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What Causes Numbness In Fingers Of Both Hands?
Question: Numbness in fingers of both hands, in the last 2 digits. Had thoracic vertebrae surgery and fusion in November, have done therapy for 2 months.
Brief Answer:
Ulnar nerve vs. C8/T1 dysfunction
Detailed Answer:
Good morning. I am a neurologist and would like to answer your questions from that perspective. You did not specifically state this but your implication from the question seems to be that SINCE your surgery of the thoracic spine the last 2 digits in each hand have been numb. Is this true? Also, you should tell me exactly which thoracic vertebrae were fused. Did you have any numbness of the last 2 digits BEFORE surgery- even in the slightest bit?
How it works is like this...the last 2 digits of the hand have a nerve root supply that comes from the vertebral body areas of cervical level 7, thoracic level 1, and thoracic level 2. The abbreviations for those levels would be C7, T1, and T2.
The actual nerve roots that poke out from between those bony bodies (C8 and T1) are the roots of interest in your case because they contribute nerve fibers to a nerve called the ulnar nerve which travels from the level of the neck down the arm and into the hand to supply the LAST 2 DIGITS of each hand.
The C8 nerve root exits between the C7/T1 bodies while the T1 nerve root exists from between the T1/T2 vertebral bodies.
Therefore, if your thoracic fusion had anything to do in terms of stabilizing or manipulating the C7, T1, or T2 vertebral bodies then, there is a chance that some manipulation could've occurred of the nerve roots C8 and T1 which would explain the symptoms you are having.
There is a very nice pictorial illustration that shows what I'm talking about below at the link of the relationship between the vertebral bodies of the spinal column and the spinal cord nerve roots that exit at each level. If you can identify the thoracic levels which were surgerized you should get an idea of which nerve roots would've been in the operating fields of the surgeon that could've been manipulated or touched.
https://sites.google.com/a/wisc.edu/neuroradiology/anatomy/spine/slide-1
On the other hand the same symptoms can come about if you have compression of the ULNAR NERVE itself as it exits the neck and comes down the arm, travels across the elbow, and passes through the wrist in order to supply the last 2 digits of the hand. Below is a link that will illustrate something called the BRACHIAL PLEXUS. This is the network of nerves that are formed from the combination of various nerve roots in the neck as they exit the spinal cord, come together, and then, organize themselves to give off branches that supply essentially shoulder, arm, forearm, and hand functions. You will see that the ULNAR NERVE is a relatively small terminal branch of the MEDIAL CORD derived from C8 and T1 nerve fibers that travel down from their respective roots in the neck.
http://upload.wikimedia.org/wikipedia/commons/0/0e/Brachial_plexus_2.svg
In the link below you can better see how the ULNAR NERVE travels in the arm through all the places I mention which can also be compromised by things having nothing to do with the surgery and so you have to consider that as you try and determine the relationship between your symptoms and surgery. For example, could you possibly have some of compression of the ulnar nerve at the elbow which is very common and can cause the same symptoms? Can there be similar compressive forces at the level of the wrist or even higher up in the shoulder region?
http://upload.wikimedia.org/wikipedia/commons/0/0e/Brachial_plexus_2.svg
The easiest way to answer that question is to get what is called an EMG and nerve conduction study test (NCV). In your case I would recommend that a neurologist perform the study since they will also understand the clinical symptoms you are having as related to the surgery you had and be in a better position to declare whether or not the surgery was most likely responsible or something else which just happened to be coincidental to the time you had surgery.
If these answers satisfactorily relate to your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part.
Also, closing the query on your end will be most helpful and appreciated so that this question can be transacted and archived expeditiously and for further reference by colleagues as necessary.
I am happy to answer additional questions in this set if any but if not please keep me informed as to the outcome of your situation by looking me up at:
bit.ly/drdariushsaghafi
The query has required a total of 120 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Ulnar nerve vs. C8/T1 dysfunction
Detailed Answer:
Good morning. I am a neurologist and would like to answer your questions from that perspective. You did not specifically state this but your implication from the question seems to be that SINCE your surgery of the thoracic spine the last 2 digits in each hand have been numb. Is this true? Also, you should tell me exactly which thoracic vertebrae were fused. Did you have any numbness of the last 2 digits BEFORE surgery- even in the slightest bit?
