AnyaMemberJune 19, 2011 at 1:49 pmPost count: 3
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.jpgDonald Corenman, MD, DCModeratorJune 19, 2011 at 3:53 pmPost count: 8436
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. CorenmanAnyaMemberJune 19, 2011 at 9:36 pmPost count: 3
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, DCModeratorJune 20, 2011 at 1:03 amPost count: 8436
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.
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