Cervical Spondylosis or Peripheral Neuropathy?

[sportologist]

Hi Dr,

I have been experiencing numbness of the last two fingers in both hands on/off for a few years. In recent months, the condition got worst and it frequently relapses many times throughout the day.

The current symptoms are: Bilateral shoulder and elbow pain, numbness on last two fingers of both hands, sharp pain in both palms (below last two fingers and padding below thumbs), pain in shoulders when arms are rotated outwards, aches in both forearms (wrist extensors), bicep pain on occasions on both upper arms, some neck and shoulder aches.

I have completed both X-Rays and MRI of the C-spine, and here are the results:


***X-RAYS***

C-Spine:
Mild uncinate joint osteoarthritis.
Cervical spine shows loss of normal lordosis with a slight kyphotic angulation at the C2/3 level.
Cervical vertebral bodies shoe neither anterior wedging nor collapse.
Cervical intervertebral disc spaces at C2/3 to C5/6 show narrowing.

Left Shoulder Joint:
Mild glenohumeral and acromioclavicular joint osteoarthritis.
Acromion process shows Type II morphology with anterior acromial spur formation.

***MRI***

I was not given the MRI report, however according to the Dr, the MRI "showed nothing exciting" and there appeared to be no spur or hernia. I can't get hold of the actual report as I am a subsidized patient.

However, I was referred for an EMG test for suspected peripheral neuropathy: complex (nerve conduction in more than one limb - bilateral HL(?) and carpal tunnel screen (nerve conduction in both upper limbs)

From these results so far, is the EMG necessary (I heard it’s useless), or should I get a CT Scan instead? I'm a subsidized patient so I can't choose a fixed specialist under the scheme, which adds to my predicament.

Given your understanding of my situation, what would you say is the most likely for bilateral symptoms - cervical spondylosis (radiculopathy) or peripheral neuropathy, or something else? Should I get a 2nd opinion? Should I still undergo the EMG test?

Thanks!

[Abhijeet Ghosh]

Dear Friend,
You are absolutely right about Ulnar nerve involvement, hence i have asked for the EMG result.
I mentioned for carpal tunnel syndrome as a second condition for the involvement of thumb.
Ulnar nerve compression is not a common condition encountered in daily practice, hence we don't diagnose this condition, unless the NVC/EMG shows the same.

Regarding the treatment followup well i will answer in this one only, for you -

For Median (CTS) or Ulnar nerve compression after NCV (Nerve Conduction Velocity) / EMG test -

1) Initial treatment is via steroid injection in the tendon sheath.
2) Upto 3 shots of steriods can be given, followed by physiotherapy.
3) If steriods fails, than surgery to relieve the compression is the only way out.

CTS responds in a much better was following surgery than Ulnar nerve compression.

Also i would suggest you to meet a phsyiotherapist for doing shoulder exercises. (especially the trapezius muscle work outs)  as well as cervical physio.
But whatever form of physiotherapy you do, please take some painkillers, as pain might be present in the initial phase of the therapy.

I hope i have resolved your query
However if some more doubts persists, feel free to discuss further as a new post.

[Abhijeet Ghosh]

Dear Friend,
The pain and numbness in the hand involving both the fingers can be co-related to "Carpal Tunnel Syndrome" (CTS).
The best way out is Surgery, for the same.
However please get the same confirmed by the NCV/EMG test.
Presently i would not advice for the CT scan as already you have done the MRI scan and MRI scans are preferred over CT for the soft tissue knowledge.
So lets go for the EMG and then plan accordingly.

A spur over the acromion can also mimic the present condition as it decreases the space from where the nerve/blood vessels emerge.
So don't loose hope and wait for the EMG.Once done, please let me know.
However till you do all the things, its better to do physiotherapy of the cervical spine and the shoulder muscles, in order to make them strong, to tolerate the pain in a better way.This would help you to buy time for the investigations.So please discuss the same with a physiotherapist.


Regards...

[Abhijeet Ghosh]

Dear Friend,
Any new development noticed?
Regards

[criscia]

I have had spinal fusion three times.  Most recently I had C3 C4 C5 done.  I expected nerve damage, after surgery everything was fine.  The migranes went away and I had minimal pain, no numbness.  Less than two weeks after this past surgery I was rearended, now I have numbness in my leg and arms after sitting for any period of time and laying incorrectly.  I fear that I will not be able to go back to work.  It has been three weeks since the accident.  I have tried ice, heat, muscle relaxers, and pain meds nothing is helping.  If I lift my arm above my head it goes numb.  The er said that the mri and the xrays looked fine.  I gave all of this information to my NS and I am not getting any information on what is going on and if there is damage and what I can do about it or even what I should be doing.  Please help me email me or post here, email is ***@****.  Please I am at my last resort.

[sportologist]

Hi Dr.,

Thanks for the reply. Did you meant Ulnar Nerve or Carpal Tunnel? As most of the numbness is on the last two fingers, I always thought it was more related to the Ulnar?

Further, my EMG is scheduled for end March, however, the follow-up with my Orthopedist will only be at the end of April, will I still be able to get your advice in this thread, or do I have to open a new one again later?

Thanks!