Neck Pain, Numb Fingers and Fibromyalgia

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Anya
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June 19, 2011 at 1:49 pm

Post count: 3

#4644

One morning about 3 weeks ago I woke up with two numb fingers (left ring and pinky). After a week, I went to have it checked out. After seeing my PCP, two orthopedic specialists, taking a couple nerve tests and MRI, I am confused with
the information I was given. Specialist one says I’ve got Cubital Tunnel Syndrome, Specialist two says it’s a byproduct of something going on in my neck (nerve tests showed relatively normal in arm and abnormal in neck). He (Spec. #2) ordered an MRI. It was given to Spec. #1 who says it’s normal and wants to perform surgery on my elbow.
I am now confused and concerned because Spec. #2 mentioned my neck could be the cause (as well as the what is causing symptoms that mimic fibromyalgia) and I’ve had pain in my neck daily for quite some time (for years, but it’s gotten much worse in the past month or two).
Aside from the spinal area, do the attached images shed any light on what may be going on?
I will try to attach my images.
Untitled.jpg

Donald Corenman, MD, DC
Moderator

June 19, 2011 at 3:53 pm

Post count: 8660

#4646

Let’s break this down into smaller components. Your only complaint is numbness of the ring and pinky fingers. You have no neck pain, shoulder pain or pain radiating into the hand. You have no weakness or incoordination. Is this correct?

You have had “a couple” of nerve tests. Does this mean two EMG/NCV tests (the needle- shock tests) or just one? What did the test or tests demonstrate? Was there a conduction block (slowing of the nerve signals) in the wrist or the elbow? Were there positive sharp waves or fibrillation potentials in the posterior cervical (neck) muscles?

Think about where the symptoms could come from. The ulnar fingers (ring and pinky) are serviced by the ulnar nerve in the shoulder, elbow and wrist where this nerve can get compressed. If these symptoms originated in the neck, normally numbness and pain radiates into the shoulder- down the arm and into the hand. It is still possible to have them originate in the neck without any symptoms in the arm, but less likely. Does the MRI demonstrate C7 or more likely- C8 nerve compression on the side of the symptoms?

The shoulder can cause these symptoms (thoracic outlet syndrome) but normally numbness occurs in the shoulder and radiates down the arm. Symptoms are made worse in thoracic outlet syndrome by lifting the arm to shoulder lever or overhead. Do symptoms become worse with overhead activity? Sleeping with overhead arm positioning is not uncommon. Are the symptoms worse with sleeping?

The elbow allows the ulnar nerve to pass in the cubital tunnel. This is the “funny bone” in the elbow. If the nerve is compressed here, numbness will start in the elbow and radiate to the fingers. The NCV test will show “slowing” in the elbow and a positive “Tinel’s sign” will be demonstrated on physical examination (percussion of the nerve will cause an electrical “zing” into the ulnar hand).

If the nerve is compressed at the tunnel of Guyan (this is in the wrist), numbness will occur into the two ulnar fingers as you suffer from. The EMG will be positive for slowing at the wrist and a Tinel’s sign will be present with percussion at the wrist.

Images were not attached.

Fibromyalgia is not associated with numbness of the fingers but can cause spinal pain commonly.

Hope this yields some understanding.

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.

Anya
Member

June 19, 2011 at 9:36 pm

Post count: 3

#4648

No, I DO have pretty constant neck pain, mild shoulder/elbow and moderate forearm (wrist) pain. I do not have pain radiating into the hand, but the left portion of it is also numb. I also have weakness in the left hand but no loss of coordination.

Yes, I had one EMG and one NCV. From my understanding, there was minimal slowing of the nerve signals (compared to the control test taken from the same hand on the fingers with normal sensation). There were positive sharp waves in the arm muscles with increasing intensity to the neck muscles (which prompted the MRI).

The first specialist stated that the MRI was normal, but wouldn’t go over it with me. The second specialist (who took the EMG/NCV tests and ordered the MRI) would not comment. (I assume he didn’t want to contradict his colleague.)

My symptoms do not worsen with overhead activity or sleep. I sleep on my back as I must use a CPAP which restricts much of my movement. I also have been sleeping with a brace holding my arm in a slightly bent position and have taken an oral round of Prednisone – with no relief.

There is pain at the ‘funny bone’ in the elbow, it skips part of the forearm then starts again at the inside of the wrist (that’s not new and I’ve always attributed that to carpal tunnel – diagnosed over 15 years ago). The numbness does not start until you get to my hand.

I’ll follow instructions sent to get the images posted.
Thanks.

Donald Corenman, MD, DC
Moderator

June 20, 2011 at 1:03 am

Post count: 8660

#4649

With fibromyalgia, it is difficult to discern what is causing pain as by the definition of fibromyalgia, you have pain in multiple areas.This does not mean that some of the pain is not caused by your neck or ulnar nerve but makes diagnosis more difficult. Neck pain radiating down the arm with head extension (bending the head backwards) can be a sign of nerve compression in the neck.

Positive sharp waves above the level of the elbow makes cubital tunnel syndrome less likely. Have your doctor give you a copy of the MRI report and the EMG/NCV report and read the conclusion yourself. It should not be too complicated with the information you now have.

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.
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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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