerve irritations' or 'mild
cervical radiculopathy' on my left side paraspinals.
As I've noted, I have no symptoms of any spinal problem,
with the possible exception of occasional lower back
pain, for which I already do a 'set' of exercises.
You indicate a set of 'physio/exercise'. I'm very active
anyways.
- Can you be more specific re: exercise?
- What other possible causes, if not radiculopathy,
spring to mind?
Thanks for your reply and this wonderful web site,
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Answer |
Well,
I cannot be more specific, sorry, the exercise, its quality
usually recommended by physiotherapist. The other causes,
such as trauma, fractures, tumors. Of course radiological
investigation would show that |
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Regarding
hand and shoulder numbness with imbalance |
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My
life mate seems to have trouble, numbness in hands, and
shoulder, and recently I witnessed the results from this
problem. He told me this morning when he woke he felt
as though his leg was going to break. I watched as my
husband walked toward a small female goat and he both
lost his balance and could not hold on to this female
goat that did not put up a fight he fell sideways and
barely could hold on. I could not believe my eyes and
realized. He must be looked at immediately. What is the
first step to helping him? He is one of the finest saxophone
players I have ever heard and he fears that he will not
be able to play, because he has lost feeling playing as
well. Its always there now but at different evels of numbness.
Please any advice would be helpful. |
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Answer
1 |
From
your email, I gathered that he has balance problem in
addition to numbness hand and shoulder. It is not clear
how long the symptoms are going on. He needs to see neurologist
soon to sort out this from peripheral to central nervous
system disease. He could need urgent management. |
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Answer
2 |
From
your email, I gathered that he has balance problem in
addition to numbness hand and shoulder. It is not clear
how long the symptoms are going on. He needs to see neurologist
soon to sort out this from peripheral to central nervous
system disease. He could need urgent management.
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Ulnar
nerve entrapment operated |
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I
have been experiencing numb, cold, muscle loss and pain
in my right hand for years. I have had 4 EMG, XRAYS, MRI
SCAN BLOOD TESTS, seen numerous Specialists. It has been
over a year ago since I had an operation on my ulnar nerve
to release it??? Since then the pain has progressively
increased and on my last two EMG they have found that
I have it in my left arm. Please can anybody offer any
advice, I am only 22 and trying to study photography which
is proving impossible. I would really like to talk with
someone who has or is going through a similar situation
as I am finding dealing with my life very hard. |
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Answer |
Ulnar
nerve entrapment at elbow can cause weakness and muscle
loss in the hand. Try to avoid leaning on your elbows.
Keep them straightened particularly during sleep. Finally,
I would recommend consulting a neurologist to make sure
nothing else is wrong, if you have not seen one yet.
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Comment |
Thank
you very much for such a quick response; I have received
an appointment to see a neurologist next week. If I have
the problem in both my arms could it occur in my legs?
I have not that I can remember, knocked or damaged both
my elbows to cause the entrapment of the nerves. If there
is anybody who has or is going through a similar situation
please leave a message. Thank you |
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Answer |
Not
necessarily so, I mean you may not get anything in the
legs. However, it depends whether there is underlying
disease. As a matter of fact, that is why I advised a
neurological consultation. Please keep us updated after
seeing the neurologist. All the best. |
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Comment
from another
Patient |
Hi:
I had both elbows done (ulnar nerve release, decompression
& transposition) and a couple of years later the problems
got worse. Both hands and feet. Part of the problem turned
out to be cervical disc problems. I had 3 level fusion
and most of the problems seemed to go away but there still
seemed to be nerve problems. The nerves may never regenerate
I am told and to add to all this, they say I have a polyneuropathy,
probably attributed to diabetes. I guess the point of
this note is that it can be a very complex problem with
symptoms & findings masking other underlying causes.
