cervical spine curvature causing neuropathy?

[malba414]

Dear Doctor,
In 2004 (age 18) I had a very minor fender bender(no one else was hurt). The orthopaedic said that X-rays of my dorsal spine show no abnormality. X-rays of my cervical spine show a definite abnormality with reversal of the curvature on the lateral x-ray. This is mostly at the C5-6 level.
Later in 2004 and 2005 (age 19) I went back to doctors with numbness in my toes. He said I had Morton's Neuroma's in both feet from years and years of ballet and pointe shoes.
The foot pain continued off and on for the next few years when driving, walking, elliptical, and forget running! All this time I was a very decent/healthy weight.
In 2007 (age 22) I noticed the same pain in my hands/fingers when driving long distances daily. The burning pain/numbness happened when holding the wheel, the phone, writing, holding a dog leash, and sleeping. I went to an orthopaedic who said it was CTS, but the only test he did was pushing my wrist back- and that did not create the pain like it should have. He gave me a wrist brace and told me to sleep with it on, but when I did I would wake up screaming because my hand was in so much pain. I decided the problem must have been in my elbow instead of my wrist, and the heavy brace was making me lock my elbow in a weird position overnight.
From 2007-2009 I gained about 40 lbs and was nearly obese. I attributed this to antidepressants I took for anxiety between 2007 and 2009. The pain continued, and a doctor tested me for thyroid problems but all results came up normal. I have since lost 21 lbs, and the numbness/tingling still continues in waves.
In 2009 and 2010 I went to a new doctor who finally believed there was a connection between my feet and hand problems. She ordered a nerve conduction study on my feet. These came back "normal". She also ordered a broad blood test which came back normal. (I did see that my vitamin B12 was smack dab in the middle of the normal range)
Based on all these normal results, what should I do next?

[malba414]

Dr. Newey,

Thank you for your response. I have been asked before to identify which fingers go numb and it is actually very hard to figure out b/c my whole hand feels like it is on fire. Recently, however, I've been waking up at night with one hand numb on the lateral fingers and the other hand numb on the medial fingers. I saw from another post, that you said a NCS would not identify the nerve damage that causes my type of feeling/sensations (tingling, burning, etc). Is that correct?

[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.

I am not clear on what you mean by reveresal of your curvature of the spine. Tingling sensation in the hands and fingers has a large differential. It really depends on the location of the sensory changes. If they occur more on the lateral fingers, it may be carpal tunnel syndrome as you mentioned. However, if the sensation occurs on the medial fingers (pinky and half of the ring finger) and medial aspect of palm, it may be a neuropathy from the ulnar nerve. This nerve is also known as your “funny bone” when tapped or hit. It has several sites of compression along its course – one site being at the elbow. Classically, it may be a truck driver who rests elbow on window/door. It should also be mentioned that with rapid weight gain or weight loss, the ulnar nerve or median nerve (which causes carpal tunnel syndrome) can be compressed and cause their neuropathies.  

Neuropathies can be caused by many mechanisms including microtrauma (overuse), hypothyroidism, weight changes, amyloidsosis, and diabetes, to name a few.

I recommend that you follow up with your local neurologist. He/she will perform a specific neurological examination focused on the ulnar and median  nerves. The neurologist may also elect to perform an EMG/NCS to evaluate the motor and sensory components of the median and ulnar nerves as they travel to the wrist. An MRI of the neck may be necessary to examine the discs in your back more closely to ensure no herniation of the discs and also ensure that there is no dilatation of the central canal of the spinal cord, which can cause cape-like numbness of the arms. An MRI of the cervical spine would also evaluate further if the pain in the feet is connected to the bilateral hands/arms numbness. Other labs, such as vitamins and autoimmune panels, may be ordered based on the history that the neurologist may obtain.

Treatment options for the ulnar and median neuropathies (if diagnosed) include surgical release/correction. However, less invasive procedure such as splinting should be tried first, as you have done. Medications are usually directed at the underlying cause and include NSAIDs such as ibuprofen. However, if the neurologist, after examining you and obtaining an adequate history, neuropathic pain may be diagnosed. The treatment for this includes medications such as neurontin and lyrica and elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well).

I see your second post and another condition that should be mentioned is fibromyalgia. Fibromyalagia is a medical condition that leads to whole body pains. Its cause is unknown, but it is characterized by diffuse aches, sometimes GI symptoms similar to irritable bowel, sleep abnormalities, low pain threshold, and other features. It is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.  Fibromyalgia occurs frequently in patients with chronic fatigue syndrome. If no cause of the condition is identified, it is best to look for other contributing factors such as anxiety or depression.

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

[malba414]

After reading some of the other posts, I thought I should add that I have a history of blurred vision that feels like strobe lights when I'm extremely dehydrated or stressed. My eye doctor told me it is a type of migraine. No real history of headache. I have been unofficially diagnosed with IBS as well.

Thanks