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Neurology  (Expert Forum)
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nerve pain in left hand and are
Answered by
Cleveland Clinic -
Cleveland - OH
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MedHelp Member's Question

nerve pain in left hand and are

by dazylane, Aug 12, 2007 12:00AM
On 1-29-07 I suddenly got a blood draining feeling in my left arm/hand & great deal of pain. My hand went cold & white. The dr told me to go to the ER,he thought it was a blot clot. The ER did an ultra sound, EKG, took 11 vials of blood and gave me 2 vicodin. I then was sent by my family dr, he sent me to get an EMG. That dr saw issues w/ my central & peripheral nerves. He sent me for an cerival MRI. When it came back he said I had c5-6 hernaited disc, he gave me spot injections & steroid pack & sent me to his partner. She set me up for 3 epidural injections. Then she thought I might have TOS,so another MRI, which didn't show TOS. I was sent to physcial therapy for traction, which had minimal results. Iwas sent to a neurosurgeon, who sent me for a myelogram. The MRI and myleogram showed a mysterious white spot that he didn't seem concerned about, however he said my herniated disc is more a shallow portursion and he doesn't see anything pinching my nerves. He gave me Neurontin 600mg 3x;s day saying I am not a surgical canidate so call him in a couple of wks. Where do I go now? What could have happened to me in Jan.? Is there some
other dr.'s I should be seeing? Still have pain and I don't know what to do or where to go? All dr.'s here want to sweep me under the carpet because it seems they don't know. Please help.
Doctor's Answer

by Cleveland Clinic, Sep 02, 2007 08:16PM
To: dazylane
Thanks for your email and sorry to hear about your problem. I think your doctor did the correct thing initially sending you to the the ED given your story. I'm glad the US was negative. Most of the time the US looks at the venous system and not the arterial system. Arterial clots are very rare and mostly related to trauma or some type of clotting disorder. If you would have had an arterial clot most likely your symptoms would have progressed in a very bad and rapid manner. TOS can be neurogenic (very rare) or you can vascular TOS. Neurogenic TOS is diagnosed by EMG and often related to an extra rib or band. In vascular TOS the blood vessels can be affected as they course through the brachial plexus. You would be best served by seeing a vascular specialist who is familiar with this disorder. It is possible that the C5-6 disc is a red herring. You might also consider an MRI of the brachial plexus to rule out any masses that could be present if the consition worsens. I wish you the best with your problem. GS
Member Comments (14)

by mike1105, Aug 12, 2007 12:00AM
first of all, TOS does not show up an an MRI. It may not even show up on nerve tests. There are certain tests you can do on yourself to see if indeed that is the problem. YOu may need someone else available to monitor your pulse while you do these maneucvers. But even then TOS is difficult to diagnose,. If you think that may be the problem, There are TOS specialists-- the one I saw is Richard Sanders in Denver Colorado.

by dazylane, Aug 13, 2007 12:00AM
Thanks for the quick attention to my e-mail.The physical therapist did a bunch of tests moving my arms this way and that way, he did not feel it was TOS, nor did the neurosurgeon. My symptoms are as follows:  lft arm/hand is pinker than the right. I have pain starting in my lft breast area, going into my armpit down the inside of my upper arm and mostly on the ulan side of under part of forearm. Pain in my wrist (back and front). Stabbing pain mostly in between last 2 of the 1st knuckle on hand. Pain is all 2nd knuckle. Tingling/stabbing in left thumb and fore finger and tips of other fingers. Pain along the pinky side of hand. Pain in thumb, fore finger and areas of palm. Hurts to extend fingers fully or arm fully. Some pain in left side of neck and shoulder.Weaker pulse in left hand. When this started I would say pain level was a 11-12 at rest. Now after 7 months, at rest I would say 4-6 and 7-8 if I try to do something like write, type, open a door, open a jar, hold something more than a few pounds etc. I have been on Vicodin 1-2 x's day since Jan. ( I stopped taking these 3-4 wks ago because I was afraid of addiction), Chantix 2x's day (haven't smoked since Feb), Feldene 1x day since Mar., Ultram up to 4x's day since Mar., Neurontin 600 mg 3x's day since July 13. Any ideas?

by mike1105, Aug 13, 2007 12:00AM
did you have some sort of trauma or injury? do you hunch over a computer alot? Are you large breasted? Do you have an extra cervical rib? Were you or are you a competitive swimmer or overhead (tennis for example) athlete? Please let me know.