Good luck, feel free to email and ask any questions |
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Lost
arm sensory function after C. fusion with normal EMG |
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About
9 Months ago I went thru Cervical Fusion on C-6, C-7 after
a job injury. I am still dealing with headaches, shoulder
pain and motion restriction and numbness in my left forearm,
which after an MRI shows a mild rotator cuff tear. I was
sent for an EMG, which took all of 30 minutes for both
tests on my left shoulder and arm, which by the way went
numb during the test, which came up negative. My question
is, is it normal for the tester not to get a reading and
if it is how do they base the results? The Ortho say my
symptoms are related to nerve root compression. The neurologist
says all nerves are intact but I drop things with my left
hand and have lost sensory function down the arm. When
the Neurologist said the nerves are fine, my wife asked
if that was an arm-to-arm comparison, which was not but
a comparison to what he termed "standards". What does
that mean? |
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Answer |
The "EMG"
studies are divided into 2 parts; the nerve conduction
studies part need taking readings and calculations, thus
obtaining the results based on those numbers and calculations.
Second part is the Needle Electrode Examination. By this
the examiner would also take certain "readings"
and make an impression, although it may not appear to
patient as clear readings as in the first part. This may
explain your first query. Regarding the last point; the
standards mean that we follow the results in comparison
to previously done studies on normal persons matching
the age and sex. However, your wife point is quite valid
and important because we frequently use the "healthy"
or non-symptomatic arm as a control (or standard) to compare
with the "sick" or symptomatic arm. The doctor
should be able to decide on this matter.
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Tingling
hand and feet with weak legs |
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I
am a 44-year-old male, 140 lbs, 5'6". For the past few
years, I have experienced weird symptoms. My hands and
feet intermittently tingle and hurt, my arms feel like
they are sunburned, I get random pin-prick sensations
about anywhere on my body. My legs are weak as I find
myself standing with my knees locked. My vision is almost
foggy, for lack a a description and images with repeating
patterns "shimmer". My memory has been real poor and I
tend to flip words around in sentences. Sometimes when
I wake in the morning, I can't tell where my arms are.
I have seen a Neurologist in 1998 and had an MRI and some
reflex tests. Came back fine. He said, "not to worry".
I am very worried. |
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Answer |
According
to your description (not all symptoms though), peripheral
neuropathy should be ruled out. You had MRI and have seen
neurologist in 98, MS was out, I guess. Anyway, EMG is
needed in your case and I would recommend seeing a neurologist
again. Please keep us updated. |
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Comment
from another
Patient |
I'm
not a physician but have similar symptoms.
Have them evaluate you for a small fiber sensory neuropathy.
(Some helpful diagnosis tests for this are the quantitative
sensory testing and the small fiber skin punch biopsy)
EMG and Nerve conduction studies and routine Neuro exams
will not diagnose this. Also when you mentioned shimmering
in the eyes thought this site would be useful. www.geocities.com/quinolones/
Many on this site have experienced long term (as in years)
visual problems, paresthesias, and sensory disturbances,
memory and brainfog muscle weakness etc.
I assume your Neuro has done differential diagnosis ruling
out things like: Lyme Disease, MS, Lupus, Hepatitis, Autoimmune
diseases, B12 deficiency, vasculitis, diabetis, viral
and infectious etiologies like Histoplasmosis, Toxoplasmosis,
paraneoplastic syndrome, Cytomeglovirus, ME, etc.
Often times Physicians assume someone just has a post
viral syndrome and labels the cases idiopathic and does
no further testing. However treatable things should be
ruled out first.
Some useful sites may be
Massachusetts General Hospital Neurology Forums
Cleveland Clinic Neurology Forums
Neuropathy Trust website
Neuropathy Association website
and www.geocities.com/quinolones/ |
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EMG
Results with ulnar neuropathy in Guyon’s canal |
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I
was involved in a motor vehicle accident in Dec. of 2000,
and have had pain at the right wrist and hand ever since.
Surgery was suggested after a EMG was done. I decided
to wait to see if it would get any better without surgery.
The results of the EMG were mild to moderate, acute and
chronic, ulnar neuropathy at the wrist on the right. The
lesions are most likely a Guyon's type 1 at the proximal
wrist on the right. I am still having some pain in that
area, and wonder after six months if I should expect to
see any more improvement without surgery. Will this be
a chronic problem or will it continue to improve over
time? |
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Answer |
What usually
happens after a traumatic nerve lesion is that the surgeon
would wait for several months before embarking or deciding
for surgery. I am not expecting further improvement following
this kind of lesion after 6 months. However, see your
doctor to discuss this further. |
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Peripheral
neuropathy and EMG |
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My
wife had an EMG performed and was told she had a PN. She
is experiencing numbness/tingling in her feet and hands
along with some in her face. Her sugar level was tested
(negative) and spinal fluids were tested (High protein).
