I am a 22 year old medical student with a past medical history of a L4/L5 disc prolapse with chronic radicular pain. For the past year I have had sharp, constant pain down my left arm and hand (C7-T1 dermatomes), left shoulder pain and my trapezius is in constant spasm with severely reduced cervical spine range of motion. The hand/arm pain is worse when I use my arm, and when I wear a rucksack. I have dysthesia and paraesthesia in the left hand in C7 and C8 dermatomes and weakness of the intrinsic muscles of the hand, especially finger flexion, thumb and finger adduction and abduction.
I also have acrocyanosis to both hands, but much worse on the left. In the cold my arm becomes globally weak and numb, with no active movement; sympoms are relieved by warming.
I have had a cervical MRI which did not show a cervical prolapse. It did show ?stretching of the lower cervical spinal cord and bulging CSF. I han a thoracic MRI which was normal, so this was just put down as an anomaly. I have had nerve conduction studies of median and ulnar nerve which were normal. My investigations by orthopaedics were stopped at this point, and the pain management service have put the neurological findings down to Wind-up/central sensitisation. I am left hand dominant, and being a medical student in my clinical years of training the hand weakness and dysthesia severely limits my clinical work.
I have recently changed GP, and after her examining me she was not convinced of the diagnosis. I suggested a rudimentary cervical rib and I am currently waiting for a chest x-ray to look for this. Abduction of the arms exaccerbations symptoms and caused a reactive hyperaemia of the left hand when the arm was adducted. I wondered what your opinion was? I have learnt to cope with my pain but the neurological deficits in my hand severly hinder my function, and I feel that my specialists have given up too soon looking for a diagnosis.
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