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Neurology (Expert Forum)
Re: Neck Pain
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Re: Neck Pain
by CCF MD mdf, Jan 01, 1995 12:00AM
Posted By CCF MD mdf on September 14, 1998 at 22:40:34:
In Reply to: Neck Pain posted by Merrie on September 14, 1998 at 22:19:37:
I had a cervical fusion last year at C4-C5 and C5-C6. My pain and numbness subsided except for continuing pain and numbness in my hands and my thumb and
first two fingers. Could this be left over from neck injury or could it be carpal tunnel? My doctor thinks carpel tunnel but it seems coincidental that it began
with my neck. what do you think?
=
Could be residual symptoms of cervical radiculopathy, could be carpal tunnel syndrome. Here's how the diagnosis could be made.
First, obviously, your doctor knows how all the symptoms came about and what the surgery did and so forth, though if I were to start from scratch, I'd have to get the story.
Second, the physical exam should define an area of abnormal sensation which could correspond to the median nerve or to cervical roots. In your case, the situation is distorted by the possibility of partial residual damage to one or more nerve roots, so the territory would not be so "clean." Of course, the exam should also check for weakness in characteristic groups of muscles and not others. However, many with CTS (or for that matter radiculopathy) don't get weakness so we go by the sensory symptoms and/or exam.
Finally, an EMG/nerve conduction study should answer the fundamental question: is there any damage to the median nerve? If not, then you can't have CTS. If so, then it may be CTS.
It's possible that no conclusion can be drawn. For example, a "mild" CTS may be defined by electrophysiologic testing (the EMG/NCS) but the clinical significance of that abnormality may be unclear. In that case, you have a combination of possible contribution of CTS and known pre-existing cervical spine root damage.
Practical advice: see what this does over time. If you now have or ever get weakness in hand muscles then have someone look into it. If numbness or pain gets worse rather than same or improving then have someone look into it.
Of course, this forum doesn't substitute for medical advice from your doctor. I hope this helps. CCF MD mdf.
In Reply to: Neck Pain posted by Merrie on September 14, 1998 at 22:19:37:
I had a cervical fusion last year at C4-C5 and C5-C6. My pain and numbness subsided except for continuing pain and numbness in my hands and my thumb and
first two fingers. Could this be left over from neck injury or could it be carpal tunnel? My doctor thinks carpel tunnel but it seems coincidental that it began
with my neck. what do you think?
=
Could be residual symptoms of cervical radiculopathy, could be carpal tunnel syndrome. Here's how the diagnosis could be made.
First, obviously, your doctor knows how all the symptoms came about and what the surgery did and so forth, though if I were to start from scratch, I'd have to get the story.
Second, the physical exam should define an area of abnormal sensation which could correspond to the median nerve or to cervical roots. In your case, the situation is distorted by the possibility of partial residual damage to one or more nerve roots, so the territory would not be so "clean." Of course, the exam should also check for weakness in characteristic groups of muscles and not others. However, many with CTS (or for that matter radiculopathy) don't get weakness so we go by the sensory symptoms and/or exam.
Finally, an EMG/nerve conduction study should answer the fundamental question: is there any damage to the median nerve? If not, then you can't have CTS. If so, then it may be CTS.
It's possible that no conclusion can be drawn. For example, a "mild" CTS may be defined by electrophysiologic testing (the EMG/NCS) but the clinical significance of that abnormality may be unclear. In that case, you have a combination of possible contribution of CTS and known pre-existing cervical spine root damage.
Practical advice: see what this does over time. If you now have or ever get weakness in hand muscles then have someone look into it. If numbness or pain gets worse rather than same or improving then have someone look into it.
Of course, this forum doesn't substitute for medical advice from your doctor. I hope this helps. CCF MD mdf.
