EE,

What helped the neurosurgeon make the final diagnosis? What tools? Was it just the physical exam?

I've heard that EMG's come up normal for many of these neuropathies. I'm wondering if any of these are more effective:

MR Angiogram
MR Neurography
MRI of brachial plexus
Scalene block
Thermography

These are some of the other diagnostic tools I keep running into in my research. I want to DEMAND the most effective test.

Anyone?

Thanks.

KY

The NS saw me after an MRI revealed a bulging cervical disc. He ordered an EMG and a mylogram(I referred to it earlier as a discogram, I think) and he did a physical too, but the ortho who sent me there had done a more thorough exam and found some irregularities with reflexes and some other neurological signs. He knew my history, I gather from the ortho, and by excluding other causes, he made the diagnosis. I hope this info is of some use to you.

Seems like you had a clear diagnostic test that showed the problem. That's the issue with me...EMG and cervical spine MRI have already shown clean.

I have an appt scheduled with a neurologist and my surgical ortho tmrw. I want to make sure I ask them to do the right physical exam and order the right tests.

If anyone has any insight here that would be great.

Didn't most of you have a test where there was an "Ah Ha" moment? If yes, I'd like to know what helped reveal your condition.

Thanks.

KY

Well, went to a neurologist today. The net-net after his exam:

1) "I don't have a punch line (i.e. diagnosis) for you."
2) Tests

So I'm having a brachial plexus MRI tmrw, another EMG next week, and blood tests to rule out infection. He did mention RSD as a remote possibility, but much didn't add up. The fact that there's nothing at all going on in my hands had him very much unclear...thus the need for more tests.

Feel happy that I wasn't rushed out the door.

I also visited the ortho who was to conduct arthoscopic surgery on my shoulder this coming Friday. We agreed to postpone for obvious reasons and he agreed with the tests. The ortho also thought my ulnar nerve was inflammed...and this all could be a case of inflammation. So he recommended continuning with the neurontin and also taking anti-inflamatories (which I wasn't sure was a good idea or not previously).

So it's wait and see until these test results come back. Should get MRI results by end of week.

KY

It sounds as though your visits were very productive and that you'll hopefully get some answers. Please keep us posted. I'll be interested to hear the outcome and best of luck to you.

Well, I got the brachial plexus MRI back. Results:

1) There is no evidence of mass or area of abnormal enhancement in the region of the right brachial plexus. Soft tissues are normal in signal. There is no evidence of an apical lung mass.

2) Moderate disc degeneration at C5-C6 and C6-C7 and there is posterior osteophytes and mild bulging of discs which slightly narrow the ventral thecal sac. There is no mass effect on the cervical cord at the C5-C6 or C6-C7 levels.

So it would seem that the brachial plexus is fine.

I didn't realize this would pick up on the c-spine. I find it "interesting" that the use of the word "moderate" was used here for the disc generation. I've had a c-spine MRI before and it spoke to more of a "mild" situation and the neurosurgeon basically kicked me out of their office.

I wonder if C5 - C7 is producing this kind of elbow pain and tingling in my pinky? Wonder if it's worth a steroid injection in this area.

Only other exam at this point is an EMG. Would this pick up nerve compression that's taking place beyond the brachial plexus? From the shoulder down the arm?

I tell you I'm confused. I've got serious pain but MRIs left and right say nothing (unless there's really something going on in the c-spine).

KY

There is all kinds of info out on the net regarding referred pain from discs and spinal alignment issues. I've never been able to sift through it all and fully understand whats being said since a lot of it is contradictory in nature, but I've also heard from medical types that doctors don't really know all there is to know about these things. Has anyone mentioned a pain management doctor who does spinal injenctions? These can often confirm different diagnosises that other tests can't, in the hands of a skilled anesthesiologist. The facet joints along the spine can be a source of nerve irritation and pain. Can you run this by one of your providers?(again, I'm just a patient)