Question: What's Causes Loss of Use of the Right Arm?

I have lost most of the use of my right arm and hand over the past 6 to 9 months. I have muscle atrophy as a result, muscle twitching/fasciculation, chronic/dull pain from my hand, right arm, right shoulder, back behind my shoulder blade, neck and up through my neck. I get sharp pains in my neck, behind my shoulder blade, and in my shoulder.

My right hand has progressively gotten colder to the touch over the last 6 months to the point now that it is VERY obviously cold to EVERYONE that touches my hand (as the weather gets colder, so does my hand, an arthrogram indicated no arterial blockage at all). I get occasional numbness in my fingers.

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My most recent cervical MRI indicates a mild central protrusion or herniation of C5-6 with minimal compression of the thecal sac. There is also a mild central bulge or protrusion of C4-5 and C6-7. Unremarkable dorsal spinal canal including spinal cord is also noted on the report.

None of the MDs I am seeing think this is the cause of my problems on my right side. They are defaulting to an Amyotrophic Lateral Sclerosis (ALS) diagnosis, even though none of them can explain the pain or coldness which ARE NOT ALS symptoms. The MRIs have all been done lying down with my neck in a slight traction position (this is the most comfortable position for me by far).

Could the problem be much worse when not in this traction position, and hence, the doctors are underestimating the affect it has on my spinal cord? What are your thoughts?

I am trying to stay hopeful, as the doctors are giving me no hope. Also, I am a 39-year-old, very active male who used to be a very active runner until the last 4 months. The back and neck pain got very bad after digging out 3 very large tree stumps by hand last fall. Your help would be greatly appreciated. Please excuse my typing as my right hand is almost paralyzed now.

Doctor's Response: Consider Reflex Sympathetic Dystrophy

The problem is not from your neck. Nerve pinching also does not make the hand cold, as this is a vascular phenomenon.

It sounds to me as though this is some variant of Reflex Sympathetic Dystrophy. This is an unusual syndrome that can come on after any kind of hand/arm trauma. It seems to be a cyclical problem in the sympathetic nervous system that leads to spasming of the vasculature and coldness. It also leads to widespread pain. If you already have atrophy, it is probably fairly advanced.

Usually, the treatment consists of stellate ganglion blocks in the neck to block the sympathetic system and an alpha blocker medication (such as Hytrin). The stellate ganglion block is diagnostic, as about the only thing it would help is a RSD syndrome (some people now call this Complex Regional Pain Syndrome). If the block does work, then aggressive physical therapy is the next step.

Avoid any operations or other trauma, as this is likely to make the pain and syndrome worse. Your best treatment option would a multidisciplinary pain clinic that is familiar with this syndrome.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.