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C8 RADICULAPATHY in EMG, normal C7/T1 in MRI. Reason.

Resolved Question:

1) How and why do i have all symptoms of c8 radiculopathy that were confirmed by emg though doesent correspond with my C7/t1 that was normal on the MRI??? 2) What else if anything could cause c8 radiculopathy in last 2 digits per my imaging that would explain this medically?? 3)Whats your final assessment and why?
To date: Undergone much PT and recieved facet injections at 2 sites: above and below ACDF. Persistent neck pain into scalpula and upper extremity unilateral hand numbness especially D4, D5. Now with new weakness in opposite hand
History/background/ diagnostics:
Former ACDF at c5/6 labeled degenerative disk in mid/late20's.. Resulted in great sucess post surgery. several years later- accident occurs: results multiple levels damaged, cervical spondylosis. ***MRI findings: no cord/ vertebral lesion and multi DDD below above acdf.
C4/5 herniation and degeneration and cord encroachment.
C5/C6- bony overgrowth causes cord encroachment.
C6/C7 herniation degeneration but without any encroachment.
C7/T1- unremarkable.. *Myelo gram- showed small extradural lesion at C5/6 with thecal sac compression. A spur projecting from posterior border of C6, small ventral defect..
***EMG- left- UE tested. Neuro exam: weakness ADM, APB, 1st D1. Decreased sensation digits 3,4,5 clawing in 5th digit. DTR 1+. NCV: left ulnar sensory nerve decreased conduction veloc (wrist-5th digit, 42/s) Polyphasic Volition 1st D1 and ADM. No acute radiculopathy, plexopathy, peripheral neuropathy. Final: Abnormal test concluded Chronic C8 radiculopathy...


Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I have read your question with diligence.
It looks that you are having chronic C8 radiculopathy.
There are various other causes for this problem for this ailment,these include-
-Diabetes
-High blood pressure
-Deficiency of vitamin B1,2,6,12
-Compression of ulnar nerve at elbow or at wrist(There are various sites at elbow & at wrist where it can be compressed, A good clinician or a neurologist can identify the site of compression)
-Cyst in course of ulnar nerve
-Compression during anaesthesia
-Aberrent artery in course of nerve
There are many other causes which may lead to this problem .You should consult to a neurophysician and ask for further investigation including antibody test & thyroid function test to evaluate your problem. Those tests and its reports will give us a better picture.
Hope this will help you.
( Note from the In House Physician : I have forwarded your case to our neurophysician and upgraded your consult for free. We are getting multiple opinions for you, to give you a more broader perspective. Once he replies, his answer will also be added to your dashboard. So right now your case is been handled by 2 different doctors to give more insight into your issue. )
Regards.


Patient replied :

I appreciate that as I paid for what I thought was a specialist to begin with???!!
So not sure what's free. I also provided great detail of diagnostic findings and would like insight based on the findings namely the MRI post the accident and the 3 disks impacted as documented how that translates to my hands diagnosis of just c8 radiculopathy with no verifiable cause. Not what I'm looking for. I have none of the other conditions you speculate to be assumptive.
More than why the C8 radiculopathy. I want an expert opinion on my imaging and symptoms shared for his perspective insight or assessment?!! Thank you


Expert:  Dr. Sudhir Kumar replied 3 Days.

Hello,
Please go through what our neurologist has to say :
I have noted your symptoms and agree that symptoms are a combination of radiculopathy along with ulnar neuropathy.
MRI findings may not correlate with symptoms. In this condition, patient's symptoms and signs are of paramount importance in making a diagnosis.
We need not look for any medical conditions, as most of them would cause more widespread involvement of nerves/radicles.
Treatment would be with medications such as pregabalin, gabapentin or duloxetine.
Physiotherapy would also help.
I hope it helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

What is it that your suggesting?
Radiculopathy is not imaging based, as I assumed there should be a strong correlation with it.
2) ulnar neuropathy please explain
3) what disks are responsible based on what detail I sent you in my symptoms beyond just neck pain? 4) so nerve damage now worsening post this accident in your medical opinion would be resolved with meds, am I understanding that correctly?????


Expert:  Dr. Sudhir Kumar replied 2 Days.

Thank you for getting back. My replies are below:
1. Radiculopathy is diagnosed on the basis of patients' symptoms and findings on clinical examination. MRI is done to look for conditions that can cause radiculogpthy, most common being slipped discs. Others being tutors such as neurofibroma, infections, trauma, etc.
2. Ulnar neuropathy refers to a disease of ulnar nerve, located on the inner aspect of forearm and hand. Common cause being pressure on the ulnar nerve at the level of elbow.
3. Discs involved would be C7-8, and also upper levels (C3-4, C4-5, C5-6) to explain inter scapular pain.
4. Surgical treatment is needed if MRI shows compression of nerves. Since there is no significant compression of nerves on mRI, medical treatment would suffice.
Best wishes,
Dr. Sudhir Kumar.


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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