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  • Weakness/Numbness in Right Bicep

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    Old 11-27-2013, 11:14 PM   #1
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    Weakness/Numbness in Right Bicep

    Hello, I have been messaging on the Spinal Cord Disorders Board, trying to gain more insight to a problem I have been having with my right arm. In mid-September, I was doing pull-ups and felt a pop and my arm gave out on me, but I am not sure where the pop occurred. It was not painful, but I immediately noticed a loss of strength. Soon after, I noticed that my arm from my bicep, through the forearm, and to index finger & thumb would become numb from time to time when I do things like wash my hands or flex at the elbow to hold my hands by my face when I brush my teeth or shave. I have lost a lot of strength in my right arm, going from doing bicep curls with 45 pounds to struggling with 25 pounds. My right bicep is still bigger than my left and has only gotten a little bit smaller (maybe due to not lifting as heavy?), but I have noticed that the forearm muscles close to the elbow and on the same side as my thumb have deteriorated. This area is soft and looks like a gorge where a muscle used to pop out.

    A little history about my healthÖ I am 29 and up until this incident, was in great health and physical condition. I workout almost every day and was training in Mixed Martial Arts. In 2006, I was dropped on my head and herniated discs at the C4-5, C5-6, C6-7 levels. While there have been times when they nerves were irritated, they would clear up over a short period of time (a week or two at most), especially after I started receiving treatment from my chiropractor. I have done PT and had nerve root injections in an effort to prevent the symptoms from occurring, but they do on occasion. I have had MRIs performed in 2006, 2011, and 2013. It was clear that I had degenerative disc disease, annular bulging, small herniations, and spondylosis at the previously mentioned levels.

    Since the pull-up incident, I have seen two neurosurgeons to get their thoughts on what was causing the numbness and weakness and what steps I would need to fix the problem.

    Neurosurgeon #1 said that the problem was coming from my neck and she wanted to perform a partial discectomy via laminotomy at the C5-6 level and foraminotomies at the C5, C6, C7 levels. She told me that getting a fusion surgery at my age would present problems down the road, but there was a chance I could reherniate the disc after having the above procedure performed, which would lead to a fusion.

    Neuro/Orthopedic Surgeon #2 told me that the above procedure would just lead to disc reherniation and a fusion shortly down the road. He told me to deal with my symptoms as best as I could or go ahead and get a fusion surgery.

    With both opinions being so different, I wanted to gather more information. They were also very dismissive of the problem being anything other than my neck. My next step was to get an EMG. The results of the EMG were as follows:

    Nerve Conduction Studies: Both lateral antebrachial, right median, radial and ulnar sensory nerve action potential amplitudes and distal latencies were normal except borderline asymmetry in lateral antebrachial responses (10 uV on the right versus 19 uV on the left). The right median and ulnar distal motor latencies, compound muscle action potential amplitudes, and conduction were normal.

    EMG: Right biceps, pronator teres and brachioradialis showed polyphasic motor unit action potentials of normal duration with reduced recruitment; insertional positive waves and occasional fibrillation potentials were seen in these muscles. Right deltoid, triceps, flexor carpi radialis, and first dorsal interosseous muscles showed normal insertional activity, no spontaneous activity, normal motor unit action potential form, and normal recruitment.

    Interpretation: This is an abnormal study. It is most compatible with acute-subacute moderate right C6 radiculopathy. A musculocutaneous neuropathy cannot be excluded in addition to cervical radiculopathy, but this would not explain the abnormalities in pronator teres and brachioradialis.

    Repeat study in several months is recommended, and correlation with cervical MRI would be helpful.

    This testing, like the MRI, shows evidence that I do have problems with my C6 nerve root. The neurologist did mention that I could have some impingement coming from my shoulder though. The statement about muscuolocutaneous neuropathy cannot be excluded and that it could not explain abnormalities in the pronator teres and brachioradialis is the part that gets me. Does this mean that there is a chance I could have impingement somewhere else besides my neck that is causing the weakness? Could it be that my bicep isnít actually being impacted by the C6 nerve, but that it is my forearm muscles not receiving signals from the nerves which are trapped somewhere else?

    I had an NCS and EMG done in 2006 when I first hurt my neck and here are the results:
    Right median nerve showed prolonged latency and decreased velocity.
    Motor conduction of right ulnar nerve showed an 8 m/s drop in velocity across the elbow.
    Sensory conductions of the right transcarpal median and ulnar nerves showed prolonged latency and decreased velocity.
    Conclusion- Right moderately severe carpal tunnel syndrome. Right ulnar nerve slowing across the elbow.

    The neurosurgeons and neurologists I saw since that incident have not talked about the ulnar and median nerves that appear to be impacted even though I have given them the testing results. Could the ulnar nerve and median nerve with the confirmation of severe carpal tunnel syndrome cause a weakness in the pronator teres and brachioradialis? Again, the doctors were pretty dismissive of anything but cervical damage causing these problems. Is there any other testing that I should get that can find out if there is a pinched nerve contributing to my weakness/numbness, like an MRI? Should I get an EMG from another doctor? My biggest fear is that I get the first cervical surgery I mentioned and have the same symptoms because the actual cause of the symptoms was impingement somewhere else. I just donít know what I have to do to get a conclusive answer to either rule out another impingement as the cause.

    Sorry for such a long post and I hope someone else out there will be able to share their story if they have had similar symptoms. Thanks!

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