How it works is like this...the last 2 digits of the hand have a nerve root supply that comes from the vertebral body areas of cervical level 7, thoracic level 1, and thoracic level 2. The abbreviations for those levels would be C7, T1, and T2.
The actual nerve roots that poke out from between those bony bodies (C8 and T1) are the roots of interest in your case because they contribute nerve fibers to a nerve called the ulnar nerve which travels from the level of the neck down the arm and into the hand to supply the LAST 2 DIGITS of each hand.
The C8 nerve root exits between the C7/T1 bodies while the T1 nerve root exists from between the T1/T2 vertebral bodies.
Therefore, if your thoracic fusion had anything to do in terms of stabilizing or manipulating the C7, T1, or T2 vertebral bodies then, there is a chance that some manipulation could've occurred of the nerve roots C8 and T1 which would explain the symptoms you are having.
There is a very nice pictorial illustration that shows what I'm talking about below at the link of the relationship between the vertebral bodies of the spinal column and the spinal cord nerve roots that exit at each level. If you can identify the thoracic levels which were surgerized you should get an idea of which nerve roots would've been in the operating fields of the surgeon that could've been manipulated or touched.
https://sites.google.com/a/wisc.edu/neuroradiology/anatomy/spine/slide-1
On the other hand the same symptoms can come about if you have compression of the ULNAR NERVE itself as it exits the neck and comes down the arm, travels across the elbow, and passes through the wrist in order to supply the last 2 digits of the hand. Below is a link that will illustrate something called the BRACHIAL PLEXUS. This is the network of nerves that are formed from the combination of various nerve roots in the neck as they exit the spinal cord, come together, and then, organize themselves to give off branches that supply essentially shoulder, arm, forearm, and hand functions. You will see that the ULNAR NERVE is a relatively small terminal branch of the MEDIAL CORD derived from C8 and T1 nerve fibers that travel down from their respective roots in the neck.
http://upload.wikimedia.org/wikipedia/commons/0/0e/Brachial_plexus_2.svg
In the link below you can better see how the ULNAR NERVE travels in the arm through all the places I mention which can also be compromised by things having nothing to do with the surgery and so you have to consider that as you try and determine the relationship between your symptoms and surgery. For example, could you possibly have some of compression of the ulnar nerve at the elbow which is very common and can cause the same symptoms? Can there be similar compressive forces at the level of the wrist or even higher up in the shoulder region?
http://upload.wikimedia.org/wikipedia/commons/0/0e/Brachial_plexus_2.svg
The easiest way to answer that question is to get what is called an EMG and nerve conduction study test (NCV). In your case I would recommend that a neurologist perform the study since they will also understand the clinical symptoms you are having as related to the surgery you had and be in a better position to declare whether or not the surgery was most likely responsible or something else which just happened to be coincidental to the time you had surgery.
If these answers satisfactorily relate to your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part.
Also, closing the query on your end will be most helpful and appreciated so that this question can be transacted and archived expeditiously and for further reference by colleagues as necessary.
I am happy to answer additional questions in this set if any but if not please keep me informed as to the outcome of your situation by looking me up at:
bit.ly/drdariushsaghafi
The query has required a total of 120 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My history, I have always scratched and itched more than I thought I should. Last September the itching on my hands became more than usual, by late September the itching turned to numbness, I also did this with my toes 15 years ago. My GP got me to a neurologist in late October, diagnosed with an ulnar nerve problem, got referred to a neurology surgeon, had surgery 12 days later, after x-Rays and MRI's, fused t3,4,and 5 on my thoracic vertebrae. Could only lift 5 lbs for 2 months, then physical therapy-swimming and exercises. Now today-6 months later-the numbness is the same as last October, have an appointment with the neurologist next Tuesday. Wear gloves all the time to mask the numbness, touching metals makes the numbness worse. Any ideas to do or ask the neurologist next Tuesday?? Thanks XXXXXXX
Brief Answer:
Ulnar nerve problem should not involve surgery to T3, 4, and 5
Detailed Answer:
Thank you for your updated information.
