[Donald Corenman, MD, DC]

#31765

Your notation; “again experiencing the full pain and tingling/numbness of my worst symptoms from before surgery, extending from neck down both arms and into hands” typically is not carpel tunnel syndrome (CTS) as CTS generally does not radiate up above the elbow and does not radiate down the arm (with rare exceptions). The EMG and neurological consult is a good idea qs well as a new MRI. I’ve seen many cases of thoracic outlet syndrome but those symptoms are generally triggered with arm position, not neck motion.

Nerve blocks contain steroids generally and I would not do a block before a new MRI is performed.

Dr, Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[cybermarc]

#31767

Are you familiar with double crush syndrome, where impingement at the wrist and neck and/or elbow etc. interact with each other and increase symptoms?

[cybermarc]

#31769

To me the double crush wrist-neck hypothesis made sense because I was first symptomatic 3 years ago in my wrists, I assumed from intensive computer use on job and at home. That then migrated up into my arms while working a farm job (and also sustained computer use.) And finally settled in neck as well.

When I said “pain going from my neck down into my hands” I didn’t mean it always goes in that direction. It can also start in my hands/wrist/forearms and travel up. It seems to go both ways.

I’m a bit daunted by the number of tests possible for something like this. The nerve conductivity tests seem only to check one nerve pathway (median nerve at wrist is what I have ordered, I believe.) What about ulnar at wrist, cubital, orbital, etc?

If this is an issue of double crush/multiple nerve impingements, I want to catch that before going into another surgery (partially because if I do need carpal tunnel release, I could have done that at the same time as my ACDF instead of now looking at waiting for another 2-3 surgeries to happen [both hands separately and possibly 2nd ACDF on adjacent level] before getting relief and being able to work/function.) Any advice on best route of diagnostic testing for nerve impingements? My surgeon says he trusts EMG for wrists but doesnt put much stock in it for neck because the muscles are so dense and so much is going on there.

[Donald Corenman, MD, DC]

#31774

The old “double-crush” hypothesis has generally been abandoned due to some studies that disproved it. Nonetheless, compression at the carpel tunnel can cause symptoms to radiate up the arm but generally not above the elbow.

The EMG/NCV will check multiple nerves such as median and ulnar nerves and is good to look for compression at various choke points (carpel and cubital tunnels). The history and the physical examination is generally much better to determine how involved the neck is with radiculopathy. The EMG is not too helpful for nerve compression syndromes (radiculopathy) generated from the neck.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[cybermarc]

#31910

Just did an NCV/EMG today which apparently turned up nothing unusual. Which is odd considering that I am still having frequent flare ups of arm pain from shoulder all the way to hand, weakness, and burning/pins and needles.

Just discovered CIDP last night, and am wondering (but not too surprised) that this wasn’t mentioned by any of my doctors. I do have bilateral symptoms plus I’ve had dysphagia/reflux problems around the time this started 3 years ago. I have also been having urine retention problems (freq. peeing in night, and more “dripping” after peeing than usual) in the past 6 months. And some balance symptoms. My surgeon, however, waved off CIDP since the EMG showed nothing.

Will get an MRI on cervical spine again and also an ESI on the level we opted not to address (C6-7) since it didn’t look as bad as C5-6.

[Donald Corenman, MD, DC]

#31915

Again, EMGs will be normal if you have a cervical nerve pain syndrome without muscle weakness (common). A negative EMG however generally rules out carpel and cubital tunnel syndromes. What do the initials “CIDP” stand for?

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Author]

Posts