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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[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!