Neck and arm pain

I have suffered with pain from my neck down to my hand for two and a half years. My hand feels numb on the thumb and index finger. My arm feels like the blood supply has been cut off, and I cannot stand the pain. My MRI showed a bulge, but the physician said it was not impinging the nerve. I have had physio, tablets and then two epidurals a year apart due to waiting lists. I am due to see him again next week. What should I ask for because I get no relief from the epidurals or medication. I am desperate to get rid of this pain, it's so severe. My arm muscles twitch, and I'm off work now, and unable to do much at all, as my whole arm feels too tired to do anything, and when I try it hurts too much.

[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.

Given your symptoms and history, you should have a radiculopathy evaluation. The spinal cord is encased by bones called vertebra. Nerves start to form as they come off the spinal cord and exit through holes formed between the vertebra. If a nerve is compressed on as it exits through these holes, particularly in an area called the nerve root, a radiculopathy results. The compression could be due to arthritis of the spine or due to a herniated disc or other lesions. The symptoms include pain at the level of the problem (i.e. neck or back etc) and pain that may radiate down the arm or leg (depending on where the problem is). In more advanced cases, muscle weakness or sensory symptoms such as tingling or numbness may occur. In most people the pain associated with a herniated disc may resolve within 4-6 weeks. 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 test called EMG/NCS can be performed to determine the extent a nerve is being compressed or damaged by a herniated disc. This test is performed by neurologist at most local offices. Also an MRI of the cervical region would assist in the localization of the injury and the extent.

I would recommend that you follow up with a neurologist. You may also benefit from a pain management specialist if you have not already seen one.

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