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Curious About My Mri And If Anything Seems To Be

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Posted on Sun, 21 Apr 2019
Question: Curious about my mri and if anything seems to be causing my pain and my arm not wanting to work. My right hand continues to go numb at the finger tips. I have had surgery fusion in my neck and my ulnar nerve relocated on my right arm.
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Follow up: Dr. Dariush Saghafi (0 minute later)
Curious about my mri and if anything seems to be causing my pain and my arm not wanting to work. My right hand continues to go numb at the finger tips. I have had surgery fusion in my neck and my ulnar nerve relocated on my right arm.
doctor
Answered by Dr. Dariush Saghafi (3 hours later)
Brief Answer:
Chronic pain and RIGHT UPPER EXTREMITY DYSFUNCTION

Detailed Answer:
Good afternoon.

I've read your questions from both the present as well as in the past with respect to your cervical fusion procedure and relocation procedure of the ulnar nerve as well. I've read consults in the past that you've requested with similar symptoms. It appears as if you've been having problems since about 6 years ago following surgery and those symptoms in the past are similar to the ones you've got in the present.

I realize that you are concerned with your symptoms since you not only have to put up with PAIN in the right arm but also fingertip numbness.

I looked at the MRI images you enclosed. Unfortunately, only looking at a small number of images is inadequate to be able to say much since I would need to magnify, expand, and also be able to easily scroll through series of images and look at all the different sequences obtained. In what you've sent I do see some degenerative arthritic disease in your cervical spine that includes minor spurring and osteophyte formation but nothing that looks terribly egregious. Again, I cannot comment on the degree of patency that the spinal canal has or not nor can I say much for whether or not there is any impingement or not in any of the cervical nerve roots because there aren't enough axial images to be able to compare plus the ones present are very dark on my screen.

If I had the original study or the REPORT itself it would be easier to issue a more solid commentary. But for what it's worth the cervical spine looks reasonably healthy for someone who had a cervical spinal fusion. I do think you were rather young to have gotten that cervical fusion. But perhaps, you were extremely symptomatic with a loss of power or function in a hand or portion of a limb which may have forced the surgeon's hand to carry out the procedure.

As far as current symptoms are concerned...they seem to correspond in their description of intensity and degree of dysfunctionality of numbness in the fingertips to when you were operated on in 2013 and then, also how you felt last year according to what I gather from reading Dr. Taka's note.

Reasons for chronic pain and ongoing paresthesias can be quite extensive, the least of which being the amount of manipulation that occurred as a direct result of the surgery itself. Translocation surgeries sometimes requires DECOMPRESSING or UNSTICKING if you will....nerves from within bony cages, or from within tight compartments of fascia or ligamentous tissue. This requires surgical cutting and snipping at times as opposed to pure blunt dissection and the result can be scarring that can later cause adhesions to once again (though unwittingly) repeat the whole cascade of events that caused the arm, hand, or fingers to become dysfunctional in the first place. I hope that makes a little sense.

In other words, the act of surgical cutting, repairing, stitching, and closing of tissues can cause SCARRING and adhesions (things sticking together). When this happens nerves and muscles can become RE-entrapped and traction placed on them again. The problem is that just going in again to release everything is similar to pouring more gasoline on the fire. It is literally better to stay with NON-INVASIVE modalities of treatment such as physical and occupational therapy that could help loosen some tissues away from the nerves that are involved in causing the numbness or tingles in the fingertips.

Judging from your description I would say that the nerve roots C5/C6 could be involved though I can't tell from this little information whether it's compression in the neck from mild arthritic degenerative disease or a consequence of the surgery that was done that could be placing some traction on the nerves tied to those nerve roots.

Also the nerve roots of C8/T1 seem to be involved given the numbness in the fingertips and these fibers are likely involved in large part due to the translocation procedure.....OR the damage that was already going on with the ulnar nerve never really healed after the surgical procedure.

One procedure that nobody has mentioned that MAY shed some light on the happenings of what is definitely just more than SKIN DEEP, :0 would be an electrical study (EMG/NCV) as well as an ultrasound that when interpreted together could very well isolate where the problem may be and also give an idea as to how repairable it is at this point. I would also screen you for CARPAL TUNNEL SYNDROME on the right just to be sure that wasn't overlooked.

