Pain radiating up arm from thumb

[Miker]

I need some advice please as I have been advised to have an operation.

I have been suffering from pain in my arms/shoulders and numbness in my fingers (left arm). I had an MRI about 1 year ago and it revealed a herniated disc C6/7 and possibly the disc above. An EMG revealed normal functioning of the nerves.The symptoms did improve after a period of rest and inactivity from sport.

About 3 months ago the symptoms returned and I also had pain and tingling in the right arm. The strange thing about the right arm was that the pain did not originate from movement of the neck but from the arm. I even have a spot on my right thumb that I can touch which sends the pain and tingling up the triceps and into the armpit. I've since had physio (including traction) which took away the numbness but the pains in the right arm continue. The neurologist did have another MRI done and the discs seem to have deteriorated quite a bit over the last year. He suggested that the only option left was to have the disc replaced as soon as the pain was too much to handle or if I lost power in my arms. The pain and discomfort is getting to the point where I feel I have no option but to have the op. (I am a 40 year old business analyst who spends a lot of time at the computer).

The op seems correct for most of the symptoms I have, but nobody can seem to explain the pain which originates from my thumb or movement of my arm and I am concerned that this problem is not eminating from the neck. Can you shed some light on these unexplaned symptoms please. (the neurologist did say that the EMG would have picked up a trapped nerve in the arm).

Thanks

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[Physiobase]

Hi Mike

I agree that an EMG study would be most useful. You mentioned sport in your post. What exactly does that entail? In order to give your more information about the neck issues in relation to the arms symptoms we would need to know a bit more about which fingers (or part of the fingers) have pain. I understand that the tumb is painful. This could be a mouse issue but is not common. The main nerve region is C6 for distribution of sensation in that part of the hand from the neck. However one would have to prove weakness to actually implicate the nerve root itself. Otherwise symptoms might simple be referred from the degenerative disc itself.

You are wise not to jump in for an operation, especially a disc replacement at this stage. If it were my neck I would have the EMG studies done. In terms of treatment it does not appear that an causes have been addresses. Rather it appears that you have had your symptoms treated....therefore benefited from their temporary but not maintained resolution. Perhaps you could shed more light on that as well.

For the record I often have symptoms like yours. They come and go and I spend alot of time on my spinal mobility and functional strength. Basically I get on with it..

I look forward to further comments and you are bound to get a lot of input for your question. You might like to tell us where you are based? <img border=0 src="http://www.ezboard.com/images/emoticons/nerd.gif" />

[Miker]

Hi,

I am based in Pretoria, South Africa.

I did have an EMG done and it showed up as normal.

The thumb itself is not painful, but when I touch the outer side, towards the base of it I get the pain in my upper arm (triceps) and shoulder. This is the right arm. I also get the pain from any movement of the arm or wrist with varying degrees of pain from acute to just an iritation. I also get tingling in the same section of the arm.

The tips of my index and middle fingers of my left hand are slightly numb and I have had numbness in the right thumb which disappeared after the physiotherapy.

Regarding the sport - I played competitive soccer until last year. I suppose heading a soccer ball for 30 years is probably not the best activity for the neck!

[WindsongTherapy]

Hi, Mike,

I don't think surgery will relieve your pain or symptoms. I believe fascia is causing your problem. There is no test or x-ray that addresses the fascial system of the body. We treat many cases like yours in our office everyday. Surgery may make your problems worse. If the fascia is bound down and pressing on nerves or blood vessels, it may be causing pain, tingling, or numbness as you have described. The scar tissue resulting from surgery may only worsen the fascial problems and binding. Please check out www.windsongtherapy.com to learn more about fascia and how it is involved in various conditions. You should look for a therapist or doctor who specializes in the fascial system. If you have specific questions about your particular condition, please do not hesitate to contact us directly by phone or e-mail.

[endroll]

Without knowing more about the specifics of your condition it is difficult to tell the exact cause of your pain. I will only say that it is possible that your surgeon is merely ascribing your symptoms to the only visible pathology. If there is a significant reason to believe that the herniated disc is responsible, then perhaps surgery may help. Of course the duration of your pain suggests that there is a high probability of central sensitisation defeating any surgical intervention.
I would recommend that you speak with another surgeon and possibly a pain management specialist prior to committing to any intervention.
I also believe that anyone ascribing your symptoms to something as simplistic as "fascia" without seeing more details of your condition should be treated with some degree of doubt. I am awaiting RCTs to show that fascia can be responsible for these symptoms and that treatment of same will produce effects in a greater population that expected by chance alone or with placebo.

[bikash63]

Hi Mike,
I got your problems, but a good orthopaedic surgeon may only help u.The compress nerve need be lifted and this need to follow good physiotherapy and corrective treatments/habits.
Get to a good Physiotherapy clinic near you and look for Netherland make Phyaction guidance series Electrotherapy equipt.You may be benefited by TENS for 20 minutes twice a day with 4 electrodes x 15-20 days. Than think for last means of surgery.
I was once HOD Physio & Rehabilitations at SAgar Apollo Hospital Bangalore(India).So came across lot many Software Engg who had this problem.Majority got Ok with PT, some needed surgery.So see yourself or email me personally.I can tell the email id of my Orthopaedic surgeon, or can visit India, I can help.
Thanks.

[sdkashif]

It is better to have EMG and nerve conduction sudies to decide further. There is possibility of carpal tunnel syndrome present along with the radiculopathy. And EMG and NCS will help in better evaluating that. If there is not much involvement of nerve to much extent and muscle studies are normal, you don't have to go for surgery. Attend a good physiotherapist in your locality to get physiotherapy. There are many good trained therapists there in South Africa which may help you.

However, the problems at thumb can be categorized and a differential of them should always be kept in view while dealing the problems. These are:

Intersection syndrome, which is tenosynovitis where the tendons of the first dorsal compartment (ie, extensor pollicis brevis, abductor pollicis longus) cross over the tendons of the second dorsal compartment (ie, extensor carpi radialis longus, extensor carpi radialis brevis), characterized by pain and swelling in the distal dorsoradial forearm: The pain of intersection syndrome is less lateral than that of de Quervain tenosynovitis and may be associated with swelling

Cervical Disce Disease

Carpal Tunnel Syndrome

Cheiralgia paresthetica or neuropathy of the radial sensory nerve (ie, superficial radial nerve) at the wrist

Cervical radiculopathy, particularly at C5 or C6
nerve root

Degenerative arthritis at the radioscaphoid joint

Kienbock disease (ie, osteonecrosis of the lunate)

Osteoarthritis at first CMC joint

Dorsal ganglion at the wrist

Scaphoid fracture characterized by tenderness at the floor of the anatomical snuffbox

De Quervain disease is caused by stenosing tenosynovitis of the first dorsal compartment of the wrist. The first dorsal compartment at the wrist includes the tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). Patients with this condition usually report pain at the dorsolateral aspect of the wrist with referral of pain toward the thumb and/or lateral forearm.

When an appropriate problem is identified, a suitable treatment plan can be given to resoleve the problem.

[dfadc2b]

sdkashif,
Wow, great post! How did you come up with that differential? Very impresssive.
danny

[Driver-Jowitt]

You have been provided with an excellent differential. However common things happen commonly, and from what I can deduce you might like to establish the possibility of de Quervain's tenovitis. If the tenderness can be accurately localised to the ulnar side of Lister's tubercle, and Finklestein's test is positive, you justify ultrasonographic demonstration of the combined sheath of EPB and APL. This would be expected to show thickening of the sheath and possibly fluid. If this proves to be the case surgical decompression is far more predictably effective than other forms of treatment (including steroid injections). Ideally it would be performed under regional anaesthetic with a tourniquet (Bier's block using prilocaine), via an 8mm incision. Sutures are usually not necessary. You would be able to use the hand the same day and put the thumb through a range of movements from the moment the tourniquet is removed; keep it dry for four days, and then treat as normal. Please let us know the outcome!