She has a hard time walking, etc......She has swam in
a pool a couple of times, and each time, has felt better
for a while afterwards.... Can anyone help?? She has also
had an MRI and CT scans which were negative......She also
has very cold feet and legs |
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Answer |
The
neurologist would try to find a cause for the peripheral
neuropathy. However, it is not always easy task. I think
she should continue the swimming exercises and attend
the neurologist for close follow up.
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Numb
hand - please help! |
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I
have one numb left hand. I guess I should start at the
beginning... I am 52, and in relatively good health. I
am a budget analyst, where I do moderate computer work,
and bartend about 8 hours per week. About four years ago,
I experienced numbness in both my feet and hands. Within
a few weeks, the numbness in all extremities except the
left hand disappeared. However, the left hand numbness
bothered me a lot, especially because I'm left-handed.
I saw a neurologist who could not diagnose it specifically.
He did nerve conduction tests over the next few weeks.
Many of them. He never did narrow down the cause, except
to say that he suspected the ulnar nerve. He determined
that I have no loss of strength. I just can't feel my
hand. But that was it. No treatment was suggested. He
pretty much said to learn to live with it. The numbness
subsided (but never disappeared) over the years, and I
therefore got used to it. (There is no pain associated
with it.) Suddenly, however, the numbness came back with
a vengeance about three days ago. My hand is almost completely
numb. I can't feel anything in my hand, and drop things
a lot. Typing this is difficult, because I can't feel
the keys--I have to be very conscious of things in my
hand. I therefore grip things too tightly sometimes, and
smash them, and my handwriting is at best jerky. The numbness
radiates upward along the outside of my arm to the elbow.
I've just today noticed that I am also numb one the underside
of my upper arm and a little down the back. All this only
on the left. I also should say that the neurologist ruled
out carpal tunnel syndrome because at the time the numbness
radiated to the wrong fingers. Now the entire hand is
numb. It's as if I've slept on it and just waken up, but
the hand won't--feels sort of thick and clumsy. I hope
I haven't been too wordy here. Just want to be very specific.
I will admit that today I've gone into the panic mode.
Don't know where to turn. Will acupuncture help? What
shall I do about this? I see no point in going back to
the doctor because I feel as though he'll just write it
off as peripheral neuropathy again. I think that diagnosis
is used sometimes as a garbage diagnosis when they can't
figure out what's happening. Someone please help me out
here. Any suggestions? I'm afraid this condition will
soon affect my work |
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Answer |
First
of all, seeing a neurologist is not that all bad, they
do help. Not all neurologists similar to each other. So,
you need to see, perhaps, another neurologist. The aim
not only to diagnose your case (possibly the exact cause)
but also to assess the severity. Then to find the best
treatment modality. I must say that some nerve lesions
are severe enough to need surgery. So, please seek another
neurologist advice. Best of luck and keep us updated.
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Comment |
Thank
you, Dr. I didn't mean to imply that visiting a neurologist
is bad--only that I learned very little from my last experience.
I do plan to make an appointment once again, and this
time perhaps I'll be a little more demanding of answers.
In the meantime, will you even hazard a guess as to what's
going on?
Also, I've been thinking about the idea of acupuncture.
What is your opinion of that providing relief? |
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Answer |
I
know that acupuncture does help, but in certain problems.
I am not too sure about your case whether acupuncture
would help or not. |
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Abnormal
NCV in different situations |
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Can
an NCV be abnormal and an EMG abnormal?
What does an abnormal NCV (peroneal) mean?
Can repetitive ankle sprains cause abnormal NCV?
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Answer |
1.
Yes they can.
2. It would mean the nerve is affected or diseased. In
case of peroneal nerve usually means affection at the
level of the knee joint (at head of fibula). Sometimes,
atrophy of the small muscle on the dorsum of the foot
(Extensor digitorum brevis) would cause abnormal peroneal
nerve study, although the nerve is fine "proximally".
