Loss of strength in hand

[mngolfer]

Nine years ago I had surgery for a ruptured cervical disk.  At that time I had pain and weakness in my right arm and hand.  Surgery fixed the problem.  Two months ago symptoms returned, first pain in shoulder and arm, then numbness and loss of strength in hand.  Now there is minimal pain but noticable loss of strenth in my hand and even visible loss of muscle tone.  I've had an MRI, EMG and Myelogram done.  My neurosurgeon says there is no surgical cause or fix and referred me to another doctor in neurology which I haven't seen yet.  What possibilities am I now facing?  Should I be concerned about an ALS diagnosis?  

[Dr Sharma]

Hi there. This looks like the same problem probably at a level up or down. Multiple nerve roots supply same dermatomes so may be the cervical disc one level up or one level down is causing compressive symptoms. Show it to a different neurosurgeon to avoid any biases. Take care.

[caregiver222]

Of course there is a possibility of ALS, but the higher liklihood is nerve impingement secondary to deterioration of the cervical discs.

You have to realize there is a potential malpractice suit so the person who participated in the orginal surgery would have to have multi-infarct dementia to suggest the surgery had anything to do with this. That being said, this surgery often has a less than desireable outcome and it doesn't mean they did anything wrong. This simply a litigenous society and anyone connected with the original treatment has an overwhelming incentive to deny any connection.

Forget the special machines. The diagnosis is by the nature of the numbness and the loss of muscle tone and the dermatome, which leads directly to the cervical area.

Generally the diagnosis is made by having the patient lie flt on his/her back and apply mild axial traction and see if there is improvement in function, sensation or strength. If this has not been done...well...there are diagnosticians and diagnosticians.

I would suggest a 3T MRI. Not a 1.5 T.

The question is "what can be done".

Generally intermittant axial traction for eight to fifteen minutes several times a day is indicated. This may not help because a partion of the cervical disc has been removed.

There is a surgical option, but do not have it done at the same facility. Make sure you have had a 3T MRI before this is considered.

Yes, it can get worse and you can lose the ability to hold a pen or pencil. But it won't progress anywhere else. You may find resolution in using an axial traction device for short periods every day from now on, A cervical collar is contraindicated because it results in loss of muscle tone.

Depending on how much material has been removed anti-inflammatories and intermittant mild axial traction may provide some relief.