It certainly sounds like some sort of neurological/vascular compression and it sounds to me like it is taking place in or around the thoracic outlet or brachial plexus. I would definitely be doing TOS like exercises and stretches (ie strengthen the mid back with shoulder blade pinching exercises and stretching the pecs and opening up the chest with things like doorway stretches). Please note I am not an MD and I am not making a diagnosis. I am a dentist who was forced to quit due to similar problems that I was able to fix pretty much on my own---I studied TOS and related syndromes for a full year and am knowlegable about it, the specialists in the country, and the therapies. I would not bank on a negative dx from what a PT has told you. It is very very difficult to diagnose. Related syndromes you can research are Pec Minor syndrome, Upper Crossed Syndrome.

by dazylane, Aug 14, 2007 12:00AM
No, there was no trauma or injury. These symptoms started suddenly and while I was just standing looking in my closet. Yes, I do a lot of computer work. No, I am not large breasted. I do not think I have an extra rib. Haven't been on a competitive swim team since the 8th grade (I am 36yrs old).  Now in my late 20's my family dr told me I had scoliosis, and that my back is twisted like a candy cane (with one shoulder forward and the opposite hip forward) and not like an S. Never been treated for it and I do have bad posture. I told every doc and PT I have been involved with, nobody was concerned.
What type of doctor is this gentleman in Colorado? It seems that I do have many of the TOS symptoms, it is so strange that I have been to so many doctors and a dentist seems to have it right :) Now are you affiliated w/ Cleveland Clinic? I thought doctors from there answer these postings? Do not get me wrong, I GREATLY appreciate your input...it makes more sense then anything else as of yet. I have downloaded some the exercises you suggested and I am stopping by the library for a video. I looked up Upper Crossed Sydrome and it doesn't seem to fit my symptoms, however, I must admit some of it was over my head. Thanks for your help!

by mike1105, Aug 14, 2007 12:00AM
I am not affiliated with the Cleveland Clinic in any way. Sometimes I chime in if I feel I may have useful information. I responded to your post simply because I have been through a similar problem and I may be able to help. Additionally, the Cleveland clinic's physician (neurologist) is way behind on answering questions in this forum.

Dr. Sanders in Colorado limits his practice to TOS. I believe he has a website in which he discusses Pec Minor Syndrome and TOS which are related. There is also a woman at Jons Hopkins named Dr. Julie Freischlag who treats this problem, although I think you will have an easier time getting an appointment with Dr. Sanders.

Please understand I am not making a diagnosis here--not only am I not technically qualified to do so but I have never seen you. Dr. Sanders and I had some discussions about the cause of TOS and Pec Minor Syndrome ( as you know I had studied this stuff for a year before I went to see him) and we both agree that it has a postural cause. I was a dentist remember. Hunched, rounded posture leads to a loosened, weak mid and upper back, along with short tight flexor muscles in the front/upper torso--these include the pecs, the scalenes, the scms.... tightness and shortness in these muscles can pinch on elements of the brachial plexus (nerves to the arm)and blood vessels in the Thoracic outlet (which go to the arm). To make it a double whammy I had played tennis my whole life to that point and was playing 3-4 nites a week when this problem started rearing its ugly head for me. Dr. Sanders surgically released my pec minor muscles and it helped (although did not totally eliminate) my problem, He said I had on the right side (my worse side) the largest pec minor tendon he had ever seen.

While the surgery helped, especially because the pec minor muscle is very difficult to stretch, I attribute most of my now 99% recvery to md back strengthening exercise, chest stretches, and posture correction--- I did not begin to feel even pretty good until a full year after my surgery, and after a good 4-5 months of 2 or 3 a-day exercise and stretching sessions and constant attention to posture.

YOu may want to get yourself a clavicle retractor in the meantime. It pulls your shoulders back.

Hope this helps