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Can C4 Bilateral Radiculopathy Cause Tingling And Severe Pain In The Arms?

Posted on Sat, 10 Sep 2016

Question: Can c4 bilateral radiculopathy cause tingling and severe pain in arms as well as legs. Also can the tingling and burning wake you from sleep
the emg says there is eletropsyiological evidence of bilateral c4 radiculopathy. There ie electropsychiological evidence of right median nerve neuropathy across the wrist.
Can the tingling snd numnbess and burning in upper extremities be caused by c4 radiculapoathy. Also cabn leg problem be cause by c4 bilateral neuropathy
Also in May for about a week or two stiff neck on left side. I moved neck forward backward side to side to try and get it to become unstiff. Also mild head ache since May that comes and goes.. Head seems to star in back and come to front of head.

Answered by Dr. Neeraj Kumar (29 minutes later)

Brief Answer:
Upload Mri if available

Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
C4 radiculopathy can explain neck pain, mild headache and pain over shoulder region.
Arm, forearm and hand are not involved.
Similarly lower limbs pain, tingling cannot be explained by C4 radiculopathy.
Is there an Mri of cervical and lumbosacral region?
Any history of diabetes, renal disease, liver disease?
You need to get examined by a neurologist for evidence of any neuropathy.
Multiple compression at cervical and lumbosacral spine may cause symptoms in both upper and lower limbs.
Mri is required in such case.
You can continue physiotherapy, neck collar.
Gabapentin dose can be increased if required.
Surgical options are available if not releived.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Neeraj Kumar (52 minutes later)

The neurologist conducted thorough neurological exam and stated there is no neuropathy. The EMG/nvs ruled out neuropathy exceot right median nerve . See above.
The MRI sayys
c4 c5 postero disc herniation causing mild stenosis with indentation upon ventral cord.
c5 c6 broad based posterior disc protrusion type herniation with right foraminal propensity compressing the thecal sac and causing mild right neuroforaminal narrowing
c6 c7 posterocentral disc protrusion type herniation compressing the ventral thecal sac.
Pre diabetic. No kidney or lver disease
Are you saying c4 radiculopathy does dot cause tingling and pain in arm

Answered by Dr. Neeraj Kumar (13 hours later)

Brief Answer:
Get investigated as advised

Detailed Answer:
Hello,
C4 radiculopathy may not explain symptoms distally in Upper limbs.
Lower limbs symptoms can not be explained too and needs imaging of lumbosacral spine and sacroiliac joint.
If nerve conduction is not showing any neuropathy then you can continue gabapentin and increase its dose gradually.
Vitamin B12 and folic acid levels can be done and supplementation taken if found to be deficient.
Wishing you good health and early recovery.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Neeraj Kumar (21 minutes later)

Did you read the above. THe EMG says
There is evidence of elctrophysiologic al evidence of right median nerve neuropathy across the wrist.
Does this alter your diagnosis

Answered by Dr. Neeraj Kumar (2 minutes later)

Brief Answer:
Not due to unilateral median neuropathy

Detailed Answer:
Hello,
No, unilateral median nerve compression can be due to carpal tunnel syndrome and cannot explain symptoms in both arms and lower limbs.
Take a trial of treatment for few weeks.
Hope you recover soon.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Neeraj Kumar (58 minutes later)

the tingling in the lower lmbs have decreased somewhat. the tingling is pretty much in the upper extremeties.
My neurologist stated she did not believe the MRI findings are causing symptoms. she stated it is psychosomatic.
Do you believe the cervical mri findings are causing symptoms. Could this truly be psychosomatic.
Is it safe to say that I donot have pheriperal neuropathy
based on emg/nvc is it safe to say i do not have pheripheral neuropathy.
one final question. In May left leg started tingling very severely. Now when I walk sometimes the leg feels weak. Sometimes it feels like it dry or without blood. t other times it feels normal. It also looks like its atrophied a little. I sometimes can not get the position of the leg right. It feels like its not connecting from the brain. Its like the leg feels like its facing outward but when I look at it its facing straight, The neurologist ruled out ms and said its psychosomatic.
An emg was cnducted n the leg in XXXXXXX and it was normal. Please advise

MRI and xray of lumbar spine were normal. Today I had e stimulation. The neurologist believe symtoms are psychosomatic. I start therapy tomorrow.