If you will carefully check the links I gave you plus the explanations from the previous message you will see that I expounded on how the ULNAR NERVE in each hand is derived from nerve fibers which are designated by spinal nerve roots C7, C8, and T1. Those spinal cord roots exit the spinal cord between vertebral bodies C6/C7, C7/T1, and T1/T2. I've provided links that illustrate each of those spinal levels as well as the location of the nerves which are of interest.
Therefore, the most important question I can think of to ask the neurologist (or better yet the neurosurgeon) is why were T3, 4, and 5 fused if there was an ULNAR NERVE problem. I'm assuming that the neurologist conducted appropriate testing using an EMG/NCV test to demonstrate the presence of an ulnar nerve problem and then, an MRI to look at the cervical and thoracic spines to see if there was any evidence of compression of the C7, C8, or T1 nerve roots.
The fusion of T3/4/5 would truly not release any pressure or alter the anatomy of the nerve roots responsible for the ulnar nerve pathology. Now, there's one more point that I made in my previous note which I will repeat. The ulnar nerve could conceivably be compressed as well at some point downstream from the neck which would mean shoulder, elbow (funny bone region), or wrist. But that's only theoretical. I believe that since you were suffering with problems in both hands at the same time that the problem is definitely at the level of the spinal cord. The EMG/NCV study should've showed that.
And so that is the major question you need to ask your neurologist when you see him:
"If my problem is related to the ulnar nerves and if the ulnar nerves were being affected because of some type of compression occurring in the spinal cord or where the spinal roots exit the spinal cord why then, were thoracic vertebrae 3, 4, and 5 manipulated and fused? What do they have to do anatomically with the ulnar nerves?"
And to be honest, the neurologist is not going to be answer that question because there is no answer...T3/4/5 do not have anything to do with nerve fibers that contribute to the ulnar nerves (at least not normally). This question legitimately has to go to the neurosurgeon for clarification. How did he think he was going to rectify your symptoms of an ulnar neuropathy by fusing T3/4/5?
If these answers satisfactorily relate to your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part.
Also, closing the query on your end will be most helpful and appreciated so that this question can be transacted and archived expeditiously and for further reference by colleagues as necessary.
I am happy to answer additional questions in this set if any but if not please keep me informed as to the outcome of your situation by looking me up at:
bit.ly/drdariushsaghafi
The query has required a total of 150 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Ulnar nerve problem should not involve surgery to T3, 4, and 5
Detailed Answer:
Thank you for your updated information.
If you will carefully check the links I gave you plus the explanations from the previous message you will see that I expounded on how the ULNAR NERVE in each hand is derived from nerve fibers which are designated by spinal nerve roots C7, C8, and T1. Those spinal cord roots exit the spinal cord between vertebral bodies C6/C7, C7/T1, and T1/T2. I've provided links that illustrate each of those spinal levels as well as the location of the nerves which are of interest.
Therefore, the most important question I can think of to ask the neurologist (or better yet the neurosurgeon) is why were T3, 4, and 5 fused if there was an ULNAR NERVE problem. I'm assuming that the neurologist conducted appropriate testing using an EMG/NCV test to demonstrate the presence of an ulnar nerve problem and then, an MRI to look at the cervical and thoracic spines to see if there was any evidence of compression of the C7, C8, or T1 nerve roots.
The fusion of T3/4/5 would truly not release any pressure or alter the anatomy of the nerve roots responsible for the ulnar nerve pathology. Now, there's one more point that I made in my previous note which I will repeat. The ulnar nerve could conceivably be compressed as well at some point downstream from the neck which would mean shoulder, elbow (funny bone region), or wrist. But that's only theoretical. I believe that since you were suffering with problems in both hands at the same time that the problem is definitely at the level of the spinal cord. The EMG/NCV study should've showed that.
And so that is the major question you need to ask your neurologist when you see him:
"If my problem is related to the ulnar nerves and if the ulnar nerves were being affected because of some type of compression occurring in the spinal cord or where the spinal roots exit the spinal cord why then, were thoracic vertebrae 3, 4, and 5 manipulated and fused? What do they have to do anatomically with the ulnar nerves?"
