Hello,
I am a 22 year old female medical student with a past medical history of a L4/L5 disc prolapse with chronic radicular pain (a caudal epidural and a L5 nerve root block failed to provide long term relief). I take a combination of drugs to manage the pain, including gabapentin.
For the past year I have had persistant pain down my left arm and hand (C7-T1 dermatomes), which is sharp and constant in nature. I also have 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 the C7 and C8 dermatomes and weakness of the intrinsic muscles of the hand, in particular finger flexion, thumb adduction 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, with no active movement possible and is numb; such sympoms are relieved by warming.
I have had a cervical MRI which did not show a cervical prolapse, only mild degenerative changes. It did show apparent stretching of the lower cervical spinal cord and bulging CSF of the lower cervical spine. I returned to radiology to have a thoracic MRI which was normal, so this was just put down as an anomaly. I have had nerve conduction studies of the 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 that the neurovascular features were down to wind-up. 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 my symptoms and causes a reactive hyperaemia of the left hand when the arm was adducted.
I wondered what your opinion was? as I would really like to get to the bottom of it. I have learnt to cope with my pain, (although sometime it can be just awful!) 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.
Thank you for your time
With best wishes
Vicky