numb fingers

[Netty]

Male patient 46 yrs old presented with numb thumb and 2nd and 3rd finger on the right hand, 3rd finger especially numb. Only arm pain but really troubled by the severe numbness that is pretty much constant. He does get disturbed sleep due to the numbness. I initially assessed for CTS but these tests all were negative and he is not troubled by any wrist pain. He has no neck pain but has restricted Right rotation, and when palpating C6 and C7 he gets an increase in numbness in the fingers! After two treatments of neck mobilization esp in rotation and neural tissue desenstizing no reduction in symptoms.

Do you think I am on the right lines believing it is a problem with C7 and what treatment path would you follow?
Any suggestions and thoughts would be appreciated?

Thanks

Netty

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[etvin]

Hello Netty,
I would like to take history of your condition
- was thae onset sudden or gradual? if it is gradual - since how many days you are getting this?
-did you get any pain? if yes - what is the nature pain? is it limited to perticular area or radiating? if it is radiating - from where to where it is radiating?
-what activity makes you the symptoms increase ? what activity makes you comfort after worsening the symptom?
-after treatment are these symptoms stabilised? (observe for 2-3 days)
-have you taken any radio graphs?

you said there is a restriction of neck rotation - have you checked your range of motion of neck? is that restriction present at end range?

[Netty]

Hi Etvin,

I do not have the problem it is a patient....................and answer to your questions the patient:-
1. onset sudden
2. Not really any pain but discomfort as result of very localised thumb and finger numbness which is pretty constant.
3. Not any particular activities that increase numbness.
4. Neck rotation to the right is restricted but does not cause pain. restriction is before end of range.
5. numbness since about the 20th March 2007
6. No radiographs taken but patient is due to see a neurologist at the end of May. GP has taken various blood tests all negative.
7. No changes following treatment.

Hope these answers are helpful

Thanks

Netty

[etvin]

Hello Netty,
I hope you are a Physiotherapist, i thought you are a patient, really sorry for that.

why dont you ask the patien to get a radiograph (MRI)?
you may get a clue for the cause.

[etvin]

Hello Netty,
According to Osullivan 4th edition, (musculoskeletal assessment)
"The symptoms that donot vary with a change of activity or body position are rarely due to musculo skeletal lesion, and in fact are a "red flag" for more serious conditions such as space occupying tumors and pathologies involving internal organs."

[Physioindeed]

Hi Netty
Have you tried Traction for cervical spine?
Have you tried neural tension test/ stretch?
How is his posture, what is his occupation, how are his muscles- special neck muscles (hypertone? shortened)
Hope I am not pointing out anything to obvious ...
kind regards
Annette

[jwilso]

could be radial nerve peripheral nerve lesion. check out the elbow and do the neural tension tests. could also do tinnels test at the radial groove. i would also look at the cervical spine.

[Netty]

Hi jwilso, Annette (Good name!), Etvin,

Thank you for all your thoughtful and helpful replies. I have carried out your suggestions.................glad to have even the obvious pointed out to me Annette!

The current up-dated position on this patient is that he has no arm pain but still has numbness in the thumb and two fingers. He is going for a consultation with neurologist on 31st May and we have agreed that he will contact me after then to tell me how he would like to proceed!

I will keep you all posted when I next hear from him.

Thanks

Netty

[arkesh_physio]

it seems to me to be a case of Cervical PID.
U can go for Mckenzies Movement with Mobilisations (MWM).