I am always very cautious and SKEPTICAL about doing repeat surgeries of this type. The experience my patients have had when repeating things such as translocations of nerves or cervical fusions involving laminectomies or laminotomies since there are still no good surgical techniques, devices, or chemical agents that have been discovered that significantly reduce the incidence of surgical adhesions, or suboptimal cicatrization (scarring) which is determined genetically in each patient. In other words, I believe when faced with repeat surgery vs. conservative approaches using medications or other interventions (tendon gliding exercises, thermal interventions, acupuncture, neuropathic analgesic medications) that one should exhaust not just once but 2 or 3 times the avenues of NON-SURGICAL interventions due to the at least 50/50 chance of additional complications and chronic pain symptoms after repeat surgery.

I think that a good rule of thumb to follow when it comes to problems in the upper extremities is that so long as there is not any muscle atrophy in the hands, wrists, forearms, etc. and there is no WORSENING function in terms of being able to carry/hold things or perform movements of fine dexterity with the fingers that I would stay with PT/OT plans to see if anything can be done to instill normal movement and sensation in the right hand.

If I've provided useful or helpful information to your question and you have no further inquiries or comments at this time then, could you do me the utmost of favors in CLOSING THE QUERY along with a few POSITIVE WORDS of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope this conversation has helped you give you a little more direction as to what you may wish to do as well as things you can discuss with your doctors in order to help get your mother feeling back to normal as soon as possible.

This query required 82 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi (0 minute later)
Brief Answer:
Chronic pain and RIGHT UPPER EXTREMITY DYSFUNCTION

Detailed Answer:
Good afternoon.

I've read your questions from both the present as well as in the past with respect to your cervical fusion procedure and relocation procedure of the ulnar nerve as well. I've read consults in the past that you've requested with similar symptoms. It appears as if you've been having problems since about 6 years ago following surgery and those symptoms in the past are similar to the ones you've got in the present.

I realize that you are concerned with your symptoms since you not only have to put up with PAIN in the right arm but also fingertip numbness.

I looked at the MRI images you enclosed. Unfortunately, only looking at a small number of images is inadequate to be able to say much since I would need to magnify, expand, and also be able to easily scroll through series of images and look at all the different sequences obtained. In what you've sent I do see some degenerative arthritic disease in your cervical spine that includes minor spurring and osteophyte formation but nothing that looks terribly egregious. Again, I cannot comment on the degree of patency that the spinal canal has or not nor can I say much for whether or not there is any impingement or not in any of the cervical nerve roots because there aren't enough axial images to be able to compare plus the ones present are very dark on my screen.

If I had the original study or the REPORT itself it would be easier to issue a more solid commentary. But for what it's worth the cervical spine looks reasonably healthy for someone who had a cervical spinal fusion. I do think you were rather young to have gotten that cervical fusion. But perhaps, you were extremely symptomatic with a loss of power or function in a hand or portion of a limb which may have forced the surgeon's hand to carry out the procedure.

As far as current symptoms are concerned...they seem to correspond in their description of intensity and degree of dysfunctionality of numbness in the fingertips to when you were operated on in 2013 and then, also how you felt last year according to what I gather from reading Dr. Taka's note.

Reasons for chronic pain and ongoing paresthesias can be quite extensive, the least of which being the amount of manipulation that occurred as a direct result of the surgery itself. Translocation surgeries sometimes requires DECOMPRESSING or UNSTICKING if you will....nerves from within bony cages, or from within tight compartments of fascia or ligamentous tissue. This requires surgical cutting and snipping at times as opposed to pure blunt dissection and the result can be scarring that can later cause adhesions to once again (though unwittingly) repeat the whole cascade of events that caused the arm, hand, or fingers to become dysfunctional in the first place. I hope that makes a little sense.

In other words, the act of surgical cutting, repairing, stitching, and closing of tissues can cause SCARRING and adhesions (things sticking together). When this happens nerves and muscles can become RE-entrapped and traction placed on them again. The problem is that just going in again to release everything is similar to pouring more gasoline on the fire. It is literally better to stay with NON-INVASIVE modalities of treatment such as physical and occupational therapy that could help loosen some tissues away from the nerves that are involved in causing the numbness or tingles in the fingertips.

Judging from your description I would say that the nerve roots C5/C6 could be involved though I can't tell from this little information whether it's compression in the neck from mild arthritic degenerative disease or a consequence of the surgery that was done that could be placing some traction on the nerves tied to those nerve roots.

Also the nerve roots of C8/T1 seem to be involved given the numbness in the fingertips and these fibers are likely involved in large part due to the translocation procedure.....OR the damage that was already going on with the ulnar nerve never really healed after the surgical procedure.

One procedure that nobody has mentioned that MAY shed some light on the happenings of what is definitely just more than SKIN DEEP, :0 would be an electrical study (EMG/NCV) as well as an ultrasound that when interpreted together could very well isolate where the problem may be and also give an idea as to how repairable it is at this point. I would also screen you for CARPAL TUNNEL SYNDROME on the right just to be sure that wasn't overlooked.