Answered by Dr. Neeraj Kumar (19 hours later)

Brief Answer:
Not seems to be neuropathy

Detailed Answer:
Hello,
Nerve conduction study is not suggestive of neuropathy.
The symptoms may be having some psychosomatic component but neck pain may be due to cervical disc.
You should continue gabapentin and behavioural therapy under doctors guidance.
Wishing you good health and early recovery.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Neeraj Kumar (1 hour later)

MRI of lumbsr spine says
Left lateral inpinges the existing left nerve root in the left 2-3. it also says buldging disc at l4 and l5. Could this be causing leg problem.

Answered by Dr. Neeraj Kumar (22 minutes later)

Brief Answer:
Take steps as advised

Detailed Answer:
Hello,
Yes, disc compression on roots may cause symptoms in lower limbs preferably upper thigh region due to L2-3 disc prolapse.
Lower disc are asymptomatic.
Continue physiotherapy, precautions like avoiding stooping forward, lifting heavy objects, sitting squatting position.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Neeraj Kumar (1 hour later)

Answered by Dr. Neeraj Kumar (30 minutes later)

Brief Answer:
Possibility of lumbar canal stenosis

Detailed Answer:
Hello,
If the compression is more it can cause secondary canal stenosis which presents with heaviness of both lower limbs on walking and relieved on standing.
Uploading images will definitely help.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Neeraj Kumar (29 hours later)

See uploaded MRI report

Answered by Dr. Neeraj Kumar (13 hours later)

Brief Answer:
Take treatment as advised

Detailed Answer:
Hello,
I have gone through your Mri and emg.
The Mri of cervical region is showing disc prolapse at few levels but not significant enough to cause pain in both upper limbs.
No Mri of lumbosacral region to evaluate compression.
Emg is showing changes suggestive of radiculopathy and median neuropathy due to carpal tunnel syndrome.
I advise to continue medications as being taken for few weeks.
Physiotherapy to be done regularly.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Neeraj Kumar (7 hours later)

could disc compression cause me to walk with abnormal gait, its like i am picking up leg to walk forward could compression cause that could upper thigh compression cause the walking problem i have described. sometimes it feels like brain has to get motivated to move leg.

The review of the lumbar mri is not contained in the answer. Dr XXXXXXX anreviewed the cervical mri. He states in the answer that he had not revewed the lumbar mri because he hadnt received it. I sent it to you today. Please have him answer questions regarding the lumbar mri. I can sne dthe lumbar mri to you again if you would like. Please read the answer. You will see it relates to the cervical, not lumbar

Answered by Dr. Neeraj Kumar (22 hours later)

Brief Answer:
Please Upload the Lumbosacral spine MRI too

Detailed Answer:
Hello,
I have got MRI cervical spine and EMG NCV.
No lumbar imaging is available.

The lesions at cervical level is unlikely to cause pain and radiation in lower limbs or thigh region.
Upload if possible Lumbosacral Spine MRI too.

Awaiting for your those images.

Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Neeraj Kumar (3 hours later)

DR XXXXXXX
Based on MRI cervical and emg cervical what do you think is causing tingling in arms. Do you think it is psychogenic.
Also have you received the lumber mri and left elg emg yet

Answered by Dr. Neeraj Kumar (6 hours later)

Brief Answer:
Disc is compressing nerve root in lumbar region too

Detailed Answer:
Hello,
The symptoms may be associated with stress too.
In lumbar region, disc prolapse at L2-3 level may be causing symptoms in left thigh region.
You should continue treatment for few weeks.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Neeraj Kumar (3 days later)

Dear Dr XXXXXXX

Attached please find final EMG study which was performed yesterday. Please let me know if you believe this is causing the tingling in arms and left leg problem. If so could a chiropractor help.

Answered by Dr. Neeraj Kumar (13 hours later)

Brief Answer:
Take treatment as advised and do physiotherapy

Detailed Answer:
Hello,
i have gone through your emg report.
The report is suggestive of right carpal tunnel syndrome, cervical and lumboscaral radiculopathy.
You can take physiotherapy under guidance rather than chiropractor advices.
Gabapentin, pregabalin or amitriptyline can be used for pain relief.
Wishing you good health and early recovery.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar