Hand and arm pain usually from neck, not back


DEAR DR. ROACH: I had a synovial cyst removed from my spine at the L4-L5 (lower back) in 2008. Ever since that surgery, I wake up in the middle of the night with numbness and tingling in either one or both hands — sometimes several times a night. Sometimes it’s the whole hand to the wrist, and sometimes just the fingers. I put my arm straight up in the air and slowly get the feeling back in my hands. I am not necessarily sleeping on the arm that is numb. I have addressed this with my pain doctor, and he says it should have nothing to do with the surgery I had in 2008. He says it could be a neck issue, but I have no neck pain. Is it just a coincidence, or could that surgery have something to do with it? I wake up at least once a night with this numbness and tingling. — B.P.

ANSWER: Given the timing, I, too, am suspicious that the surgery had something to do with it; however, it’s not something I’ve heard of after synovial cyst surgery, and it’s in the wrong place (at L4-L5) to cause hand symptoms. Also, I can’t figure out why it would be intermittent in both hands. I understand why your pain specialist is concerned about your neck, and indeed it’s possible to get pain, numbness or tingling sensation in the hands or arms from cervical spine disease without any symptoms in the neck. An MRI is the definitive way to evaluate this area anatomically.

Hand pain during sleep raises the concern about both carpal tunnel syndrome (compression of the median nerve of the wrist) and its lesser-known counterpart, cubital tunnel syndrome (compression of the ulnar nerve in the cubital tunnel of the elbow). A careful physical exam often can diagnose these; however, sometimes more definitive testing is required, such as an EMG (electromyelogram), a study of nerve conduction. A neurologist would be the expert in diagnosing this condition if your regular doctor hasn’t been able to.

DEAR DR. ROACH: What’s the best way to obtain and maintain healthy, white sclera? Mine appears to be a light, off-white gray. — M.T.

ANSWER: Sclerae — the whites of the eyes — tend to thin with age and reveal the darker-gray choroid underneath. This is benign and common, but I don’t know of any way to prevent or reduce it. Scleral color changes can happen with rare diseases like osteogenesis imperfecta, and some collagen diseases. The sclera also can change color as a result of scleritis (inflammation of the sclera), and this often happens in relation to Wegener’s disease or rheumatoid arthritis.

The bottom line, though, is: If you are having no symptoms, it’s overwhelmingly likely that these changes are the benign form.


DEAR DR. ROACH: Several weeks ago, I contracted a bad cold with much congestion.

I have received an antibiotic plus nasal spray, and most of the congestion is gone. I have no pain. My concern is that my ears are still partially blocked. I can clear them by pinching my nose and blowing, such as one does in an aircraft, but I must do this frequently. I am worried about hearing damage. I don’t know what else to do. — R.F.

ANSWER: The Eustachian tube connects your middle ear with the back of the throat and equalizes the pressure in your ear. It is common for congestion to linger. Fortunately, it does not permanently damage hearing, and usually goes away by itself. Decongestants can help, but do not use a decongestant spray such as Afrin (oxymetazoline) for more than three days.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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