I am always very cautious and SKEPTICAL about doing repeat surgeries of this type. The experience my patients have had when repeating things such as translocations of nerves or cervical fusions involving laminectomies or laminotomies since there are still no good surgical techniques, devices, or chemical agents that have been discovered that significantly reduce the incidence of surgical adhesions, or suboptimal cicatrization (scarring) which is determined genetically in each patient. In other words, I believe when faced with repeat surgery vs. conservative approaches using medications or other interventions (tendon gliding exercises, thermal interventions, acupuncture, neuropathic analgesic medications) that one should exhaust not just once but 2 or 3 times the avenues of NON-SURGICAL interventions due to the at least 50/50 chance of additional complications and chronic pain symptoms after repeat surgery.

I think that a good rule of thumb to follow when it comes to problems in the upper extremities is that so long as there is not any muscle atrophy in the hands, wrists, forearms, etc. and there is no WORSENING function in terms of being able to carry/hold things or perform movements of fine dexterity with the fingers that I would stay with PT/OT plans to see if anything can be done to instill normal movement and sensation in the right hand.

If I've provided useful or helpful information to your question and you have no further inquiries or comments at this time then, could you do me the utmost of favors in CLOSING THE QUERY along with a few POSITIVE WORDS of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope this conversation has helped you give you a little more direction as to what you may wish to do as well as things you can discuss with your doctors in order to help get your mother feeling back to normal as soon as possible.

This query required 82 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Dariush Saghafi (2 days later)
Is there a way to upload all the imagines not one at a time? I should have the full report tomorrow
default
Follow up: Dr. Dariush Saghafi (0 minute later)
Is there a way to upload all the imagines not one at a time? I should have the full report tomorrow
doctor
Answered by Dr. Dariush Saghafi (1 hour later)
Brief Answer:
You may wish to contact Tech Support

Detailed Answer:
I know of no telemedicine platform that can upload the contents of a CD ROM full of MRI images which would really need to be done in batch format since there are literally hundreds of images obtained in a variety of sequences.

But no worries.....the report will be just DANDY.....of course, if you wanted to HAND CARRY the CD or DVD all the way up yonder to XXXXXXX OH....I'd be happy to pop it in the computer and we could spy it together and then, use all the functionality of the reader as well. That's another thing that no telemedicine platform can duplicate which is the DICOM Reader that accompanies all these images.

Perhaps, the tech support people at Healthcaremagic.com have some ideas....but I doubt it...not a cut on them at all you understand. I just can't envision any telemedicine website allowing an entire upload of this type of information. Nor can I envision uploading each MRI image from a disk up to a site like this 1 .jpg pic at a time!

We'll just wait on the report and see what that says and go from there. You don't happen to have any other diagnostic testing do you? I'd be particularly interested in an EMG/NCV study, a CT myelogram, or a plain old CT of the cervical spine that could very well be from BEFORE surgery as well as after.

Cheers young lady! Let's see wassup tomorrow....
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi (0 minute later)
Brief Answer:
You may wish to contact Tech Support

Detailed Answer:
I know of no telemedicine platform that can upload the contents of a CD ROM full of MRI images which would really need to be done in batch format since there are literally hundreds of images obtained in a variety of sequences.

But no worries.....the report will be just DANDY.....of course, if you wanted to HAND CARRY the CD or DVD all the way up yonder to XXXXXXX OH....I'd be happy to pop it in the computer and we could spy it together and then, use all the functionality of the reader as well. That's another thing that no telemedicine platform can duplicate which is the DICOM Reader that accompanies all these images.

Perhaps, the tech support people at Healthcaremagic.com have some ideas....but I doubt it...not a cut on them at all you understand. I just can't envision any telemedicine website allowing an entire upload of this type of information. Nor can I envision uploading each MRI image from a disk up to a site like this 1 .jpg pic at a time!

We'll just wait on the report and see what that says and go from there. You don't happen to have any other diagnostic testing do you? I'd be particularly interested in an EMG/NCV study, a CT myelogram, or a plain old CT of the cervical spine that could very well be from BEFORE surgery as well as after.

Cheers young lady! Let's see wassup tomorrow....
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2472 Questions

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Curious About My Mri And If Anything Seems To Be

Curious about my mri and if anything seems to be causing my pain and my arm not wanting to work. My right hand continues to go numb at the finger tips. I have had surgery fusion in my neck and my ulnar nerve relocated on my right arm.