3. Yes, I have seen it. Although, the changes are "mild"
involve the EMG (needle electrode examination) rather
than the NCV (nerve conduction studies).
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EMG
for Elbow and failed Carpal Tunnel |
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Please
explain which areas of the limb are tested for these problems,
I need to be prepared. |
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Answer |
Presumably
by failed Carpal Tunnel, you mean a failed Carpal Tunnel
release (surgery). The carpal tunnel is located at the
wrist, so if your doctor is planning an EMG for the elbow
area, he must be looking into other causes for your pain/numbness.
Typically an EMG for any arm/neck problems would involve
shocks (nerve conduction studies) in the lower half of
your arm, and needle examination (no shocks, but a "microphone"
type needle to "listen" to electrical activity
present in muscles) of the arm and possibly neck muscles.
Discomfort felt during an EMG is quite dependant on the
individual. Each exam is different for each patient. Skill
of the technician or physician administering the test
can also have a great deal to do with the degree of discomfort.
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Numbness
is getting worse and spread to whole Lt. Side; now I'm
scared |
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Since
my last post from just last night, the numbness has spread.
I'm now numb all the way down my left side, though not
as severely as in my hand. From the shoulder down, down
the left rib cage, all the way to my ankle (but only on
the outside of both the arm and the leg.) I tried today
to get an appointment with several area neurologists,
and can't get one until mid-August! My family doctor will
see me day after tomorrow, but I'm not sure what he can
do, other than sympathize. At this point, I think I'd
rather know what it is not, than to get rid of the symptoms.
I'll deal with the symptoms later. But my imagination
is going nuts, with thoughts of everything from MS to
diabetes to stroke to heart attack. Again, I have no pain
and no loss of strength (thank God.) But my fear alone
is weakening me. Please help me drag myself out of this
panic. |
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Answer |
Seek
help, use the fear to find the advice about your problem,
but do not let the fear control your mind please. It would
be better to go to an emergency department in hospital
or as you said see the family doctor, to be reassured,
until your appointment with the neurologist.
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Comment
from another
Patient |
Your
family doctor might be able to get you in to see a neurologist
sooner. The exact same thing happened to me- he got me
in to see the neurologist the next day. Mine turned out
to be nothing and eventually subsided (it has not completely
gone away, but almost). The family doctor can test for
diabetes. The neurologist tested for lupus and MS- they
never did figure it out (that's a little unsettling but
at least I am better). Apparently sometimes it can be
some sort of a weird virus. I went for a second opinion
and he thinks it maybe a very mild case of Guillain Barre. |
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Comment |
Thanks.
Even typing this is such a consummate pain (not literally)
in my rear. Just wanted to say that I saw the doc today,
and he has ordered blood tests, nerve conductions/EMGs
Monday at the neurologist, and a carotid study at the
hospital in two weeks. (Can’t get a consult with
the neurologist, but he'll do the tests, read them, and
send their findings to my family doctor--go figure.) I
hope mine disappears as well, but for now it's just getting
more severe. He did rule out heart involvement and diabetes
and says he suspects peripheral rather than central nervous
system problems. This thing is screwing around with my
mind now, and I’m fighting very hard to fight the
fear of the unknown. I’ll let you know... |
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How
accurate are the test results for spreading numbness in
hand and feet? |
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I
had Nerve conduction and EMG tests done last fall as a
result of spreading numbness in my hands and feet. The
results showed that I had "mild, symmetric, axonal,
predominately motor polyneuropathy with loss of fast conduction
fibers." The condition began to improve on its own,
so the doctor said not to worry about it. (They do not
know what could have caused it.) Because I still have
intermittent, mild numbness I went for a second opinion
(using the same test results). The second doctor said
that the test is very subjective and that I may not, in
fact, have nerve damage. How subjective are the test results?
Should I be concerned if the tests reflect that I have
mild nerve damage? . |
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Answer |
This
is quite interesting question. Although, nerve conductions
and EMG are "objective" tests. But certain factors
must be well controlled such as temperature and distance
measurement. As well as stimulus setup. Those are in a
way "subjective". Anyway, the examiner is usually
fully aware of those factors and they are standardized.
If the abnormalities are really mild, they may be considered
as insignificant. What matters is that you are clinically
feeling better.
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