Partial numbness/distorted feeling in arm and muscle atrophy of triceps. Back and/or neck cause?

by Rebekka T.
(Los Angeles)

Greetings and a heartfelt 'thank you' for providing us with so much in-depth information!

I'm not expecting an elaborate answer, however, if you could give me/us some very general advice, I'd highly appreciate it.

My husband has been experiencing a decrease in his sensory abilities in his right arm. His entire arm feels chronically 'off' or 'under water' as he says; somewhat muted with regards to sensations. His upper outer arm area (triceps) has been twitching and locking up every now and then. This region also displays a noticeable reduction in muscle mass - possible atrophy.

Further - at the very beginning, his chest muscle was also constantly spasming. This has luckily improved.

To add some confusion to the mix - right before these nerve related issues in his arm started, he went through a month of the most incredible pain in his upper back, close to the armpit and possibly affecting the rhomboid muscle. He said at the time that he might pass out from the sheer level of pain. He was stuck in a bend over and turned-to-one-side position for several weeks. (Possibly affecting neck muscles?) This must have been an acute and sudden injury, which resolved over time. A later ultrasound revealed some darker shading within the muscle - a potential muscle tear? The general area of the upper back pain was affected a few years prior very similarly. Ever once in a while he gets nervous because he gets slight pain in the same area of his back. (Maybe a result of a healed but overall weak spot in his back muscle?)

The nerve issues in his arm and chest muscle followed very soon after the back issue improved.

No doctor has given him a proper diagnosis. He finally went to a neurologist who, after me doing some research, agreed that the scalene muscles and/or thoracic outlet syndrome potentially contribute or cause the nerve/s distress. I had previously told my husband to gently massage the scalenes, which (to our surprise) resulted in relief in his arm. He was also able to feel the distorted nerve sensation more intensely in his arm when pressing on the scalenes in a certain way.

His neurologist conducted a 'nerve signal test' along his arm, which showed a small difference in signal intensity between his healthy and the affected side.

He is also scheduled for a neck focused MRI.

His neurologist suggests that this shouldn't be an issue stemming from the spine, due to the symptoms improving over time.

I believe his symptoms flare up whenever he forgets to stick with his scalenes massage or has long days at his desk.

- Would you agree that this is most likely not spine related?

- Is there a possibility for the back pain to radiate into the arm and cause nerve distortion, or is it most likely an issue stemming from the neck when it comes to the arm?

- If the MRI is inconclusive, are there any other diagnostic procedures or healing treatments you recommend?

Thank you for taking your time to read through this lengthy message! Any advice is greatly appreciated! (Sorry, I'm not a native speaker but have attempted my best in terms of grammar.)

Best regards.

Hello Rebekka,
Your English is remarkably good for a person who has another first language; far better than what the average American writes in this column!

The most common target areas from a pinched nerve from the cervico-thoracic junction area are the triceps and rhomboid muscles, both of which your husband has. I would be very surprised if the MRI comes back negative.

That acute 'stuck and turned to one side position' is known as a torticollis and whilst there are other causes, this is almost certainly from an acute disc injury in the lower neck.

The twitching (known as a fasciculation) and wasting of the triceps are the hallmark of the condition. Most likely there was also loss of the reflex and sensory change. Were they measured and what were you told?

Three more classic signs would be Spurlings, the Upper Limb Tension Test and the Shoulder Abduction Relief sign. Using the site search function at Chiropractic Help, you can find information on all three. I bet they were all strongly positive and may still be. You can try doing them at home but beware; they are designed to stress the painful nerve root; be gentle.

Does raising his arm above his head relieve the pain in the arm? Conversely, in a Thoracic Outlet Syndrome, raising the arm usually increases the symptoms.

You make no mention of an x-ray of his neck; was there a loss of lordosis and how are the joints of Luschka, also known as the paravertebral joints?

This is one of the most painful syndromes I know of; it's excruciating and nights are often the worst.

A denervated muscle is also weak and prone to a tear, but that is not the underlying problem.

In a serious case like you are describing, the cord may also be affected; be on the lookout for so-called 'long tract signs'; ask the neurologist about them.

Clinically this condition is very challenging for all professions; I have just discharged a man, painfree, with very similar symptoms but I certainly don't always win in such cases. My advice is look for a very experienced chiropractor who will take time to examine him thoroughly once you have the results of the MRI. I suspect you are going to be under pressure to have surgery immediately; that may be best and inevitable, but I always believe a conservative approach should be tried first.

Good luck and let me know how you get on.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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