And to be honest, the neurologist is not going to be answer that question because there is no answer...T3/4/5 do not have anything to do with nerve fibers that contribute to the ulnar nerves (at least not normally). This question legitimately has to go to the neurosurgeon for clarification. How did he think he was going to rectify your symptoms of an ulnar neuropathy by fusing T3/4/5?
If these answers satisfactorily relate to your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part.
Also, closing the query on your end will be most helpful and appreciated so that this question can be transacted and archived expeditiously and for further reference by colleagues as necessary.
I am happy to answer additional questions in this set if any but if not please keep me informed as to the outcome of your situation by looking me up at:
bit.ly/drdariushsaghafi
The query has required a total of 150 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
After your last answer I checked the procedure on November 17th and I was very much wrong in what I reported, sorry, this is what was done "anterior fusion of C4 thru C7". Now with this corrected new knowledge, what should I be asking my neurologist?? Again I apologize for the bad information and your time spent. XXXXXXX
Brief Answer:
Glad you checked
Detailed Answer:
Thanks so much for much for checking on things. I thought we'd have to be sending that neurosurgeon back to Anatomy School or something! LOL.....
At any rate, an anterior fusion of C4-C7 makes much more sense and again looking at my explanations in the previous 2 answers you can quickly see that the most likley cause to your symptoms could very well be the involvement of the C7 and C8 nerve roots which the surgeon probably decompressed. Recall, that nerve root C7 exits the cord from between C6/C7 vertebral bodies while nerve root C8 exits between C7/T1.
I guess if it's true that the numbness in your hands is absolutely the same as it was before then, the surgery (whatever it was supposed to accomplish in terms of decompression of the nerve roots) did not help.
However, to understand WHY THE PROCEDURE DID NOT WORK I think the following needs to be answered:
0. How about a followup EMG/NCV at this time? This will tell the neurologist where any ongoing problem exists. I don't know that a repeat MRI of the neck would be necessary if you're willing to be a pin cushion one more time.
1. According to the NEUROLOGIST, exactly WHERE was the problem with the ulnar neuropathy in the first place? He should be able to tell you that information based upon results of the first EMG/NCV combined with the MRI study of the cervical spine before surgery was undertaken.
2. Was there any indication by way of the studies done that there could be compression of the ulnar nerve at some point DOWNSTREAM from the spinal cord? Again, look back on my other answers, most common places where nerve entrapment occurs in people would be at the shoulder (rare), elbow (most common), wrist (very common). Were any of those locations showing problems in terms of conduction velocities or the needle examination PRIOR TO SURGERY?
3. If the answer to #2 is NOTHING DISTANT FROM THE CORD was a problem then, is it possible the procedure didn't work because the nerve roots were not freed up ENOUGH or is it possible other damage could've occurred at the time or following the procedure in terms of the healing phase that prevented you from noticing any improvement at all? I believe this question is one the neurosurgeon is more equipped to answer as opposed to the neurologist.
4. If a repeat EMG/NCV shows that issues are still "back at the cord" then, for some reason the procedure didn't work and/or needs to be redone. Did healing not occur as expected? Could unexpected damage have occurred to the C7, C8 nerve roots which was inapparent at the time of surgery preventing function to return post procedure? Again, these are questions I believe the neurosurgeon should be asked as opposed to the neurologist.
5. Is there an expectation on the neurosurgeon's part that significant improvement in the next 6 months can still occur? If odds are low is there anything he could recommend that should improve those chances?
I am happy to answer additional questions, however, since this is the 3rd response in this set my request is that you CLOSE THIS QUERY at this time, rate my answers, and then, open up a new query if you have further questions. I would even be willing to look at results of the EMG sudies that were previously done if you'd like an opinion on those results as well as any digital films you may have such as MRI's, CT scans of the cervical spine to see just what looked like prior to surgery.
If you would like to route another set of questions to my attention you can do so by landing on my page at: bit.ly/drdariushsaghafi and filling out a request to direct a question to me.
Otherwise, I wish you well and would love to hear how this case turns out. I'm just as curious as you to know why such a major procedure had zero impact on your problem?
