Carpal Tunnel Syndrome

[Davy9]

Dear Sir,

I have a history of radial nerve damage at the cervical level. Several years ago I underwent plating and fusing of several cervical vertebrae (C3,4 & 5). After said procedure I had residual paralysis, pain and skin numbness in the right arm. The paralysis abated but I have been left with persistent pain, periodic spasms, numbness, etc... in the limb. The arm has remained stable at this level for some time.

2 months ago I lost the feeling in the thumb which I assumed was a reappearance of a symptom that once was present but improved sometime ago. I have since lost the feeling in the index finger which was not at all involved previously. Both fingers remain without feeling all of the time.

We are between insurance coverage for another month. I intend to visit a physician for this but will in customary fashion have to wade through seeing a GP, etc.. To help me negotiate this adventure I have few questions you might help me understand.

1). Are these new symptoms more related to a new process with CTS being the likely candidate or can they be a continuing consequence from my prior radial nerve damage? Since the hand and the arm are otherwise symptomatic with permanent nerve damage other symptoms elude differentiation. The wrist and the forearm have ached, twitched, jumped, you name it... as a matter of routine.

2). If it could be both how best might an accurate Dx of CTS be discriminated? Will an EMG still reflect trouble on top of existing problems?

Thank you

[myodoc]

Dear Sir,

It sounds like the cervical process accounted for the original symptoms. Injuries at the root level in the neck can affect territories supplied by the radial nerve but usually at the lower segments. C3/4 usually affects the neck whereas C5 affects the upper arm. The distinction is at C7 versus the radial nerve. The radial nerve can be affected as high up as the brachial plexus. If an EMG study was done prior to surgery, this would have clarified.

The present symptoms of numbness in the thumb and index finger can either come from carpal tunnel syndrome or involvement of the C6 disk. Both can occur simultaneously also. An EMG study would be helpful to clarify. Depending upon the results, a progress MRI scan of the cervical spine may be warranted. Beyond that, we can always treat the symptoms with medications.

For now, I would recommend an EMG study to clarify.

Hope this is helpful.

[Davy9]

Thank you for your input. I do have serial cervical MRI studies for reference. I'll take it from here and see where it goes. In time I'll update the thread.