Persistent Ache-Numbness Despite Negative MRIs/X-Rays

[sportologist]

Hi Dr,

My original question to you was posted at http://www.medhelp.org/posts/Back-and-Neck-Surgery/Cervical-Spondylosis-or-Peripheral-Neuropathy/show/1194422?personal_page_id=1285426#post_5464899

After seeing my Specialist numerous times and having X-Rays and MRIs taken, he told me there is nothing he can do.

But my symptoms are still present: numbness in ulnar region of both palms, weakness when exerting pressure from hands / lifting heavy objects, aches and pain in left shoulder when I cross my arm or bring it to my back.

X-Ray result was given to you in my last post (see link above).

Here are the latest EMG and MRI results:

**************#1**************
MRI Brachial Plexus:

Multiplanar inversion recovery and fast spin echo performed both sides.

Visualized cervical cord unremarkable. No cervical rib or obvious fibrous band noted. Surrounding musculature related to barchial plexus show normal configuration.

Noted a prominent draining vein exiting the (R) C7/T1 exit foramen adjacent to the exiting (R) C8 nerve root, without resultant mass effect. Signal flow voids arising from vertebral arteries are maintained.

No MR evidence of acute muscular denervational changes. Visualised sections of upper parts of lungs are well aerated.

MRI of the bilateral brachial plexus show no overt mass effect upon visualised roots, trunks, divisions, and cords. No cervical/accessory ribs or obvious fibrous band identified. A prominent draining vein is incidentally noted of the (R) C7/T1 exit foramen.

------------------Due to words limit MRI reports continue in next message----------------------

[Abhijeet Ghosh]

Dear Friend,
I can understand your concern. The main problem here is that since i have not examined you, i will not be able to give a  full and final diagnosis. We would have to rely on the treating doctor's analysis only.

Who would you recommend I seek a consultation from - orthopaedic or a neurology?
                                            Try to seek for a good neurologist's opinion (in private).

I would have to seek one out in private practice - what tips would you offer me to seek out a good specialist for my case?
                                              Don't show your results in the first go. Wait for his advice and then show him the investigation results (in the same consultation) and proceed.

I hope it satisfies your query.
Please discuss, after the consultation..

[sportologist]

Hi Dr. Ghosh,

This is really frustrating. Repeated consultations and tests all showed nothing. Based on my description, the symptoms, and the test results, what would be your best guess, or speculation, as to the cause - one or many, please just share your thoughts.

I can probably live with the numbness, but the pain experienced when I  move my arms (abduction and adduction) from side to side, upwards, or backwards, coupled with the weakness experienced when I exert myself (push/pull/grip), are really what's bothering me the most.

As for a second opinion. Who would you recommend I seek a consultation from - orthopaedic or a neurology? I would have to seek one out in private practice - what tips would you offer me to seek out a good specialist for my case? The government doctors are apparently not being very helpful.

Thanks.

[Abhijeet Ghosh]

Dear Friend,
We are in a real problem now as the investigation results are not providing any conclusive results.
Second opinion is a must now as we are still beating around the bush.
However till that time, i understand it can be little difficult for us to manage the situation.

It's a real difficult situation with a lot of symptoms you are facing but no respite.
As far as Kyphosis is concerned, well that a reversal of spinal curvature.
It can be due to the muscle sprain / pain in the neck muscles. The neck bones are arranged in a curve, with a lordotic pattern. But in your case, the pattern is lost due to muscle pain.
I think, till the time a second opinion is taken, please meet a good physiotherapist and continue some good , quality physiotherapy, in order to stay away from the symptoms.

We are stuck up here in absence of a quality investigation findings....as the diagnosis is still not confirmed.
And since i have not examined you, i am also not able to confirm the diagnosis as the reports are showing a grey region for diagnosis.

Please discuss more... as i really want to help you.

[sportologist]

**************#2**************
MRI Cervical Spine:

Sagittal T1, T2 and TIRM weighted images of cervical spine acquired, along with axial T2 and MEDIC images through the C3/C4 to C7/T1 discs. Sagittal gradient echo images were also performed.

Mid lost of cervical lordosis with subtle kyphosis centered upon C3/C4, rest of spinal alignment otherwise preserved. Vertebral and disc heights maintained. There is expected T2 signal arising from the intervertebral discs.

No herniation of C3/C4 to C7/T1 discs revealed through axial images. No uncovertebral hypertrophy and the patency of the central canal an exit foramina is preserved at these respective levels.

No acute bone marrow or soft tissue oedema pattern identified. No paravertebral mass lesion encountered. Visualised cervical spine appears unremarkable. Images through posterior cranial fossa structures show no overt abnormality.

Apart from subtle kyphosis centered upon C3/C4, there is no acute bone marrow or soft tissue oedema to suggest conclusive MR evidence of recent acute injury.

**************#2**************
EMG Report:

Nerve conduction study of bilateral median and ulnar nerves is within normal limits. The left ulnar sensory potential is SLIGHTLY low compared to the right. Consider imaging the left thoracic outlet for an accessory rib or fibrous band if symptoms are progressive and troubling.

**********End of Reports************

So, what would the the cause of my symptoms. My specialist is just putting me on hold and gives me another appointment in 6 months as a review. He said there is nothing he could do.

What exactly is going on? What is a slight kyphosis? Will an acromial spur cause symptoms in my left shoulder as per the X-Ray (mentioned in previous question - see link)? Should I get a second opinion, or seek other form of treatments?

The numbness is on/off, the muscle weakness is every time when I exert myself, and I get pain in the pad just below both my thumbs when I grip or hold something tight. The shoulder pain happens every time I lift my arm, crosses it to the other side, and bend it over my back.

Please advise.
Thank you!