Concerned

For 3 weeks now I have had a painful stiffness to my right shoulder, what feels like sore muscle pain, shooting pain to elbow and into my hand, also partial numbing tingly feeling in thumb, index and middle finger. I had an arthroscopy on shoulder in 05 but this pain is way worse. My hand strength is so bad can't cut food with the right hand. What could be going on? I had to give up my job as a CNA I can't work like this.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are several possibilities, which include cervical radiculopathy, carpal tunnel syndrome, Parsonage-Turner syndrome (which is inflammation to the brachial plexus), and others. I’ll elaborate on a radiculopathy and carpal tunnel.

The vertebrae (bones of the spine) have material between them to cushion and allow for mobility. This material may be squished out. This is called a herniated disc. It can be squished out centrally or laterally. In most people the pain associated with a herniated disc may resolve within 4-6 weeks. The pain is the distribution of the nerve root that supplies a region. For example if you have a herniated disc affecting the C6 nerve root (lower neck), you will have pain certain areas including the thumb. A minority of patients do not respond to medical/conservative management and require surgery.  Symptoms suggesting the need for urgent surgery include muscle weakness, loss of bowel or bladder control, loss of sensation, and progressive pain.

A cause of numbness of the index finger and middle finger is carpal tunnel syndrome. It usually also has sensory changes of the palm at the thumb, index and middle fingers, and the ring finger on the side near the middle finger. Carpal tunnel syndrome is a compression/entrapment syndrome of the median nerve at the wrist. It usually results from excessive use of hands and occupational “microtrauma”.  Other causes include hypothyroidism, amylodosis, and arthritis to name a few. It may also arise during pregnancy and resolve after delivery of the child. The sensory changes usually are worse at night. Patients may complain of having to shake their hand to wake it up. Over time, you may develop atrophy of muscles of the thumb supplied by the median nerve.

A test called EMG/NCS can be performed to determine the extent a nerve is being compressed or damaged by a herniated disc. It also evaluates the muscles supplied by the nerves. This test is performed by neurologist at most local offices.

I recommend that you follow up with a neurologist. You will need to have a thorough examination. You may also be referred to have an MRI of your neck and an EMG/NCS

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.