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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