As an aside it is for outcomes such as these I always counsel my patients that if numbness or sensory symptoms are the ONLY problems being experienced in the hands or the feet that an invasive procedure such as neck surgery should be deferred until adequate PT/OT has been tried (several times) and secondly until the patient literally CAN'T STAND THE SYMPTOMS ANYMORE. Otherwise, I see surgery as a crap-shoot in that things could get better, get worse, or (as in this case) they could stay the same.
The query has required a total of 201 minutes of physician specific time to read, research, and compile return envoys to the patient.
Glad you checked
Detailed Answer:
Thanks so much for much for checking on things. I thought we'd have to be sending that neurosurgeon back to Anatomy School or something! LOL.....
At any rate, an anterior fusion of C4-C7 makes much more sense and again looking at my explanations in the previous 2 answers you can quickly see that the most likley cause to your symptoms could very well be the involvement of the C7 and C8 nerve roots which the surgeon probably decompressed. Recall, that nerve root C7 exits the cord from between C6/C7 vertebral bodies while nerve root C8 exits between C7/T1.
I guess if it's true that the numbness in your hands is absolutely the same as it was before then, the surgery (whatever it was supposed to accomplish in terms of decompression of the nerve roots) did not help.
However, to understand WHY THE PROCEDURE DID NOT WORK I think the following needs to be answered:
0. How about a followup EMG/NCV at this time? This will tell the neurologist where any ongoing problem exists. I don't know that a repeat MRI of the neck would be necessary if you're willing to be a pin cushion one more time.
1. According to the NEUROLOGIST, exactly WHERE was the problem with the ulnar neuropathy in the first place? He should be able to tell you that information based upon results of the first EMG/NCV combined with the MRI study of the cervical spine before surgery was undertaken.
2. Was there any indication by way of the studies done that there could be compression of the ulnar nerve at some point DOWNSTREAM from the spinal cord? Again, look back on my other answers, most common places where nerve entrapment occurs in people would be at the shoulder (rare), elbow (most common), wrist (very common). Were any of those locations showing problems in terms of conduction velocities or the needle examination PRIOR TO SURGERY?
3. If the answer to #2 is NOTHING DISTANT FROM THE CORD was a problem then, is it possible the procedure didn't work because the nerve roots were not freed up ENOUGH or is it possible other damage could've occurred at the time or following the procedure in terms of the healing phase that prevented you from noticing any improvement at all? I believe this question is one the neurosurgeon is more equipped to answer as opposed to the neurologist.
4. If a repeat EMG/NCV shows that issues are still "back at the cord" then, for some reason the procedure didn't work and/or needs to be redone. Did healing not occur as expected? Could unexpected damage have occurred to the C7, C8 nerve roots which was inapparent at the time of surgery preventing function to return post procedure? Again, these are questions I believe the neurosurgeon should be asked as opposed to the neurologist.
5. Is there an expectation on the neurosurgeon's part that significant improvement in the next 6 months can still occur? If odds are low is there anything he could recommend that should improve those chances?
I am happy to answer additional questions, however, since this is the 3rd response in this set my request is that you CLOSE THIS QUERY at this time, rate my answers, and then, open up a new query if you have further questions. I would even be willing to look at results of the EMG sudies that were previously done if you'd like an opinion on those results as well as any digital films you may have such as MRI's, CT scans of the cervical spine to see just what looked like prior to surgery.
If you would like to route another set of questions to my attention you can do so by landing on my page at: bit.ly/drdariushsaghafi and filling out a request to direct a question to me.
Otherwise, I wish you well and would love to hear how this case turns out. I'm just as curious as you to know why such a major procedure had zero impact on your problem?
As an aside it is for outcomes such as these I always counsel my patients that if numbness or sensory symptoms are the ONLY problems being experienced in the hands or the feet that an invasive procedure such as neck surgery should be deferred until adequate PT/OT has been tried (several times) and secondly until the patient literally CAN'T STAND THE SYMPTOMS ANYMORE. Otherwise, I see surgery as a crap-shoot in that things could get better, get worse, or (as in this case) they could stay the same.
The query has required a total of 201 minutes of physician specific time to read, research, and compile return envoys to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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